hashing through 45 more days

Exam week starts tomorrow so I didn't leave the apt today. I did study in my cat ears for awhile but only my roommates got to see my headband costume. Oh well.

I will miss the chance to go on a Grenada Hash once I'm stateside. I mean there is always hiking but it is not quite the same.....

Happy Halloween!

Pics take at the La Phare Blue Halloween Hash last year, good times were had.

T-46= the calm before the storm?

Tropical Storm Tomas has now been upgraded to a Cat 1 Hurricane. It doesn't look like Grenada is in its direct path so while that is good news I still worry that tropical storm conditions may mean loss of electricity so I'm enjoying my a/c and lights for now and keeping my fingers crossed. There is an ill defined wind not blowing from any certain direction and rain off and on... I've never really lived in hurricane territory before, it is a strange feeling, this eerie calm... 

This is the latest email from the school:  

GRENADA REMAINS UNDER TROPICAL STORM WARNING  
All students, faculty and staff are advised to remain at home/in shelter until the warning is lifted.

Picture above- our water supply, as they turned our water off last night. We are currently using water from our holding tank but this is our supply of "fresh water" until this is over.

"No Comment" (47 days to go)

I was taught that if you didn't have anything nice to say.... So I should just say "No comment" and leave it at that... I should, but I won't because:

As Tropical Storm Tomas approaches the island and we get ready to turn off our water for the night I am ready to go home. As in California, near my husband and away from here home. (Please Tropical Storm Tomas, find another island to bother, I'm begging you! Or better yet just play in the water and take a detour south, you don't need to bother with land, the water is better, I promise. You can come another time, but this weekend I would really like to study with a/c and lights. I hope you don't mind but you are not welcome here.)

If only I had a picture of "No Comment"... I don't but I do have this one, taken on the drive to the Hospital today as I reflected upon all of the named Raggae buses. (Think mini vans with loud music and interesting window decals.) This is actually a tour van but you get the idea.  And there is a King Elvis Raggae bus as well, although I didn't get a picture. Sorry!

Others I saw today....
Mr. Faithful
DJ Thunderz
A New Beginning
Flavours after Flavours
No weapon form against me shall prosper
No Comment (my favorite!)

a clean desk and good mail- days 49/48

Okay, I told you I didn't keep track. After I posted last night (or rather early this morning) I realized that I only had 48 days left. So this post is for days 49 and 48.

Things that I love about Grenada continued...

A desk that is (mostly clean), no clutter, no extra stuff, just what I need to study. As I was pondering why this never seems to happen at home it dawned on me that I've had to share a desk with Dr. Boyfriend (and although I love him dearly, tidy is not exactly a good description of his work space). But it isn't all his fault either, there is the issue of mail. We get so much of it, it always accumulates and some of it you don't want to throw out but you don't have the time to put it all away each day either so it piles up and takes over the desk.... but here in Grenada I don't seem to have that problem. The only mail I ever get is much desired. Artwork from my nieces and fun cards from family and friends. No bills, no junk mail, just love in the form of stamped paper in my mailbox.

This is the latest piece of mail, a post card from a dear friend traveling in Japan. (Snow monkey and baby, SO cute... at least I think so.) I am proudly displaying it on my desk!

Back to studying. I love this part of the term when classes are over but exams are still a few days out and you can study and organize and do lots of practice questions. And if that makes me a med school dork, so be it.

a pictorial countdown of sorts- 50 days left

Okay, so in an effort to blog more, remember all the things I appreciate about Grenada and make sure I am appropriately reflecting during my final weeks of my final term here I've decided to blog a picture a day. Today is day 1, or rather day 50 as that is how many days I have left in Grenada.

Now, I really wasn't keeping track per se, but everyone else is and I'm hardly immune. Plus I think it is only natural after two years on this island to start thinking of home and thus how many more days until then. And I think any 2nd year medical student at any school is sick of lectures and ready for clinicals come this point. But whatever, I'm doing a countdown. I'm not sure why I am trying to justify it. Here goes day 50, just 49 to go....

 The view from my balcony.... enough said.

Grand Rounds-Volume 7 No.5: Lessons Learned

Welcome to this Edition of Grand Rounds. I'm honored to be hosting for my first time. The topic is education and lessons learned. I hope you enjoy!

