Notes from Spice Island

Anatomy of a 6 week Rotation

2012-02-03T16:18:00.000-04:00

Week 1: excitement, meeting new people, figuring out who's who. this is going to be great.
Week 2: still excited to be in a new rotation, settled and ready to learn, call is fun.
Week 3: tired. time is going by so slowly....i can't believe i'm only half way done. call is exhausting.
Week 4: omg. am i still on this rotation? very tired. call is dreaded. did i mention tired.
Week 5: the end is near. i kind of like this rotation. i'm sad i only have two weeks left.
Week 6: exams, done. that was great! i can't believe how fast time goes by....

I'm just about done with OB/GYN. It was fine. I liked the OB part and tolerated the GYN... clinic and L&D were great. The OR, not so much.... but then again I already knew surgery wasn't for me. It was a good experience and I'm glad to have another rotation behind me.

IM is up next and while I'm ready to learn and excited to be going somewhere that I have autonomy and actually contribute to patients care I'm a little apprehensive about working 6 days a week for 3 months on the wards. But regardless I'm going. And then fourth year will be here so ready or not, here I go...

Cali is just 8 days away, so long New York!

My break-up with coffee

2012-01-14T10:47:00.002-04:00

It became my New Year Resolution so to speak. It wasn't planned, it just kind of happened.

Now this was kind of a bid deal because I absolutely LOVE coffee. Latte. Cafe au lait. Regular cup of joe. I don't care just give me anything fresh roasted, organic or simply non-instant and I'm happy. I probably drink 2-3 cups of coffee on any given day and sometimes much more. There is the obligatory morning cup and then another one sometime in the afternoon. There are countless cups to drink while reading the NYT on Sunday mornings or while studying at whatever coffee shop I choose on the weekends. Coffee is my study buddy, my comfort drink, my friend.

But I was over it. And on January first I had my last real cup of coffee. I switched to black teas for a few days so in an attempt to prevent withdrawal headaches. Then I went to decaf teas only. And I survived. Now there were a few afternoons in clinic when I was convinced all I needed was a shot of espresso to make my headache disappear. (And I did get one migraine, but I think it was probably the dehydration, skipping lunch and a busy overbooked clinic that did it, not the lack of caffeine.)

Somehow I made it, including one night on call without a single cup of coffee. And I didn't miss it as much as I thought I would. However the hospital coffee leaves very little to be desired and there are no good/convenient coffee shops between home and work so that probably helped. But in any case, I now know I can live without coffee, and it isn't even that difficult. But I ~~like~~ LOVE coffee...

And so yesterday for the first time in almost two weeks I drove 10 minutes out of my way and ordered a grande nonfat latte. And it was wonderful. Coffee and I are back together, at least for now.

Oh, yeah, I write a blog....

2012-01-11T16:57:00.001-04:00

Hi dear readers !I didn't forgot about you, although my lack of posting may make you think otherwise. Insert normal excuses here- busy, nothing interesting, blah, blah, blah. Anyhow, I hope you enjoyed the Holidays, Happy New Year to you!

So, what have I been up to? If you are keeping track at home I'm in my second to final rotation of third year. I just have four weeks of OB/GYN left and then I'm headed back to Cali for IM and then I'm a grown up MS IV! Crazy how time went by so fast.... Of course things are not quite THAT easy because I do have to take those little things called the Step 2 CK and CS, and arrange my schedule for next year, etc, etc. But I'm marching on....

Peds was amazing and everything I could have wanted in a rotation. Great teaching, interesting cases, cute kids, good diversity and basically confirmation that I was born to be a pediatrician. Every day was fun. I heart babies, teenagers and all those in between. I was even able to spend several days in peds neruo clinic and that was amazing too. So all in all I am happy and ready to get to fourth year already so I can hang out with those kids again! Last night I was on-call on L&D and just down the hall from the nursery so I made a few trips (to check on the deliveries of course) and just because babies are way cuter and more fun than moms' in labor. Or at least I think so.

So OB/GYN. Well I started with clinic so I've gotten to see a little bit of everything and then last night on call I scrubbed for one section and helped with one NVD so all in all I'm getting to see what I'm suppose too. I feel like I'm missing the gene that makes one wax poetic about the miracle of life and witnessing a birth. I suppose I am more upset by how cold the anesthesiologist is to the patient in the C-section, how scared she seems and how horrible it must be to have a baby brought into the world this way. The patient was alone, Spanish speaking and clearly scared. Not a single person in the OR spoke Spanish, or if they did they kept quiet. It broke my heart to see her sitting there, her eyes trying to hold back tears and her entire body shaking (from cold or fear or both). I held her hand before I scrubbed in and a caring nurse or two did the same but during the actual C/S it was only the anesthesiologist behind the curtain with her and he most certainly wasn't comforting her.... but the baby was fine and patient's family appeared shortly thereafter to be with the patient and see the new baby so maybe I'm getting more upset about this than I need to be.

Of course normal vaginal delivery doesn't look like a piece of pie either. Oh my goodness, the crying, the screaming, the mess, the (seemingly) never ending labor. The vaginal delivery I saw was a bit better in that mom got to breastfeed and hold baby within five minute of the actual delivery and the family was in the room, cheering, and celebrating. So maybe magic for them, not so much for me. But babies were born and life begins anew so I'll try to focus on that positive as I sign off today.

Hopefully I'm back to regular scheduled blogging in this new year.

blame it on the kids

2011-12-06T09:52:00.001-04:00

HPI: female medical student with sore throat x 3 days, non-productive cough developing over last 24 hours along with hoarse voice and headache, possibly a subjective fever
sick contacts- numerous kids with strep, RSV and all other sorts of viruses seen and examined in the last week courtesy of her time spent in the Peds ER
cough drops and Advil has been mildly effective. no change in appetite. recent difficulty sleeping due to nasal discharge and cough.

PE: pt looks tired and miserable but not that sick. throat is mildly erythematous and adenoids are visible but without purulent discharge. cervical LNs tender.

DDx:
URI/Laryngitits- unspecified viral, top contenders include:

Steptococcal Pharyngitis - (pt has had strep throat no less that 50 billion times in her life and blames her sensorineural hearing loss on all the antibiotics she took as a kid trying to get rid of the same. pt can swallow without too much difficulty and lack of real fever, appearance of the throat are less suggestive of this dx)

A/P: Most likely viral so therefore no treatment warranted.

Rx: Take the morning off to stay home, drink tea and study. (Pt would not want to get the healthy kids coming for well-visits sick, after all!)

10 fingers, 10 toes...

2011-11-20T09:34:00.001-04:00

I just finished my two weeks of inpatient floor work and next I have a full week of newborn nursery. We had an intro lecture on Thursday and I'm quite excited. How cool is it that I will get to check a newborn and perform physical exams for the very first time for these little ones? Plus they are cute even if there heads are molded into some interesting shapes from the delivery process. And I am sure I'll learn a ton too. Time to brush up on causes of neonatal jaundice.

Peds soldiers on and I'm loving it. Show me the babies!

this is it

2011-11-17T00:24:00.001-04:00

peds is here, i'm 1.5 weeks in and have seen plenty of asthma and RSV... plus a few interesting cases, rare and otherwise. the teaching is great. the hours are okay. the patients are wonderful. so really, no complaints except that i feel like i know nothing. there is so much to read and study but every day i'm learning.

i love the population and the diversity. one minute a 7 day old baby and the next a 17 year old teenager. parents of all varieties. play is part of the job. i heart it all!

In my Alternate Profession...

2011-10-30T12:49:00.000-04:00

.... I could wear a costume to work tomorrow.

If I couldn't be a doctor, I'd be be a first grade teacher.

Why? Kids are great, but more than that, I love holidays! I love decorating and I love the festivity of the occasion. It doesn't really matter which holiday, I just like celebrating it. I grew up in a pretty conservative christian family and Halloween was often downplayed. We were allowed to dress up but it was always as benign, non-scary things. (A strawberry, a ballerina, a hobo.) Our candy was frozen for safekeeping (i.e. taken away from us) and everyone knows that once your chocolate is placed in the freezer it is never quite the same again. But I survived and my love for Halloween and all other holidays has only grown with time. Pumpkin carving is one of my favorite traditions and I got to help my niece and nephew with their creations yesterday. So. Much. Fun!

I'd like to dress up tomorrow but I'm not sure the geriatric psych patients would appreciate my efforts and staff might think of me as inappropriate, so I'll settle for watching the Village Parade and counting down to the next holiday and one of my all time favorites- Thanksgiving!

links galore

2011-10-23T20:04:00.000-04:00

Just a few recommendations if you are looking for something psychiatric tinted to enlighten/entertain or distract you.

LISTEN
Real 'Sybil' Admits Multiple Personalities were Fake
An NPR Segment that I stumbled upon yesterday...

READ
for the moment/hour/day-
The NY Times Lives Restores Series- Parts 1-3 now available, here is the link to the first article

for the week/month-

"Sybil Exposed" by Debbie Nathan (I'm reading this now, 1/3 the way through and so far I'm intrigued and saddened. I guess the original Sybil work is up next.)

"The Center Cannot Hold" by Elyn R. Saks (I haven't yet read this but it is on my list as well.)

