But although she didn't wind up in the field she worked in for her Westinghouse project, the contest nonetheless had a big effect on her romantic life. As she was working on the project at the U.C. San Diego summer program, Ramachandran met and become friends with a young man named Joel Moore. He, too, became a Westinghouse finalist later that school year. Ramachandran placed 10th. Moore was the first runner-up after the top 10, meaning he came in 11th. They would remain close together, getting married in 1999. Ramachandran notes that Moore hasn't held her slightly higher finish against her. "In fact, we each mention our individual ranking on our CVs [curricula vitae]. But somehow whenever it comes up, we can't escape mention of the fact that we had consecutive finishes!"

What she's doing now: Moore became a physics professor at the University of California, Berkeley, in 2001, so Ramachandran decided to take a pathology residency in the Bay Area at the University of California, San Francisco (U.C.S.F.). Though she loved pathology work—analyzing tissue samples and helping surgeons, oncologists and other doctors decide on courses of treatment—she didn't like the fact that she wouldn't meet most of the patients she was helping to diagnose. "The idea of giving up day-to-day patient interaction was one of the biggest decisions I had to make," she says. "But I came to realize that the pathologist plays a very key part in the behind-the-scenes workup." In particular, she loved the challenge of trying to make a difficult diagnosis.

This year, she's on a fellowship in gastrointestinal (GI) pathology at U.C.S.F. "I think one of the things that appealed to me is that all of us at one time or another have had GI pain, but abdominal pain is one of the most difficult diagnoses to work out," she says—something she experienced firsthand when she had her appendix removed in college. "It's something everybody as a patient can relate to," which helps make the "very long road" of an MD–PhD, plus a residency and a fellowship, worthwhile.

She's been winning fans along the way. Ramachandran "is an outstanding young physician," says Linda Ferrell, a professor of surgical pathology at U.C.S.F. "She has already participated successfully in several ongoing clinical research projects"—including her current one, which involves comparing different kinds of liver tumors—"and has also demonstrated her leadership skills in her role last year as one of two chief residents in our department." She adds that "she will no doubt progress to be an outstanding contributor in the field of pathology."

Ramachandran hasn't forgotten her spelling bee roots: She still cringes at spelling errors. "The truth is, I page people using shorthand and abbreviations as well," she says, and she understands the conventions of text messages. "But to me there's a difference between that and an official document, where you should take the extra step to make sure everything's spelled correctly." Sure, we live in an era of spell-check. "But that's no substitute for just proofreading."

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