The classroom (aka- how a medical student spends her days..) 
Clinical Skills & Patient Communication

To start us off let’s talk about the physical exam. Is it dying? The Stanford 25 is here to say no, or at least attempt its revival. Check out this post discussing the use of simulation technology in medicine. And browse the blog sidebar for 25 physical exam skills every doctor should know.

In contrast Fizzy gives us a humorous reflection of medical students learning heart murmurs on her blog, A Cartoon Guide to Becoming a Doctor. Do you know the 6 grades of heart murmurs?

Don't forget your communication skills! Dr. Val of Better Health shares her experience as a patient and reminds healthcare staff to Please Hold the Snark.

And finally a medical sign that won't be found in the textbooks. Dr. Happy of The Happy Hospitalist presents "Texting in the ER Sign" as a good prognostic indicator for the clinical findings of status asthmaticus.

Review for Step 1: Anatomy, Neurology and Nutrition

For a fresh look at some anatomical illustrastions from Edo Period Japan we have a blog by medical student Kambiz.


The Tangled Neuron bring us The Trouble with Expectations and a reminder to take health headlines (particularly Alzheimer’s research headlines) with a grain of salt.

In case you have ever wondered what exactly is in those prenatal vitamins The Examining Room of Dr. Charles is here to break it down for you.


Pondering life over lunch break...
Miles in My Shoes offers a "Karate Kid Lesson" for  medical students like me.  And if you are done with your training maybe you'll find the reflection apropos as well. In either case, it is worth checking out.

On to Hospital Rotations (aka what kind of doctor should one become?)

Internal Medicine

Dr. Manning of ACP Hospitalist brings us a lesson learned in her touching post, One is Enough. Her synopsis: “A physician trying to make it to a colleague's educational seminar learns a life lesson about what's truly important when she misses it.”

Pediatrics

Beth of Life. Not Terribly Ordinary. chronicles her arrival as a new attending in The Ride.


And from the unique viewpoint of the medical photographer come this post: Two Kids in Hospital from The Sterile Eye.


ER & Radiology

The Colorado Health Insurance Insider gives us an example of The Wisdom of Evidence Based Medicine with this post about reducing the number of CTs given to children with head injuries.


Primary Care & Geriatrics
 
The Doctors' Rheum posts a love letter to her friends in primary care thanking them for their incredibly difficult job.

Nurse Resnick of Health AGEnda writes about the need for Increasing Gerontology Education for Nurses.

---
I think it is time for a coffee break. Go grap yourself a cup, drink in those antioxidants and while you do, read this post about blueberries and coffee gratis The Cockroachcatcher.

So, are you ready to go run a marathon? No!?!  (Me neither...) but Traci did and tells us all about it in her blog with the post Just DID it!

Dr. Pullen.com updates us on the progress made in Preventing teen traffic deaths.

Next up, you can read about how "researchers learn a lesson in unintended consequences when they try to influence medical decision-making through policy changes" here courtesy of ACP Internist.

And on to life lessons taught and those that teach us. A touching tribute by Insure Blog, In Memorium- Bye Papa.


And now for a few things 
NOT learned in medical school

Academicobgyn writes an informative series of two posts regarding the insurance appeals process- Part 1: How it all works and Part 2: Winning your appeals. This is worth the read if you or your doctor are trying to get an insurance appeal granted or if you are a medical resident and are looking for a moonlighting opportunity.

Healthbusinessblog brings us a look at mini-meds (low coverage insurance plans) and how they can be useful in some patient populations.


And the learning is never done. In finale we have...
Lessons not yet learned

How To Cope With Pain shares Guess What? There's STILL a Lack of Knowledge about Pain Treatment.

I thank you for stopping by. And I'd like to give a big thank you to Dr. Nick Genes of blogborygmi and Dr. Val Jones of Better Health for letting me host.

Don't forget to check out Grand Round next week with a special election themed edition, Dr. Wes is hosting. Enjoy your Tuesday!

Grand Rounds Call for Submissions- Lessons Learned

I am honored and excited to host my first Ground Rounds here next week!

The topic is education/ learning but this is broad. I welcome stories from your medical training and other lessons learned along the way. What are you still learning? If you are a patient or educator what do doctors/doctors in training still need to learn? Poems and comics are welcome as well. I look forward to reading your submissions.

Include your post, url link to your blog entry, blog name and a sentence or two about who you are and where you fit into the health care system. If this is your first time submitting to Grand Rounds you can follow this link for further instructions and writing guidelines.