"The Bell Jar" by Sylvia Plath

This is a classic and if you haven't read it, you should.

WATCH
In case you would rather a video, this one and the prior two in the Lives Restored Series are well done and get my recommendations as well.

---

That's all for now. Two more weeks of psychiatry. My goal is to prepare for the shelf and stay interested in all of it. Now, back to my book!

how to bribe your patient into compliance?

2011-10-21T21:19:00.001-04:00

answer: with coffee and tea. No joke!

Geriatric psychiatry is a lot of things... however holding my interest is not one of them. I tried to give it a fair shake. And for about a week I was intrigued and pleasantly surprised by just how much I liked it. But it must have been the newness, or the fun patients I had that week because my enthusiasm quickly wore off.

Last week was rough. I didn't really want to go to work and once I was there I just couldn't wait to leave. My patients were belligerent, agitated, hostile and demented. I feel bad for them. But not bad enough to make myself bribe them to take their medications like my Attending does. I mean I guess if getting a cup of tea or buying a cup of coffee is all it takes for a patient to become compliant why not do it? But in my short experience it only works for a limited amount of time. And even if patient complies for the moment/day/week then what? Even if the patient is discharged it is not like we won't see the same patient back next week or month for the same thing.

Medication non-compliance is real. Psychiatry is a revolving door. I wish this were not the case or there was something else I could hang my hat on. But so far that is all I've got.

I only have two weeks left. And it is bearable but not exactly fun. Now the admission notes and discharge summaries just feel like scut work. Write this. Dictate that. Go talk to a patient that is laying in bed naked and refusing to take any medications or put on any clothes or eat any food. Wait for said patient to decompensate to point of needing IM meds or become so dehydrated or hypoglycemic that she qualifies for medical transfer. Type up discharge summary for transfer. Repeat.

Did I mention, I only have two weeks left? But on the upside I do have a whole entire weekend (off) to study in NYC so I'll survive. One latte at a time. Maybe I need to be bribed just like my patients. Oh my...

Adam

2011-10-12T21:08:00.001-04:00

Adam was only hours old when I met him. He had been born during the night to a new mother following an uneventful pregnancy. He came into the world in half a days time. The mother delivered her son, without drugs but in a hospital, the norm for Grenadian women. When I met him he was wearing a blue and white sleeper and looked perfect. Tiny, sleeping, a brand new baby. Mother was resting, exhausted but awake and father had just come back with breakfast for both of them.

Adam was one of my first pediatric patients, ever. I was in Grenada at the end of my 2nd year of medical school and it was my second hospital day. After a short introduction from our preceptor on how to interview the mom we were left alone. The mother's story was like any other pregnancy. She gained weight, maybe a bit too much, 40 lbs perhaps, she didn't really know. The delivery was okay, she said it was longer than she expected but no real problems. And then we examined Adam. As we did so our preceptor came back. She asked us to look carefully at his head and eyes and where they were, how far apart there were and if they lined up with his ears. As I slipped off his baby hat I noticed that his ears did look a little low... Then she helped us take off his sleeper and we took off his tiny baby socks. His feet were curved at some unnatural angle as if they were tomatoes staked to the ground. His hands were clenched but fingers were extended as if they had been glued into position. I listened to his heart and heard a murmur that got higher with each expiration. Another student listened and said Adam was wheezing but I'd heard wheezing before and this was not it. No, this murmur was a discernable patent ductus arteriosum. My first.

We finished our exam and helped dress Adam. The parents asked our preceptor about his feet and hands and they were told a surgeon would come and talk to them about options. I later asked about genetic testing, it looked like textbook Trisomy 18 but our preceptor just shrugged and said that Grenada lacked such resources, it would take money and time to do genetic testing and so was unlikely...

Adam would be a year old this month. I'm just reflecting on some of my firsts.

Happy Birthday Adam.

the good, the bad and the crazy

2011-09-29T23:52:00.001-04:00

-day 4 and so far inpatient psych is

good - I have a wonderful attending that let's us pretty much do everything. Admission notes, interviews, MMSE, discharge summaries, etc. Some of the other teams are still on "needs supervision" to talk to their patients or write a progress note but we have full reign which I appreciate.
- Our weekly lecture series is going to be great if today is any indication. There is a full time pharmacist that works on the unit and he gave us a great lecture on antidepressants today. Yay for learning pharm!
- I have a favorite pt that likes to compliment me in another language and dances in his wheelchair whenever there is music or mention of the same. You can't be sad when your pt is dancing in his wheelchair.
-Did I mention 9-5, no weekends, no call?

bad - Psych is depressing. Pt's have no insight, poor hygiene, hear voices and scream at you. Treatment is medication (sometimes forcefully) and structure. But a reading room without books and a place that smells like urine half of the time is not exactly my cup of tea.
-I hate the old fashioned keys needed to get into anything on the unit. The entrance is key coded but the rest of the until requires keys. And of course none of the keys fit well so it can take 5 sec or 15 min to open a door. We have computers that are fingerprint access enabled but we need a key to get into the nursing station. Does this make any sense?

crazy- enough said. Stories will follow.

Pscyh, The Big Apple and Life as I know it-

2011-09-28T05:20:00.001-04:00

So, today will mark day three of psychiatry. I'm at an inpatient geriatric psychiatric hospital so my experience is thus limited. However in just the first two days I've gotten to see and do quite a bit and my schedule is strictly 9-5 with no call or weekends so I'm not complaining. And of course I'm in NYC so I'm going to live up these next six weeks.

Museums, broadway, apple picking upstate- check, check, check! Shopping, eating out at super yummy and fancy restaurants, fun runs in Central Park- Yes, yes please and sign me up!

In any case. I'm back in THE City and I'm ready for whatever, whenever and lots of it. And I'm pretty sure psychiatry will keep me entertained during the day at a minimum. Bring it!

Coast to Coast

2011-09-23T16:05:00.000-04:00

24 hours ago I was completing my last rounds of inpatient Family Med.

Today I am trying to fit New York City appropriate clothes into a suitcase so that

tomorrow I can fly across the country in preparation for my psych core that starts Monday.

Life is busy. I will update soon, promise!

"for the dead and the living, we must bear witness." — Elie Wiesel

2011-09-11T12:06:00.000-04:00

Today a patient died. I met him in the ER just five short days ago. At that time he was talking, breathing, living. But then he got sick.Very sick. And surgery and medicine and a stay in the ICU could not fix his failing organs or return him to health. His family watched in disbelief as each day he got sicker and sicker... And today they had to say goodbye.

As a doctor in training I am privileged to be with patients all stages of life and sometimes even death. Today is a day to remember and as such I am reflecting on all the patients that I have met whose lives I glimpsed before they were over. I will remember... the smiles, the jokes, the lives of my patients.

I will remember them because to remember is to bear witness, and this is something I can do.

---

This day in September, ten years ago started normally enough for most people. Preparing for work, boarding a plane, going about their day to day business... no one knew what unimaginable things the day would bring. I was in Boston at college, in class and not privy to the first tower being hit.... but as the news started to make its way around campus and throughout the world my would be husband came to meet me and as class ended I walked out to see him standing in the hall, waiting and in the instant I saw him, I knew.

I didn't loose a family member and I only vaguely knew people affected by the attacks, at least at that time.... However we later moved to NYC and then I met countless people who had been there, witnessed the towers falling, walked over a bridge to safety or fled the city afterwards. I know families that decided they could no longer live in NYC and I know people who never-not in a million years- considered leaving.

New Yorkers have solidarity when it comes to 9/11. So today I partially feel like I'm on the wrong coast.

People still talk, people still remember, but the events are not quite so raw, not quite so close to home... Of course those that lost their lives on 9/11 were not all New Yorkers. And really it doesn't matter where one is today or where one was ten year ago. What matters is that we remember for those affected by 9/11 and especially for those who lost their lives.

It has been a decade, but we still remember. It is one thing we can do.

To be or remain in a specified place or situation, typically one perceived as tedious or unpleasant

2011-08-31T18:38:00.002-04:00

-also defined as the theme of family medicine inpatient (FMI). Well, at least this week.

Patients are "stuck" at the hospital while waiting for placement into a skilled nursing facility or rehab center. They are not longer acutely ill and there is nothing that we are doing for them each day, other than a courtesory exam and progress note. But still they cannot go home and insurance or lack thereof dictates placement, or lack thereof, so they stay in the hospital. Day after day. But what is a good learning experience on day 1 or 2 or even 5 becomes a bit tedious on day 12, 18 or 23. When nothing changes and all labs are normal and meds adjusted. Everyone is bored. Even the nurses pleadingly ask, "when can Mrs. Smith go?"

Patients are "stuck" at the hospital because they need a consult from a service that is MIA or because they need cardiac stress testing but it is the end of the month and the pharmacy is out of persantine or it is the weekend and they must wait until Monday for pathology to give an official reading or for some non-weekend working dept to sign off.

