Christina Twyman held her future in her hands.
It was a simple piece of white paper, folded twice to conceal the name of the hospital where the Johns Hopkins medical school senior would spend the next few years of her life, in a residency program in internal medicine.
It was one of more than 14,000 "Match Day" letters opened simultaneously yesterday at Hopkins, the University of Maryland and 123 other medical schools across the country in ceremonies suffused with drama, tradition and silliness.
"It's the culmination of years of intense work, in college and then in medical school," said Dr. Thomas W. Koenig, associate dean at the Hopkins School of Medicine. "It will define their future research or clinical careers. It's another huge defining moment in the life of a physician."
Across town, in Maryland's Davidge Hall, the excitement was equally palpable. "It is bigger than graduation," said doc-to-be Richelle Medford, whose mother, Sheryl Medford, traveled from California to sit by her side for the event. "We are all dying."
At Hopkins, it wasn't just Twyman's future she held in her hand. It was also her husband's. "My husband lives in New York," the 26-year-old explained. "He's a corporate attorney. That's why New York is so good for him."
She had applied for residencies at the Cornell and Columbia medical centers, and the Mount Sinai Medical Center - all in New York City - hoping to end the commuting part of her commuter marriage, at last.
But she also applied to the University of Pennsylvania hospital and to her favorite - Johns Hopkins. "I love Baltimore," she said. If she were matched with Hopkins, the couple would deal with it, somehow. "Hopefully, he'll come down here as well," she said.
So Twyman waited nervously in the lobby of the Turner Auditorium, shoulder to shoulder with friends and classmates hoping to celebrate good news.
Some came with their spouses and small children. They snacked on cheese, fruit and cocktail sandwiches as the clock wound down toward noon. That was the hour designated by the National Resident Matching Program (NRMP) for all medical students across the nation to open their Match Day letters - some finding joy, some disappointment.
The matches are made by a computer after the nation's medical school seniors pick their specialties, investigate programs, have interviews and then make a list - in order - of residency programs where they would most like to train.
At the same time, the residency programs scrutinize the applicants, go over their medical school performances and conduct interviews. Then they submit their top picks to fill almost 22,000 first-year openings (not all of which will be filled by the med school seniors). The computer does the rest.
The Association of American Medical Colleges says this year's 15,206 applicants from U.S. medical schools constituted a new record. Of those, 14,201 were matched to residency positions. The rest will participate in a "scramble" this week to get into one of the remaining open slots.
In Maryland's Davidge Hall, where the school's first medical students heard lectures 200 years ago, it was all about tradition.
One by one, the names of the Class of 2007 - the school's bicentennial graduates - were called, and they descended the steep steps to the front of the auditorium. Each plopped $5 into a red bag (the bills by tradition going to the student called last), received the match letter and put their signatures on a large bound volume that students have signed for decades.
Some tore into their letters. Others couldn't. Some fiddled with them before finally peeling off the tape that held the envelope together.
Leela Sirotkin sat in an aisle on the steps of the auditorium, her mother in front of her. "I am so nervous," she said, praying for a match in emergency medicine at Orlando Regional Healthcare in Florida. "It is that puzzle- and problem-solving that I love," she said.
Finally, she was called - second to last, just missing the $750 pot in the red bag. She took the paper and sat down, dialed her father on her cell phone and handed it to her mother while she opened the letter.
Sirotkin began to laugh: "I got my No. 1! Oh, my God. I am so happy."
Back at Hopkins, after speeches and a silly skit in which super-spy James Bond saves the letters from thieves, the medical students filed by a table, picked up their letters and plastic glasses of champagne, then waited for the signal to open the pieces of paper bearing their fates.
Salt Lake City native Ben Paxton's top choices for his training in radiology were Massachusetts General Hospital in Boston and Duke University Medical Center in Durham, N.C. "They're really good programs," he said as he waited with his wife, Juli, and 16-month-old daughter, Elise.
"Radiology is the future of medicine," said Paxton, 27. "It's being relied on more and more by everybody for diagnosis and [disease] management." The hours are better than in some specialties, he added, noting, "I can come home at night."
"Tall Paul" Herickhoff of Garden City, Minn. - 27 years old and 6 feet 6 inches high - applied to 25 residency programs in orthopedic surgery. "I like being in the operating room, using my hands," he said. He also likes orthopedic surgeons, whom he describes as "a little rough around the edges." His top choices were the University of Iowa, Dartmouth College and the Mayo Clinic.
At the count of three, the students opened their letters, with shrieks, whoops and a few tears around the room.
Herickhoff is going to Iowa, Paxton and his family are headed for Duke. And Twyman's sleepless nights of anticipation ended with a match - to Hopkins.
"Yes! I'm so happy," she shouted. Then she snapped open her cell phone to tell her husband - in New York.
"I love you," he replied.