Submit entries to spiceislandqueen@gmail.com by Sunday October 24th at 6pm EST.

"Learning is not attained by chance, it must be sought for with ardor and attended to with diligence." -Abigail Adams

Confessions of a Med Student- Part I

I always meant to write a little summary/reflection for each term but never got around to it. This is my stab at it before I leave Grenada. I will try to write about a term a week over the next month.


Term 1 Rehash
(Biochemistry, Anatomy & Embryology, Histology, Bioethics)  

Okay, I'll admit it. I hated biochemistry- yep, hate! I know that is awfully strong but it is true. I was scared I was going to fail. I didn't enjoy the class. The department obviously was having some type of family feud and despite going to special group review sessions given by upper termers I just didn't feel like I got it. Theoretically I was interested in the material, but when it came down to it, I really had a hard time counting ATP and remembering enzyme names. Biochem haunts me to this day which is too bad since Pharmacology is like applied biochem. The upside is I understand the importance of pharm in my clinical years so I'm tolerating it. Biochem is #1 on my list to focus on for USMLE Step 1 starting now,  but I feel like I retained nothing...  so of course I'm not happy about having to study it. Again.

I didn't like anatomy either... I know, I know, what kind of a medical student am I? (Now you are probably waiting for my future confessions that I don't like patients or blood makes me faint...) I wanted to like anatomy. I tried. But it was so much to memorize and no matter how much I studied, I would always feel like I knew nothing when I stepped into the wet lab. The smell didn't bother me, and I liked the idea of finding vessels and nerves and muscles. But who knew that bones had so many parts? Not I.  During the term, I felt rushed and unsure of everything.  Every week I dreaded anatomy small group. I was scared to be asked a question I couldn't answer. I tried to prepare and study but there just wasn't enough time. I remember being tired and stung out on caffeine. The physician tutors would inevitably ask us something we didn't know and I'd always feel bad, like it it was my fault I hadn't read and memorized that exact page of Gray's. Maybe it was all part of the process, you have to be humbled and you have to realize that medicine is so much larger and more complex than you will ever master, but still you have to try. (I would love to go back to anatomy now, just for a week or two, into the wet lab and see if having the foundation makes it more palatable. I'm guessing it would. (I could probably arrange this if I was super motivated but honestly I didn't like it enough the first time around and I have NO plans to go into surgery so I'll stick to Netters and BRS Anatomy for the Boards.)

Histology was tolerable. I enjoyed it more than biochem or anatomy, although I didn't feel like I had the time to truly master it... It was like everything else, a bit overwhelming in depth but necessary foundation.

Bioethics on the other hand was my favorite class of the term, of course it was only worth a minor 3 credits and only lasted half of the term, but I actually enjoyed it (although I was definitely in the minority). I found it interesting and manageable, unlike the rest of the term. Or course the realization of this during Term 1 also made me question exactly what I was doing in medical school... I just hoped and trusted it was going to get better.... and kept going.

Medical school was/is hard. During first year I truly doubted myself for the first time (maybe ever). I wondered if I was smart enough. I was lonely, I missed my husband. I didn't feel academically satisfied no matter how hard or much I studied. However, now that I'm approaching the end of my 2nd year I can appreciate that it wasn't so much WHAT I learned during first term but that I learned HOW to learn and HOW to study. But at the time, it was painful and not my favorite part of medical school. So there you have it. (And it did get better. So if you are an MS 1 and reading this, hang in there. You can do it!)

Stay tuned for Part II (and Term II).

"The Best Place on Earth" (A Camp for Teens with Multiple Sclerosis)

In the middle of Rhode Island is a place where teenagers who have MS (Multiple Sclerosis) gather for 5 days each summer. They travel from all over the US, Canada and even sometimes farther to greet old friends and make new ones. Some of them have just been diagnosed and do not know anyone with MS, let alone a fellow teenager. In five days they go from being strangers to being family. At MS camp not having MS is belonging to the minority.

In some ways it is normal summer camp, the teens kayak, do a ropes course and tell stories while roasting marshmallows around a campfire but in other ways it is so much more. The teens are able to talk about dating with MS, when to disclose their illness to friends, how to manage meds away from home, etc. They watch each other do medication injections and swap stories of diagnosis, spinal taps, countless MRIs and commiserate on how much they hate taking steroids for relapses. They talk about hospitalizations and how they were diagnosed, everyone compares symptoms and they soon realize that someone else truly gets what they are going through. MS is a greater bond than anything else. The pretty cheerleader from Colorado jokes with the awkward guy who bowls and loves to fish from Florida. Together they help another camper with his dinner tray, as MS has left him spastic with a noticeable tremor. Over dinner they look like normal teenagers, texting jokes to the far end of the table and trading SillyBanz (TM) bracelets.