I am "stuck" in the hospital because my rotation mandates that I am there 12 or 13 hours each day and while these hours make sense for my resident who is covering all the patients and overseeing all the admissions they hardly make sense for me when there are four other medical students on the team and I only get every 5th admission. Especially when we have finished rounding and I have seen all my patients, the same patients that are also stuck at the hospital, and there is absolutely nothing to do while I wait for the hours to pass. So far I've successfully snuck into the OR, slept, hung out in the ER, offered to go to Starbucks for the team, and a dozen other non-FM type things. I think I may give my patient a manicure tomorrow (because she is stuck, she asked me to, and because that way at least I'll be productive, though knowing my luck there is some hospital regulation again this.)

Yay to being half way done with FMI, almost.

*Oh, and yes I realize I could and should study (and I do) but FM is considered an elective and so there is no shelf exam or test. Plus the rotation is Pass/Fail and right now Step 2 seems far away.... But if you have any other suggestions for passing time in the hospital, please share!

"Just you wait...."

2011-08-20T09:06:00.001-04:00

These words seem to be a running theme lately. If you are newish medical student, or just starting off resident, chances our you know what I'm talking about.

Are these words of warning? Are you trying to save us? What makes other, older, wiser nurses, residents, attendings want to deflate the bright-eyed and bushy-tailed Bambis' of their idealistic views? Why do you need to tell me it won't last? Why shouldn't we be as eager as a toddler to get a new toy?

Three examples:

-My friend Beth is one week from being done with her training and she has a job lined up to work as a PA in the ER. While rotating one day in her future ER, a nurse, and soon to be co-worker tells Beth that she will become like all the others soon enough, JADED. Beth denies this. The nurse insists. She has seen it happen, time and time again. It isn't clear why she is telling Beth this but it makes an impression.

-During my first week of surgery rotations I happened to work a long day. I arrived to the hospital around 4am and happened to talk to one of the nurses about a mutual patient of ours. The RN was working the night shift and remembered me, so 18 hours later when I was back on the floor checking on a patient before I left for the day she made sure to tell me that my enthusiasm was temporary. She also told me I should go home. And while she was right and maybe I did need to go home I remember in that moment thinking to myself, I hope this lasts, I hope I always care this much about each patient I take care of, this is my job to be devoted.

A classmate started her rotations this week and she is on my FM team. When she got her first patient to admit she did a celebratory dance, complete with clapping and jumping up and down, right in the middle of the ER. I laughed (I can recall my own enthusiasm and the joy one feels when she is finally seeing a patient, by herself.) The resident gave her a funny look as she skipped happily away. "What is up with her?" the resident asked me. "It is her FIRST patient!" I replied. The resident sighed, "I wish I was still so excited to admit a patient, I don't remember ever being that eager."

And yet, I am sure the resident was. At one time she was an idealistic, eager, enthusiastic doctor in training. Just like we all start out as... Bambis.

And I'm sure those nurses are right. Over time, in a few years, or maybe a decade my friend Beth may become jaded. The ER is a tough place to work. ER staff deals with sick, scared, patients. People can be at their worst and burnout in the ER field is real. But does that mean we have to try and take the idealism away before it wears off?

I did tire of 16 hour days. And note to self-seeing the same nurse separated by two shifts signals it is time to go home. But it will continue to happen. Even if I'm not always happy about it. And I should stay so devoted.

And yes, my classmate will stop dancing every time she gets assigned a new patient to admit. However my hope is that we continue to remember that feeling of enthusiasm from time to time.

Idealist, devoted, enthusiastic. Sure we all still Bambis but you know what, we wouldn't change it for the world, being a Bambi is a pretty cool thing! Go ahead, call me Bambi, I'm proud to be!

(Now where is my nurse like Carla?)

And because we all need some music in our day and not because this has ANYTHING to do with my post...

Revelations!

2011-08-17T01:26:00.000-04:00

So, I'm only two day into my Family Med* rotation so I'm not sure if that is really enough time to come to any conclusions. But I'm going to anyhow because I have the time to blog and because in just two days time I've come to realize a few things about myself... First a quick comparison, which is probably not fair to either field but its my blog and I'll compare if I want to!

Going from Surgery to Fam Med feels like running a marathon to strolling in the park. Everything moves a whole. lot. slower. Everyone is nice. The attending bakes you homemade chocolate chip cookies (literally), the resident apologizes for not having time to teach and for being so busy. You are asked repeatedly each day if you need to eat and then given ample time to do so. All patients are seen by the attending, every day! It is like an alternate universe. And I'm not sure what to make of it.

All of this is good. And nice. But it kind of bores me. In two days I've only gotten a single patient to myself. I did help another student with her H&P and co-wrote a single note this morning. Plus I got the priviledge (a.k.a. intern too busy so asks me to do it) of updating our team's entire patient census list which was grand total of 6 patients. But back when I was a surgery student I saw 6 patients/ wrote 6 notes in a single morning.

Okay, so my patient. I did his admission H&P on Monday and today I got to present him to the attending and help her with the A/P so he's mine until discharge. Except that not tomorrow morning because our team switches to night float for two nights so another team covers our patients (I don't know how that makes any sense but that is how it is). Anyhow, maybe by the end of the week I'll have two whole patients. That's the hope anyhow.

Oh, so my discoveries. Well while we were busy waiting for rounds to start, then later munching down chocolate chip cookies, then later at lunch, then later waiting for rounds to resume and then end, I realized that I did not like that attending had to run off to deliver a baby in the middle of my presentation. Or that the 11am weekly lecture was canceled because of the same. I know, it is medicine and things happen. But I think I need a schedule, a plan. I don't get stressed when plans change per se. I'm okay improvising or adjusting but I do like having structure. And surgery had that going for it. Cases were scheduled. When one finished another started. There was some predictability of what days were clinic versus OR versus just rounds.

Family Med is the embodiment of unpredictability. In the next six weeks I never get more than one day off at a time. My schedule changes every week. Actually it changes ever day or two. As a medical student on a rotation this is not a big deal. But I cannot imagine a life of this. So I guess that means inpatient Family Med is off my list... which is too bad because the people are SO nice. Maybe it is the laid back nature and the I can deal with anything, at any time mentality that makes these people so cool. So I hope that they can be my friends. But I guess I'm too uptight for their field. Surgery vs Medicine: It is the classic do versus think. And come to think of it, I've always imagined myself somewhere in the middle. Child Neurology is a middle ground, right?

*Disclaimer, at my hospital the Family Med rotation is all inpatient so it is really more like an IM elective and probably not wholly reflective of FM

** This post is not to slight either Surgery or Family Med. I met some brilliant surgeons that were quite capable of thinking and even treating the whole patient. I learned a lot of medicine from my attendings during surgery. And it is important that we have people who love Family Med and do it all, it is SO needed. I just don't think I'm one of them.

Three Months Later

2011-08-11T19:36:00.000-04:00

Patients seen: 88
Surgeries scrubbed into: 26
Lives lost: 7
Goodbyes said: 1
Hands held: 15

Surgery is over and I don't think I'll miss the ER/traumas or sad stories that bring the patients to the hospital. I'd rather not have to contemplate skin grafts for the women who fell asleep while smoking causing her bed to catch on fire and burn 30% of her body. Neither cup of noodles nor sparklers should never be given to children to children under 7. Gas stoves or BBQs and unsupervised cooking for children- please no. And just in case you didn't know: grandma driving while on amphetamines, uncovered empty pools without water, holding a boiling pot of beans in your lap = very bad ideas. I use to think hang-gliding sounded like fun, but after seeing the results of landings that didn't quite work out maybe I'll rethink that. I have had my fill of gun shot wounds and stabbings. Pneumothorax, appendicitis, cholelithiasis - check, check, check!

The OR was actually quite fun most of the time. I can see the appeal, and I even liked about half of the surgeons I met. I'm crossing surgery off my list but am so thankful for the long rotation (even if I wasn't always thrilled during it.) I will probably never see brain surgery or even a lap appy again, but I'm so glad I got to experience them.

(Next time I post I'll be on inpatient family med. Stay tuned.)

Don't know what to call this post- surgery is almost over and I'm still happy to be a medical student

2011-07-24T15:40:00.000-04:00

Just four more days of 4am note writing and surgery will be over. One more clinic day, one more call... it is winding down. In some ways I am done with surgery and glad that it is (almost) behind me yet it was pleasantly bearable. I like the hospital and the patients, most of the residents are amazing, my attending is great, I think I've learned a lot. I am now comfortable with all types of wounds, I know how to scrub, suture, tie and I can be of some help in the OR. I like clinic and seeing patients post-op. I don't mind consults and I've survived rounds more often that not.

That isn't to say that I want to go into a surgical field or that I've loved everything about these past 11 weeks but all in all, it could have been much worse. We'll see how the oral and written exams go of course but I'm content.

I have a few favorite patients and a bunch of sad stories to tell including some with happy endings, but that will come later. For now I am just trying to reflect, study and get ready for what is next.

My happy/celebrating patients...

2011-07-09T17:52:00.000-04:00

Best news ever?
-How about telling a patient (and her family) that she doesn't have breast cancer. The biopsy was negative and the mass is benign. Yes there was a party in the clinic and yes I laughed and celebrated with the patient. And yes, I got to tell her the good news myself.

2ne best news ever?
-One of my first patient's from neurosurgery, a patient that was at one time in a drug induced coma -went home. I thought he was going to die, but despite the complicated surgery, new-onset seizures and hospital acquired pneumonia he somehow got better. Medicine is amazing!

My crying/scared patients...

2011-07-05T20:33:00.001-04:00

Waking up from surgery can be scary. I have never had major surgery but I imagine that waking up in an unfamiliar room with what seems like a million people staring at you musts be a little unsettling. Today my patient woke up and she looked scared. I met her last week in clinic when I did her H&P and I had talked to her before the surgery so she knew that I would be present in the OR. She was having an elective surgery and the complication rate is low. She did well during surgery but it was slightly more difficult that anticipated and so her lengthened surgery status earned her an overnight admission. I held her hand as she woke up and her eyes told me she was scared. I went with her to recovery and told her that we would be keeping her overnight for observation. Or maybe the nurse mentioned this to her, but in any case I had to explain it to her. She didn't want to let go of my hand so I offered to stay. For half an hour I stayed by her bed and answered questions about her surgery. I tried to reassure her and I offered the only thing I could think of my time and my self. Eventually I tracked down the attending to come reassure her and I continued to check on her throughout the day. She will be fine. I was told by a resident that I wasn't acting like a surgeon. But you know- I am okay with that.

Being newly diagnosed with cancer. Being alone in the the hospital over a Holiday weekend. Being in pain. These are depressing things. So understandably my patient was minutes from tears when I entered her room this morning. She felt forgotten about. A simple procedure and biopsy of her mass were put on hold over the long weekend. As she talked and cried I offered her a tissue and she said they were bigger and softer the the hospital issued ones. She most likely has terminal cancer (and she knows this) and yet she thanked me for giving her a kleenex and listening to her. As a medical student I don't have much power, I can't make decisions and my knowledge of actual important medical information is tiny. But I can provide kleenex, hold a hand and lend an ear. Maybe these aren't behaviors of surgeons but they sure make me feel like I'm doing something.

Today was one of the most fulfilling days I've had in surgery. I went to the OR but it wasn't what I did in the OR that I am reflecting upon, it is all of the stuff I did beforehand and afterwards. Patients by their very nature are going to be scared, anxious, neglected. Isn't it our job as physicians to notice this and do our best to help them cry, accept and move on? Isn't it our job to comfort them?

Red, White, Blue and Surgery

2011-07-04T13:41:00.001-04:00

Happy 4th of July to all! I am actually enjoying gen sx, suprisingly more than I expected, but that doesn't mean I don't appreciate having a three day weekend and especially today off. I'm home in SD with my hubby and have plans to watch the fireworks later. In the meantime I'm enjoying the day. And I have a bit of time to reflect on what has been two weeks of gen sx so far.

I've seen some interesting cases and have enjoyed clinic, consults and pretty much everything in between. The new interns have arrived and the whole hospital is fresh with new faces and lost looking white coats. I actually feel like I have something to offer the team, my intern finds me helpful and it is kind of refreshing.

I have discovered that I like being in the OR. It is fun, which sounds weird to say and I can't seem myself doing the training or putting up with the surgeon types for 5+ years in order to be in the OR but I do see the appeal.

I have confirmed that I don't enjoy the ER. I don't like the pace, the noise or the rawness of everything. And I hate not knowing what is happening with the patient after they see me. I need follow through and the ER doesn't provide that. However I do like the ER docs. Shift work and cool colleagues are definite pros.

I like clinic. I like taking to and examining patients without too much of a time constraint. I like reading the chart, knowing the history and seeing someone who is going to be followed. I love it when I get to see the same patient for 2nd time, either post hospital d/c or follow-up appt, etc.

So to recap. Surgery- I don't like surgeon mentality but the OR is pretty cool. ER- not my cup of tea, but the ER docs are awesome. Clinic- seeing patients makes me happy.

I hope you have a wonderful, festive and safe 4th!

Tired, but Inspired

2011-06-21T06:15:00.000-04:00

My first day of gen surgery went well. Rounding was done at warp speed and I've decided I really don't like wounds or dressing changes. Not so fun.

Also I was assigned a SOAP note for a pt that had been in the hospital for three months. I spent 1.5 hour reviewing his chart yet somehow managed to miss the part about him having a stroke. But my Junior resident had my back and my senior resident was quite understanding about it. Other than than it was just more of the same. Consults for the ER, yadda, yadda. Yet somehow the day lasted from 4am to 7pm. I was so tired and yet I am still not sleeping through the night. But at least I managed 4 hours of sleep before I was wide awake. I guess I can go in early and give myself plenty of time to read mammoth charts. I don't know what else to do at 3am. Other than read. I recommend this middle of the night on-line browsing and inspiration: In Iran, A Brotherhood of Doctors

Up All Night

2011-06-20T03:00:00.000-04:00

So, night float is over. Of course my body doesn't know that. So despite the fact that I start general surgery tomorrow and have to be in to write notes at 4am I am wide awake in the middle of the night. Which would be okay except I've only slept for 3 hours so far. Oh, the transitions. This is the part of the job that you really don't prepare for. But despite what it seems, I am really not complaining. Night float for two weeks certainly beats the alternative of being q4 on-call. Because on-call really means just working for 30+ hours straight. So the night float system is fine with me. I am now quite comfortable doing consults, responding to traumas, writing post-op notes, etc. I don't know if that means I am ready for the real thing, i.e. 6 weeks of gen sx but I'm about to find out.

And without further ado here is a brief recap of nights: what I saw and what I did, when the rest of the world was sleeping.

10 Trauma Consults- pt in the ER and stable but being consulted for C-spine clearance and/or possible sx. For example if you crash trying to land your hang glider or a wheel falls off your ATV you'll get a full H&P from the surgery team starting with the medical student. And this does include a DRE. Fun all around, right?!?

2 Trauma Alerts- ER pt that requires a trauma team response (medical student, residents and all ER staff). Perhaps you cut a major artery b/c you were drunk and mad and punched your hand through a glass window- this is where you'll end up.

5 Trauma Activations- ER pt is being transferred or walks in off the street in possible critical condition so entire trauma team + Attending responds. (Medical student does the paperwork.) Stab wounds, gunshot wounds and high speed MVAs all end up here.

ER Consults for Surgery/Admission- Abdominal pain that might be surgical. Post-op pts with irretractable pain or a fever. People that do stupid things requiring surgery for removal. These are the bread and butter consults. My most common consult was for gallstones +/- pancreatitis.

OR cases-
3 lap appys (2 x I got to drive the camera)
2 toe amputations
1 perineal abscess I &D
1 open exploration for small bowel obstruction
- suturing is harder than it looks!
- first knots tied = fun (thanks Dr. BF for all the tutorials)
- first opening incision

Not to mention countless hours of TV watched in the resident lounge and a few hours of sleep stolen while waiting for something to happen. All in all nights were an okay way to get my feet wet, now it is time to swim.

Good night!

Transitions and such

2011-06-07T19:48:00.000-04:00

Tonight starts the first of my night float section of surgery. I am not really ready to be done with neurosurgery and I guess the team feels the same about me as I was invited to scrub and assist in a case tomorrow. I hope I am awake enough after being up all night. Can you say coffee? With any luck I'll see a trauma or two and perfect my consults and post-op notes tonight. And then see a cool neurosx case in the AM. Have I mentioned lately how much I love med school and third year?

And, in other news I finally found out my placements for the rest of the year. My schedule looks something like this!

Family Medicine (6 weeks) -CA
Psychiatry core (6 weeks) -NY
Pediatrics core (6 weeks) -NY
Holiday break 12/19 - 12/30/11
Ob/Gyn core (6 weeks) -NY
Medicine core (12 weeks) -CA

So all in all I am very happy with this. I get to stay at my current hospital for FM and then only move across the USA once. Hopefully I can set up sub-Is and electives on this coast for 4th year.

I am one step closer. Time to work. Have a wonderful night, I'm off to the hospital.

It IS brain surgery

2011-06-01T01:23:00.001-04:00

So far I'm s/p day two of week two in my neurosurgery rotation and I have:
performed my first lumbar puncture
observed a craniectomy and tumor resection
watched a patient go into surgery talking and emerge aphasic
witnessed seizures and gotten crash courses in how to read an EEG and prescribe AEDs
assisted in a subdural hematoma resection x 2
seen a stroke patient in his final hours
held hands with patients pre and post-op
seen all varieties of aneurysms: s/p rupture, coil and clip
worked with three amazing residents that take the time to teach
scrubbed for surgery four times
been told I need to read and I should know this or that
been told I am the best medical student in a long time and that I should consider applying to neurosx

It is fascinating, it is exciting. It makes being at the hospital from 5:30am until 6pm or 7pm or 9pm seem like a blink of the eye. Clinical rotations make the first two years worth it. I know that I am only starting my third year and that I don't really know that much, but I know that I like clinic and I like patients and I like talking to their family members. I like being at the hospital. I don't always know what to do but at the same time, I feel like I belong. And so- being an MS III is a good thing. (And now it is time for bed.) I'll have lots more to share once I am done with my rotation (only three more days, -tear-sigh) and have had time to properly reflect...
Stay tuned.

Lost (and Found?)