Camp inspires me.  For five days I belong to a community with these teens.  Many of them have dealt with more medicine than adults two and three times their age. As a group these teenagers have a maturity that comes with having to shoulder a chronic illness. Before medical school when I shadowed MS clinic I would see these teens in the context of their neuro exams and symptoms. I was privileged to be able to look at MRIs and be present as they were given the diagnosis. I was there with some during neurocognitive testing and I got to know each better during the three hour test battery but only at camp did I have the opportunity to really spend time talking to these amazing teens about their lives.

Camp is transforming. A previous patient is now appreciated for his acting skills and silly jokes along with his fear of another relapse and the belief that maybe if he just forgets he has MS, it will go away. David doesn't skip his meds because the shot is all that horrible but more because by taking it, he reminds himself of his vulnerability and like all teenagers he thinks nothing will ever happen to him, except that it already did... (But he is still persevering, so this life lessons has been learned.  Camp ends and David resumes his DMTs with the encouragement of the other campers. Camp success story #223.) Alisha plays soccer and tells the other campers of having to learn how to walk again and how horrible it was to miss her own HS graduation because she was in the hospital with a relapse. But then she talks about how she got a phone call from another camper and how much that cheered her, she reminds the campers that they need to keep in touch throughout the year, how sometimes that text, Facebook message or phone call can mean the world.

I have been honored to attend and inspired by MS Camp for the past five years. This summer I will be in my third year of medical school and busy with clinical rotations so unless I can arrange to have camp week off I won't make it. But 40+ campers will and once again they will find themselves in the middle of their MS Family in the Best Place on Earth.

In case you need more inspiration. See the video below. It is a little dated, as it was filmed during my first ever camp five years ago, but I think these teens tell it better than I can.



Update. Recent Facebook activity.

Alisha to David- "Camp 2011 :)"
David to Alisha- "I can't wait, best place on earth!"
13 Likes. 2 Comments.
Link to old photo album titled- Camp is Love.

***Names, details, identifying data changed, etc. Video filmed and posted to You Tube with permission.

Calling All Student Bloggers (And non-students too!)

Announcing Grand Rounds, Blog Carnival here on October 26th! I am excited and honored to be hosting my first ever Grand Rounds.

Since I'm a medical student and spend my days in lecture and learning about how vast the knowledge of medicine really is I thought education would be an appropriate topic. And I think that one of things that attracted me to medicine in the first place was the never ending opportunities for lifelong learning.

I just read a great article in the New York Times about the Physical Exam. If you are a medical student and have never submitted to Grand Rounds in the past I suggest you do so now. What do you think about the physical exam? Do you feel like SGU or your school prepares us to be well rounded physicians? I want to know!

And if you are not a student but a practicing physician, educator or patient I want to hear your stories too. What have you learned? What are you still learning?

Be creative! Comics, poems and other art forms are welcome too. I'd like to either organize the entries by Subject/System (Biochem, Anatomy, Cardio, Path, etc) or via Physical Exam (head to toe) so if you have a funny anatomy lab story or a teachable moment to share, now is the time!

Send entries to spiceislandqueen@gmail.com

Deadine is October 24th, 6pm EST.

Happy writing!

I Hear Not

"Sometimes it feels as if [I'm] literally in the back seat of the car, auditing a fascinating conversation but unable to distinguish — over the noise of the traffic, the defogger, the wipers and R.E.M. on the radio — exactly what’s being said."


These are not my words, but they describe very well how I feel so much of the time.... I am aware of the general content of what people are saying but the exact words are up to my imagination and skills I've refined over the years. Cars are actually the worst spot and having a real conversation in one, forget it. Windy areas outside are a close second, and noisy dark places, well I may as well go sit by myself in the corner because I'm not going to hear what you say. If I can see you, I do okay because I'm sure I lip read to some extent. 