2011-05-16T16:00:00.000-04:00

Since I'm on the "study hall" portion of my surgery core I have a bit of time to roam the hospital and ponder life. And I am studying. I've read/outlined the first 19 chapters of Lawrence's "Essentials of General Surgery" but it doesn't take an entire day to read three chapters so I have some time.

Last week I went to the ladies room and found a very well-loved lost lion in my stall.

I found him propped up, just like this so I have to think that he fell out of a stroller or was dropped and someone hung him here in hopes he would be reclaimed. I checked the restroom later in the day and he was gone so hopefully his owner was happily reunited.

I don't have any patient stories or amazing tidbits of info to share with you (yet) but I'm one week closer to being on a team, writing notes, rounding on patients and all of that fun stuff. In the meantime I'll leave you with this fun fact: the liver has over 2000 metabolic functions. So love your liver, because it loves you! Oh, and good luck to any and all of those "already brave" lost lions (and other well-loved stuffed animals) out there.

-Kudos if you read a rather amazing blog and get the reference!

False Start

2011-05-10T19:01:00.000-04:00

So, I have been orientated. I am at my surgical site and new home for the next three months. But due to new SGU guidelines our 12 weeks of surgery now includes protected study time. Which is great, but guess what? I ended up getting my two weeks of study time upfront and my six weeks of general surgery at the very end until the day before exams. Yippee for me! (NOT.)

So no early morning rounding for me or scrubbing in to watch a case, or any of that. Just sitting in the assigned library or conference room from 8am-4pm. Of course I can take breaks and leave for lunch but it kind of feels just like studying for Step 1. Sure I get to walk around the hospital in my short white coat and attend all the resident and academic lectures but I just don't feel like a third year. I know, my time will come. Pretty soon I'll be wishing I was back in the library with the entire day to read (at least this is what I am telling myself.) I have entertained the idea of just walking into a patient's room and assuming her care like I belong there, no one will call if there are extra notes in her chart, right? Fine, I suppose I will just stick to pre-reading for surgery. It has been a long day. In a quiet/boring kind of way.

Time for Fun Facts:
-A normal healthy person sighs 9-10 x per hour. This protects the lungs from atelectasis. (Patients undergoing and awakening from anasthesia do not sigh or cough and thus this is a possible complication. I'd never thought of sighing as protective, had you?)

-Licorice consumption can lead to renal potassium loss. (Okay, I think I knew this one, but it is still pretty cool, so be careful what you eat!)

There are more, but I don't want to bore you. I am 90 pages in to Lawrence's "Essentials of General Surgery" and I have to say, I wouldn't be if it were not for this protected study time, so yay!?!

13 days until my neurosurgery rotation, at least I have that to look forward to!

(gulp)

2011-05-08T19:57:00.000-04:00

Tomorrow is my first day of third year. I think I am ready but it seems like I can't really be ready because I have no idea what this will be. It feels like the first day of school and the start of first year all over again.

For those of you playing along at home I got my first choice in that I got to stay in California (for now). I was assigned surgery as my first rotation which is 12 weeks long. And while I am not at a clinical center I am within driving distance of Dr. Boyfriend for weekends, etc. Of course after surgery I will have to most likely move and then move again and again but I don't know what comes next so I really can't worry about it right now. Instead I just have to focus on remembering my anatomy and being the best third year I can be.

The new apartment is set up and unpacked. My fridge and freezer are stocked. I have clean laundry. I guess I'm ready. In the meantime I am enjoying a glass of chilled wine. Cheers to surgery!

Confessions of a Med Student- Part V

2011-04-27T19:04:00.000-04:00

After much delay this is the final Grenada installment of my confessions series. The following post is all about Term 5. Follow these links for previous terms: 1st - 2nd - 3rd - 4th

The schedule: Pathophys, BSCE (Basic Science Comprehensive Exam Review), Pharm, Clinical Skills, oh and don't forget to self study for Step 1!

Lectures are in the afternoon which I liked much less than morning lectures. Because I went to class most of the time I felt like I never really had a chance to study until after dinner which is a bit late to start (think back to first term, yikes!) and what this meant for me was that I had a lot to cover on the weekends and that I rarely went out during the week. I found that 5th term was just a busy as 4th but that might have only been my class going perception.

Mornings are consumed with small groups and clinical rotations. One day of the week you go to the Hospital for Clinical Skills and mini-rotate through the different wards. In theory you get to see a variety of patients and practices but really the point of this is not to learn about pediatrics vs OB/GYN vs Family Med (that's what 3rd year is for!) but to practice taking histories and doing physical exams. As long as you don't expect that you will be suturing in surgery or actually doing anything of importance this can be a fun morning to hone your skills and meet a variety of Grenadian docs. I enjoyed being about to see the difference between the hospital, private practice and clinics. It was educational on many levels. Grenada does not have the resources of a well developed country and so the type of medicine practiced did not always reflect the US style health-care system but there are fundamental similarities and for the most part the teaching was good and the patients more than willing to assist as themselves.

There is a small group for everything! Pharm, Clinical Skills and Pathophys all include a morning session and depending upon the tutor/Prof/subject they ranged from helpful group learning experiences to a total waste of time. In theory these were great but in reality it was lots of busy work preparing for the sessions and then attending, etc. And because these were in the morning I tended to not get a lot done beforehand or during the lunch break. I think it is because of the schedule that so many students stop going to class. Small groups + mid-day break/lunch + class = day over and no studying accomplished. If I could have stomached sonicing I would have but alas I had to stick out the lecture hall. Hence my lack of life outside of 5th term. But I guess it is medical school after all...

Class in and of itself was okay. The pharm department is well run (I heart Dr. Dasso) and lectures are as exciting as pharm can be I would guess. Basically it was biochem on drugs. I hated biochem and found pharm to be a fair amount of work and a ton to memorize but I somehow survived. Small groups were a bit tedious for my liking but overall I think SGU pharm prepares you well for Step 1.

Pathophys is taught in conjunction with BSCE and is basically a huge review course: Pathophys is a subtle repeat of Path minus the morphology and BSCE is a review of everything else (anat, biochem, histo, physio, etc). I annotated into First Aid and started doing questions in prep for Step 1 as part of the class studying because at this point it all becomes one and the same. Which is not to say that prepping for BSCE or spending Friday afternoons in Taylor are enjoyable but if you use your time wisely the work you put into BSCE can be helpful come Step 1.

I already wrote about Clinical Skills. And actually I thought these small groups were some of the best. Each week a different system is assigned and the tutor takes you through a case and review which as a group you use to review the system and arrive a diagnosis. (Bonus- minimal prep needed besides reading through that section of First Aid and the class notes.)

All in all, 5th term is like your senior year of anything else. It is physically hard to be in Grenada and you just want to go Study for Step 1 and be done with basic sciences already. But the classes are okay and the material matters so you just do it. And then before know now it, you are packing your suitcases and shipping your things home. Grenada is over and two years of your life never felt so difficult, rewarding, simultaneously long and fly-by quick. Then you take a break (optional) and prepare for an exam that will test your past two years and determine your future. So yeah, that is 5th term in a nutshell. I hope this has shed some light on the final term of basic sciences. I do not yet miss lecture, but I do sometimes miss Grenada. Enjoy it while you can.

Time's Up!

2011-04-26T01:50:00.000-04:00

So the torture is over. I have officially been notified that I will start rotations in California at my first choice spot. I still won't get to live in the same city as Dr. Boyfriend but we'll settle for the same state and time zone.

I can't believe it. In just two weeks from today I will be starting my third year rotations with surgery. Which means I need to do some serious anatomy brushing up before then. And find an apartment. Buy a car. Pack and move. Little things really...

tick tock

2011-04-14T09:26:00.001-04:00

I'm back in NY and staying at my mother-in-laws. Last night I could not sleep. Maybe it was the jetlag or sofa bed mattress but as I tried to count sheep I could only hear the tick tock of the wall clocks. I ended up taking them down and stuffing them into a closet but even the perfect silence couldn't lull me to sleep.

A few of my classmates have received their clinical placements but I am still waiting. I have few bad things to say about SGU (I am more than thankful for the opportunity and I do believe the school does a decent job educating us) but I guess the sheer number of students overwhelms the Clin Ed office plus when it come to communicating with us and administrative issue SGU leaves a bit to be desired. But it is what it is, I'm just going to whine about it.

So, in the middle of the night when I couldn't sleep I started composing a few blog entries in my head. Why is it that it seems so easy to be eloquent at 2am in the morning. In the light of day the ideas are like dreams, the concept is remembered but the grandeur is missing.

Anyhow. I never finished my Confessions series and I need to do that before I completely forgot what it was like to be in Grenada and all that was 5th term. And I do want to post on my Step 1 strategy for those of you wondering. I promise I am working on them. Maybe I'll get around to posting both before I find out where and when I start third year. That seems reasonable/likely.

The Waiting Game

2011-04-10T16:25:00.000-04:00

Disclaimer: Whiny post ahead. Since I have nothing of substance to blog about I'm whining. Feel free to skip this one and come back another time.

Waiting is so hard. The agony. I really thought that once I had my passing Step 1 score I would be assigned a clinical site. Previous correspondence from Clin Ed had been received to confirm that I could start in early May in California, which I would LOVE to do and I replied accordingly. Yet May is now less than a month away and it would be nice to know WHERE I am going so I can find an apt, buy a car, etc. Little things I know. Yet despite many emails and inquiries Clin Ed will only tell me that they have not yet begun placing students in California. No timeline, no promises. They are masters of being vague.

Me: "Is Arrowhead (a hospital in Colton, CA) an option?"

Clin Ed: "We will note your preference to be placed in Arrowhead and if it is an option you will be considered for a spot there."

Great, thanks! For nothing. (Sigh.) Previous terms have been given a prelim placement spots but I guess it was problematic so they changed they system this year and we are not given a chance to appeal our placements. We were able to request an area, at least in theory. They assign us, we go. I can live with that but I did think I'd know by now. On the bright side I leave for NYC in just three days. One final vacation before third year starts, whenever that may be...

what is 46xy?

2011-03-31T13:42:00.000-04:00

My 4 year old nephew asked me this just the other day, "what makes a baby a boy or a girl?" What a good question nephew. Well I'll save you the answer I gave him but offer a link instead.

Enter Grand Rounds last week's edition that I just got around to reading now... Zoe (I've always loved that name) is a rocket scientist from Australia that just happens to have a chromosomal abnormality. Her blog and story are both fascinating and enlightening. I spent the morning reading her blog and thinking about this. I invite you to do the same, this is the entry that got me started, They mean well (Part 1). Happy reading!

I have always been interested in ethics, maybe pediatric endocrinology isn't out of the question.

Pass

2011-03-30T12:35:00.000-04:00

I haven't been able to sleep since I took Step 1. I'm not normally prone to insomnia but the anticipation of my Step 1 results has made sleep these past three weeks a difficult feat. My niece woke me at 5:30am this morning and although she crawled in bed with me and immediately fell back to sleep I was wide awake. I knew that today would bring my results.

I'm not sure how I feel about my score but I know that I will be a doctor one day and this is another hoop I've successfully cleared.

I will write more later about what I think worked and did not work for me. For now, I'm just going to await my clinical placement and start planning 3rd year. I guess I'm trading one anticipation for another. I've been doing a bit of networking and I may try to shadow a pediatric neurologist in my area. It would be nice to have options for 4th year. Time to move on. (After I enjoy the rest of my vacation that is.) Happy Wednesday!

auntie love

2011-03-28T01:29:00.000-04:00

I love being an aunt. I love the feel of little hands searching for mine in the dark theatre and not letting go, the entire show. I love the questions, the awe of a 7 year old and the smarts of a 9 year old. We had a most wonderful afternoon, just us three girls. No tears, no fighting, just a fun-filled time watching Cinderella (the girls favorite), Little Red Riding Hood (my favorite) and a few other story book characters come to life in "Into the Woods" the musical. We only stayed for Act 1 and it was perfect in length and substance. Not too long, not too scary and everyone got their happily ever after...

I love being an aunt. I love that we had to dig up bugs with big sticks. I love that during hide & seek the same hiding spot never gets old. I love that at 4 years old he wants to know when his voice will change and that I am the one he thinks to ask. Boys can be fun too.

I love being an aunt and for the next 8 days that is my sole purpose.
(I promise to return to normal med school blogging soon.)

one too many

2011-03-27T00:56:00.000-04:00

So I am home (where I grew up, where my parents reside and where my sister and her three children live) for vacation.

I love being auntie to my two nieces- 9, 7 and 4 year old nephew. However three is just one too many. I can't possibly hold all three of their hands when crossing the street. I can only sit by two of them at the dinner table and no matter how hard I try someone is always left out. I just try to be mindful that it not always the same one. I try... but my iphone is often the surrogate me. Luckily my iphone is a big hit so the left out one is usually pretty happy.

I like to believe that children should not outnumber the adults. Of course I am breaking my own rule and taking the two girls to see a musical tomorrow afternoon. I hope I survive. Right now I'm off to bed because my 7 year old niece likes to get up before the sun (yawn).

Correspondence

2011-03-25T16:18:00.000-04:00

To: Spice Island Queen/Student
From: Clin Ed/SGU_LN
Sent by: ABC/USL/SGU_LN
Date: 03/25/2011 12:29PM
Subject: USMLE Step I Results

Hi Spice Island Queen!

At this time we still have not received the results for the Step I exam. Please email a PDF copy to clined@sgu.edu as soon as possible.

Regards,
ABC
Clinical Placement Coordinator

Dear Clin Ed,

I don't have my Step 1 results either! I am expecting them any day and will forward a copy to you just as soon as I receive them.

Fingers crossed,
Spice Island Queen

P.S. A friend who took the step 4 days before I did said he received his score report exactly 3 weeks after his exam so if that schedule holds I should receive my report on Tuesday the 26th.

7 words

2011-03-23T23:14:00.000-04:00

Describe the thing you love most in seven words:

boyfriend is the perfect one for me

(my) rainbow in an otherwise dark cloudy sky

acts like life's purpose is my happiness

excellent doctor, like I'll strive to be

---
I don't often blog about my husband but he is my best friend, cheerleader, support, entertainment and the love of my life. I couldn't imagine medical school without him by my side (via Skype counts).

It has been a decade of togetherness and although neither of us are perfect I do believe we are perfect for one another. This is my blog about medical school and becoming a doctor but my relationships are part of that process and his is one of the most important in my life.

To love and life happily ever after!

The Blog Challenge

2011-03-22T20:43:00.000-04:00

Since I'm in third term limbo I have just a little bit of spare time on my hands. Today's entire agenda was getting a massage. Yep, that is it. Don't feel too sorry for me! And tomorrow.... I have absolutely nothing planned or anything that I must do. It is great but at the same time kind of boring, but I can always read another book. I talked to my mom today and she remarked how it would be nice if I could somehow bottle up the spare time and save it for some future use. Agreed. Anyhow, I've been spending my oodles of spare time reading and stumbled across a new blog and this idea. Post something every day- for a month. But I don't want to just write non-sense so I'm doing this- NaBloPoMo. Let me know what you think. If you also blog I challenge you do do the same.

Today's prompt: Give us links to five must-read web sites you go to every day and tell us why.

Somewhere during 1st year I discovered Google blog reader, it saves tons of time and all my blogs are in one spot. I only have to check my home page to discover new posts. Here are my current favorite 5.

1) Grady Doctor heartwarming, thoughtful, poignant posts about life as a mother and physician in a teaching hospital. Often her posts make me laugh, smile and even cry. She is truly inspirational.

2) Mothers In Medicine I have been following this blog since the start of medical school. I hope to one day be a mother and this blog gives me hope.
3) A three way tie for third-
A Thousand Times Over
Tales of a Brown-Haired Freak
A Caribbean MD is Good Enough for Me
All three are written by fellow SGU upperclasswomen. They keep me grounded, anticipating what comes next and looking forward to the next step.

4) Getting Better- a hybrid of diverse medical bloggers all in one spot, what is not to love?

5) A Farmer in the Dell A blog about food and farming. There is something appealing about contemplating dinner and dessert. Maybe I'll be a farmer in my next life.

So those were my daily blogs. But of course I don't read JUST blogs. The other website that I visit every day is The NY Times because every girl needs a news source. I like that I don't have to read about celebrity meltdowns on NYT and for the most part it keeps me up to date in current affairs. I don't like that I will very soon have to start paying to read this. So sad...

Well, that is all for today and this post. Until tomorrow!

Confessions of a Med Student Part IV

2011-03-21T19:42:00.001-04:00

This is a little late in coming but welcome to the fourth installment of Confessions- my reflections of past terms, one at a time. If you want to read any of the prior confessions series you can find them here, here and here.
----

Term 4: the breakdown-
PATHOLOGY with my Path Group NOS
the dreaded MICROBIOLOGY
plus to keep you on your toes- CLINICAL SKILLS

So this the term you have been waiting for. You have only heard scary rumors and sad stories of students that had to decel. And now it is here and you have already been on the island for six weeks completing third term and you just want to start already. You may have pre-read some of Robbins and every single upper classman has told you some conflicting thing about this term but you don't really know what to think. Do you go to class? Do you use Goljan's Rapid Review or just rely on Robbins. Baby Robbins and Big Robbins? Annotate into First Aid? To be or not to be?

Anyhow, for me I was apprehensive but prepared. The best part of fourth term is being able to pick your lab group. And I think this can make all the difference. I had my lab group solidified before 2nd term was over and having a group of classmates that I knew and trusted made lab fun instead of torturous. We were Path Group #1 aka Path Group NOS (yes, we named our group and we even wore matching scrub tops to lab occasionally... there is this whole must be dressed professionally thing that we were trying to do without actually dressing up or wearing white coats.)

Anyhow, my lab group started with two friends* that I had studied well with during first and second terms. We each then asked other study partners or lab partners from previous terms and in the end we had a pretty diverse group of students. Some young, some older. Some AOA, some not. Some girls, some boys. Some Russians, some Indians. Some from Canada and some from the USA. We met for pizza at Prickly before 4th term started in order for everyone to get to know everyone else. And we continued to hang out at Prickly during the term, once after the first exam and another time towards the end of the term for Dundy (think "The Office" TV show) style awards. We had fun and by enjoying lab and each other we kept sane and made it through.