What exactly do I not hear? Try 20% of everyday spoken language in an ideal (quiet, no background noise) setting. Of course I can lip read and 20% of words does not equal 20% of content. Sure if you randomly walk up to me and without me seeing your face say a word I only have an 80% of getting it correct.  However, people don't talk in words, they communicate in sentences with body language and intonation so I end up getting by. And for those non-ideal times, I have hearing aids. I was only officially diagnosed and fitted with hearing aids shortly before medical school started. And I hate wearing my hearing aids (if you couldn't tell) but they do help in some situations and since I don't want to be the incompetent medical student I wear them in those situations. 


It has only been a little of 2 years since the audiologist looked at me and asked "can you hear me?" as she raised her voice and sat down in front of me with my audiogram. I wasn't prepared for the label, for being told I had severe bilateral sensorineural high frequency hearing loss and that I needed to consult an ENT (in case it was progressive or part of some other pathology- its not.) I wasn't prepared to have someone tell me that I needed hearing aids. Of course now, with perspective it is not so bad but thinking back to that visit, I walked in hearing and walked out with a label. I wasn't emotionally prepared and nobody was with me. I remember calling my husband, he was at work so I left him a voice mail and then I just sat in my car and cried,  I mean I "knew" I had high frequency trouble hearing because I didn't hear sounds like a tea kettle whistling or a pager peeping but I didn't think those high frequencies were actually involved with my day to day hearing of conversation, etc.  

I'm still adjusting and I'm becoming more comfortable disclosing my hearing loss to my friends and classmates.  I told every one of my 12 path group members and my CPD group of 5 at the start of last term and it made it easier for me to compensate or ask for someone to repeat something. The more people I tell the more comfortable I become with putting my hearing aids on in public or changing a battery when I need to, etc. During first term I completely protected who saw them, when I wore them and I've come to realize that it is just easier if I disclose. It is part of who I am at this point (I have no idea when my hearing stared to fade but my theory is the massive number of antibiotics I took during my childhood when I would get strep throat after strep throat. Beware of those aminoglycosides!) 


So that explains why when you call my name walking around campus I walk right on by. I didn't see you, and while a normal person would hear you calling, I don't and so I keep right on walking. Also don't whisper to me in class, there is a 99% chance I won't hear what you are saying (hearing aids or not.) Sorry! 

My latest audio report.

*Quote from David's Lipsky's totally unrelated book on David Wallace Foster, "ALTHOUGH OF COURSE YOU END UP BECOMING YOURSELF"

Pumpkin Inspired

So one of the things that sucks is not so nice about being in medical school far far away is missing occasions and celebrations. And I am not normally one for self-pity but I've been a little homesick this week. My cousin is getting married this weekend and most of my extended family is going to be there. My mom is one of 11 so between all of her siblings and their children that means a lot of family. And it is in Colorado so not only am I missing a beautiful wedding, I'm missing a fall wedding. I love fall and it pains me to be stuck in sunny hot summer weather for the foreseeable future... no fall for me.

But to lift my depression I have pumpkin! A friend was stateside earlier this week and she was amazing enough to find and bring back a Pumpkin Brulee scented candle for me, so at least my room smells like fall! Also I bought fresh pumpkin at the grocery store which inspired me to bake a simple and healthy pumpkin bread. (To turn the muffins into a sweet afternoon treat I added a not so healthy glaze and cranberries.)

 Pumpkin Bread/ Muffins with Cream cheese glaze and cranberries

For the Bread/Muffins you will need:

2 cups whole wheat flour

1 cup white flour
1/2 cup honey

1/2 cup light brown sugar
1 t. baking powder
1 t. baking soda
1/2 t. sea salt

2 t. cinnamon
1 t. nutmeg
3/4 cup applesauce

4 eggs

1/2 cup butter, melted

Mix dry ingredients.  In separate bowl mix wet ingredients and the sugar. Combine and stir well.  Pour into a buttered/floured pans.  Bake for 45-55 minutes at 350 degrees, or until a toothpick inserted in the middle of the loaf comes out clean. (For muffins bake 25 minutes at 400 degrees.)

Makes 2 small loaves or 1 medium loaf and 6 muffins or 24 muffins.

For the cream cheese glaze

Blend together

8 oz. of cream cheese

1/2 cup powdered sugar

1/2 t vanilla

1/4 cup milk

Garnish with cranberries, enjoy!

Recipe adapted from several others including these-

http://heavenlyhomemakers.com/healthy-treat-for-today-applesauce-bread

http://www.tastebook.com/recipes/670650-Applesauce-Pumpkin-Bread