*Note, I had other friends who were NOT in my lab group and this became important for several reasons. 1- If I ever needed to gripe about my lab group, which wasn't often but on the rare occasion when I did, I could to so with friends not in my group. 2- I studied with someone who was in another lab group so we could share what our tutors had highlighted, trade slides, etc. My opinion is that it is okay not to have your roommate, best friend or primary study partner in your lab group, and in some ways maybe even better.

So Pathophysiology... Lots of time spent in lab, but that can be okay, IF you have a good group. Or it can be time to sit and read Goljan or Robbins, it is really up to you. Same thing applies to concept maps. Most students hate them and think they are a waste of time. And I can see how that might be the case, but if you choose to make a concept map on something you need to learn, or have trouble remembering it can be helpful. I used my concept maps during pathophys and even studying for Step 1. But you can also scribble something out in 5 minutes and hand it in too, again it is up to you.

Besides lab, I did go to class but then I was always a "go to class" kind of gal. It really depended upon who was lecturing but most of the time I felt like I had to be there. If you sonic you miss the slides and since it is path slides are helpful. Sure, not all the VPs were amazing but for the most part I like to think that going to class only helped me.

Path was difficult, not because it is hard, but just because of the enormousity of it all. But it is doable and I found it fun. You are learning the stuff you came to medical school to learn, or at least that is how I felt. I didn't read Robbins cover to cover but I used it to prepare my slides and look up stuff that wasn't well covered in the notes. I tried to review all the green boxes and know the images. I also had Baby Robbins which lived in my bag through 4th and 5th term (plus it is pocket sized so I can use is during my clinical years too.) I didn't use Goljan or First Aid until 5th term but sometimes they would have been helpful. Best free resource, webpath! I made myself do the questions on Friday nights when I was too burnt out to study anymore. Also I did Robbins review questions with a study partner and found it kept me from falling behind. We had a standing date each weekend to do questions from the previous system. For me, staying caught up on the material was key. And by going to class and having regimented study dates I never really had a chance to fall behind. And speaking of falling behind, that brings us to micro.

Microbiology. I only think this class gets a bad rap because it is taught in the same term as Path. The key to this class is to not fall behind or let path overshadow it. Again I went to class (85% of the time) and being in class made me strive to keep up with the material. I would spend a full day every other weekend organizing my notes, making tables, etc. For practice questions I used High Yield the days right before the test. It wasn't the easiest of classes, but it was fairly straightforward IF you put in the time. (And SO important for later, aka pharm and Step 1.)

Clinical Skills. This was the class I expected I would love. But it turned into a pain and time suck which I blame on the lack of organization that is the Clinical Skills Dept. They have so many smart, capable physicians, but yet no leadership or organization. The class does teach you needed skills, how to interview a patient, do a physical exam, etc. it just isn't very efficient. As far as exams I found that doing practice questions from old exams was helpful. And pocket Bates is useful without being overkill. Also for the practical exams it did help to have a couple of friend and actually practice all of the skills with beforehand. (It amazes me how so many of my classmates just tried to memorize their way through.)

So that is fourth term in a nutshell. I think it really was my favorite term (but that doesn't mean it was easy or that everyone I knew made it through.) But with some preparation, a lot of hard work, a good lab group and a dash of good luck you will survive it too.

I promise to post on 5th term before another month goes by. Stay tuned.

Happy Match Day!

2011-03-17T15:01:00.001-04:00

So, today is the day that all fourth year medical students await. Today decides their fate. You see on match day one is "matched" with a residency program and it isn't until match day that the medical student finds out where she will be completing her residency. Of course the medical student know that she will be matched to one of the programs on her rank list (and if she didn't, she would know this and have scrambled, more on that in minute.) She has interviewed and carefully constructed her list, but it may be 20 programs long and involve five different cities and states so it is with trepidation, excitement and anticipation that match day arrives.

I was with Dr. Boyfriend on his match day. Most US medical schools, his included, hold a special ceremony where everyone is given and envelope and at noon they open the said envelope and smile, scream or cry with relief or disappointment. I was with Dr. Boyfriend and his classmates and most of them matched to one of their top programs (like #1 or #2 or maybe #3 or #4, rarely further down the list. Plus 96% of US medical students match so the scramble is the exception.) Anyhow, I was with him and he matched at his top choice in OB/GYN and it happened to be where I was living/working so we were both happy, relieved and excited. Most of his classmates were also happy. I remember one girl who matched to her #1 choice (but for some reason in her mind she thought she was going to match further down the list to a NYC program.) Anyhow, there she was crying and upset and we all wondered what to say, "I'm sorry you matched to your #1 program????" Well fast forward a few years and she is married and very happy at said program but the thing is, you never know, and the match is out of your control is so many ways. It shapes the next three-five plus years of your life and this decision comes via a computer.

So back to that day of Dr. Boyfriend's match. His graduating class was around 100 students so there were just a couple that had to scramble. I know that they all did scramble and I forget details but I think someone matched for categorical but needed a pre-lim year and hadn't matched, so he scrambled and ended up in Hawaii. We all laughed and thought, well that isn't too bad, I mean it is Hawaii for a year! So yeah, that has been my personal experience with Match Day.

So now six years later I am in the middle of medical school, but it is not a US school and so Match Day for my types goes a little differently. I still have two more years until I will be the one matching but I pay attention to my upperclassmen and where they match, how many match, etc. It is still early in the day so SGU has not yet updated the list but here is the link. Right now it only contains those that pre-matched (aka signed outside of the match, this is one of the only advantages to being a IMG), matched to a Canadian program (their match was last week) or matched into a program that uses an early match system (mainly competitive programs like ENT, Plastics, Ophthamology so that students that don't match can try to again with the regular match in a different field.) Anyhow the list is just a fraction of what it will be. So keep checking if you are interested.

So far I haven't heard too much about students scrambling, but then again I'm two years out and don't really know that many upperclassmen. I guess only time will tell. In a given year we are told that 85% of SGU student match. Now that includes everyone and being an international medical school not everyone tries to match. And we know that some sign outside of the match. But there are of course an unlucky few... So, fingers crossed for all of those matching today, that they did in fact match or were able to scramble.

So, about the scramble. On Monday those students that did not match were notified. And on Tuesday a list of program that had not filled was released. Last year there were 8,794 unmatched applicants and only 1,060 unfilled spots. So if you are one of the unlucky few and not taking in account anything else, you have a 1:8 chance of scrambling for one of the coveted unfilled spots. And it is a scramble, the student and any help she can recruit calls, phones, faxes, emails and begs for an interview in hopes of gaining a spot. This is another time when being a US medical student has its advantages. If you need to scramble and chances are, you don't, most likely your Dean will make some calls on your behalf. If you go to SGU, well good luck with that. Needless to say, you don't want to scramble.

I cannot even fathom what it would be like to finish four years of medical school and then not have a place to go for residency. This is the real underbelly of being an IMG, what they don't tell you at the open house and what you hope is only a rumor or thing that happens to those less fortunate students that go to lesser schools than the Harvard of the Caribbean. Now it is looking a little bit better for next year. The NRMP is introducing SOAP which from what I gather will be a controlled scramble, basically a 2nd match. To read about these changes see the NRMP website and SOAP pdf. I don't know if it will help IMGs like myself but I guess time will tell. I think it will help the highest qualified applicants secure a spot and will take much of the "luck" out of it. Sure the US students will be served first, but that is how it is now anyhow.

So to all those matching today, I hope that Match Day gives you much to celebrate. Go enjoy a green beer and cheers, you've worked hard for today!

What WIll I Be?

2011-03-16T22:12:00.002-04:00

What kind of doctor will I be when I grow up??? Match Day is tomorrow and as my fellow classmates find out where there will be training I can't help but wonder what I will be matching into in just two short years from now.

SGU's office of career guidance website hosts a Pathway Evaluator, so I took a few minutes and filled out the questions and came up with this list of my top 10:

Internal Medicine
Geriatric Medicine
Child Neurology
Endocrinology, Diabetes and Metabolism
Neurology
Child and Adolescent Psychiatry
Pediatrics
Psychiatry
Rheumatology
Medical Oncology

The thing is, if you asked me today, what I wanted to do I would tell you pediatric neurology (and it shows up on the list above as #3, for what it is worth...) And I do think I could do that and be happy. But there is so much to medicine that I have never experienced and who is to say there isn't something else I would like better or be better suited to.

I know (or at least I think at this moment) that I want to work with children. Soon I will start clinicals and I'll get my six weeks of pediatrics to confirm my intent. But I have to wait until fourth year to do a sub-I so if I am interested in pediatric oncology or child-neuro or genetics it will be at least a year before I am experiencing them first hand, so that means that for the moment I'm stuck waiting. I've been thinking of trying to find an SGU alumni in the area to shadow. What it really comes down to is that I'm getting impatient. I want to be on the floors yesterday. And I really just want my Step 1 score to arrive in the mail so I can stop thinking about it.

A Day at the Museum

2011-03-16T01:18:00.000-04:00

It was resident free Tuesday so I went for the afternoon to the Museum of Man. My favorite moments had to be:

1) when viewing a skull with lytic lesions due to syphilis a couple walked by and the girl said, "honey look, this is what happens to your brain when you get infected!" True, syphilis is bad and not just for your man parts. Maybe this is a good way to keep STDs at bay.

2) watching the very pregnant woman and her husband (no children were with them so I assume primigravida) in front of the Being Born exhibit. I mean it was pretty good exhibit showing the baby in different labor stags coming down the birth canal but it just seemed ironic that there she was, about to pop and she was studying how a baby is born.

Clearly, life after step 1 is pretty good. I also finished my third book in a week while I sat in the park... I love people watching.

Boyfriend's Carrot Muffins

2011-03-14T19:06:00.000-04:00

Since I have time to bake again and husband was craving some carrot muffins I came up with these. They were inspired by this NYTimes recipe but I didn't like the recipe contained oil so I made my own, aka adapted from several others. (Dr. Boyfriend is doing Weight Watchers and I try to make baked goods that he can eat and not have to sacrifice many points for....)

To make this is what you need:

1 1/2 cups all-purpose flour (or soft white-wheat flour)
3/4 cup brown sugar (or 1/4 cup Splenda brown sugar blend)
2 teaspoons baking powder
1 teaspoon baking soda
1/4 teaspoon salt
2 teaspoons cinnamon
1/2 teaspoon nutmeg
2/3 cup nonfat vanilla yogurt
2/3 cup skim milk
1 1/2 cups grated carrots
1/2 cup chopped walnuts (or raisins or both!)

Preheat oven to 400 degrees. Mix all dry ingredients and slowly stir in yogurt and milk until wet. Fold in nuts/raisins and divide evenly into greased muffin pan. Makes 12 medium sized muffins. Bake for 20-25 minutes, toothpick should come out clean. Enjoy!

Muffins as made with wheat flour and Splenda blend (no raisins) are 2 points per muffin for Weight Watchers Points Plus.

Life After Step 1

2011-03-14T16:31:00.000-04:00

Step 1 is over!!!!

Yep, I sat for it last Tuesday and life after Step 1 has been good. SO good that I just haven't sat down to blog or reflect. I've been too busy trying to cook/bake/read/walk/explore/spend time with Dr. Boyfriend/make travel plans/etc.

I won't know until my score arrives if my study method worked but for all of those wondering about how I studied I'll try to put together an overview and post it at a later date (once scores are in hand). In short I used all the normal stuff, First Aid, UWorld Q-bank and personalized schedule with some help via CramMasters iPhone App.

Right now, it is time to enjoy my vacation. I'll be back later. Match Day is Thursday, good luck to all of those matching!

Tetanus Induced Fake Smile

2011-02-21T16:47:00.000-04:00

... due to facial spasms, aka Risus Sardonicus. I am just two weeks away from Step 1 and on my third pass through First Aid. Every once in awhile I notice or learn something new, not sure that you will find it as interesting as I did but I just wanted to say I'm still here. I promise to finish my Grenada reflections once the exam is over so until then, or until the next random fun fact. Back to USMLE World I go...

Different view, same thing

2011-02-09T23:26:00.000-04:00

-my view while studying from a hotel in San Francisco. I'm here with Dr. Boyfriend while he is at a conference. A change of locale is as exciting as my studying gets but at least my lunch break involves a new city block to explore and I am taking this weekend off to enjoy Napa so I have that to look forward to. (Plus wine is always a good thing.) One month to go. Sigh.

Lap puppy in a coffee shop

2011-01-30T00:05:00.000-04:00

I finally found my coffee shop, a home away from home to study at. Big tables, comfy purple chairs and random puppies. I'm not exactly a dog person but this one's owner asked me to hold her for a minute while she washed her hands. Then she put her in my lab before I could object and she was cute...

Anyhow studying is on schedule and going as planned. My test is scheduled for March 8th, so now it is just about memorizing First Aid and doing World questions every day... when I'm not too busy puppy sitting...

A Walk in the Park- Bunnies on Leashes and Lazy Lion

2011-01-18T15:05:00.000-04:00

Week three, day two of studying. Nothing really to report. I plan to take a practice exam at the end of the month and see how much progress I've made. Until then it is just review, questions, First Aid, repeat.

Because I've been studying at home more than not my breaks have been walking to the park. And well the most exciting part of my day is usually found on these walks. I don't know why but a guy had three bunnies on leashes but it made my want to take a picture.

Also last week we had friends in town so I took a study break and went to the Wild Animal Park with them. Lazy lion napping on random car in his exhibit.

Now it is time to get back to chicken-wire and fried eggs. (Hats off to you if you can name the pathology to which I am referring.)

Beware of Polar Bear Liver

2011-01-05T18:26:00.001-04:00

Did you know that eating polar bear liver may cause Vitamin A toxicity? Just a random fact learned today.

It is day three of Step 1 studying and besides my four new packages of gum I don't have anything more exciting to blog about right now (but btw, I totally recommend the Stride flavor- Mega Mystery.)

Back to it, enjoy your Wednesday!

Spice Island Queen's 2010 Blog Recap

2010-12-31T14:12:00.000-04:00

So here is my blog 2010 year in review (The rules: take the first sentence or line from the initial post of each month).

What do Minnie Mouse, Santa, Michael Jackson, the Rockettes, Cinderella's carrriage and the nativity scene all have in common? So, third term in a nutshell: Mental Illness - one case The Power of Placebo I just checked my school email and this is the opening line: "There are wild rumors circulating about the water shortage, most of which are very far from the truth." Classic Rock knocked on my door, "come outside and bring your camera." Just a minute to rant.... Each set of pictures describes one pathology (See link to Path Pictionary V). Summer Break- Day 2, I'm here with a new West Coast address. I love the sound of the rain on our tin roof in my new off campus apartment. This sounds crazy even to write but if all goes well I will be celebrating being done with my boards in just six months from today! So one of the things that ~~sucks~~ is not so nice about being in medical school far far away is missing occasions and celebrations. So the week before last I told you all about how much I adored biochem, not! Today marked the last official day of Basic Sciences.

May 2011 bring you much peace and joy. And have a safe and festive New Year's Eve, cheers!

Day Zero (aka home sweet home)

2010-12-16T15:28:00.000-04:00

I made it! Yesterday I said goodbye to Grenada and now I'm back in the good old USA with my husband in our cozy apartment and I couldn't be happier. The tree is up (he surprised me) and lit, we plan to decorate it tonight. The weather is a 60 degrees and I'm thinking of flannel sheets and sweaters. I guess after living on a tropical island for two years this is good intro to mild California winters. The Colorado blood in me not so secretly wishes for snow at Christmas but I'll settle for being with the ones I love.

Time to unpack and contemplate studying. I have a brand new 2010 First Aid and RR Biochem not to mention some lovely new pens. I can walk to Starbucks and I get to have good wine and dinner with the love of my life tonight. Life is good. I need to reflect on the past year of medical school but for now I'm just going to enjoy being home. Happy Holidays!

Grenada Goodbyes with 2 Days To Go...

2010-12-13T21:25:00.000-04:00

I thought this post would be easier to write. I'm done. No more medical school in Grenada. In just two days I fly home. Basic Sciences are over and this chapter of my life is closed. It seems both triumphantly amazing and like a big let down simultaneously.

Since Thursday there have been parties and more parties, several trips to the beach, a drive around the island and sailing trip to another island. I'm not bolting from Grenada but rather making the rounds and saying my goodbyes.

It wouldn't be a pictorial countdown without a picture or more, so...

The Shadowfax catamaron sail boat that took us around Grenda and to Hog Island. My third time going, love it!

Christmas spirit in Grenada. Did I mention I heart X-mas lights?

Belmont Estate and Chocolate Factory. Beautiful plantation and they do a nice lunch if you find yourself on the North side of island. If in doubt, go! (Its worth the trip.)

This time tomorrow...

2010-12-08T14:27:00.000-04:00

...I will be finishing my final exam of basic sciences. Two years of medical school will be over and I'll just 6 days away from leaving Grenada.

I'm trying to decide what this means for my blog, it will be hard to write Notes from Spice Island when I'm not ON Spice Island but I'll figure something out.

In the meantime I've got some pharm studying to do. And a few more raggae bus decals and pictures to share.... enjoy! (Next time I blog I will be a MS3. Crazy, huh?)

Also seen around town: Log In, Swagger, Bawl & Beg, Street of Heart, Just Amazing, Playboyz, Royalty, Endz Out, The Baddest King, Overcommer and Street Smart.

9 ladies dancing (and I'm dancing too, in celebration of single digits!)

2010-12-06T01:00:00.001-04:00

Woo hoo, just 9 days to go. Oh Grenada, I will miss you at some point, in the maybe not so distant future but right now I am ready to go home! Pathophys final is tomorrow (well today) and then pharm on Thurs. The end is near.... So to celebrate and because I love Christmas and dancing so much, here is a hodge podge of of things for your viewing pleasure.

First up a video of an orchestrated dancing mob. Because it is fun. I think I need to find more of these (after exams) but today the credit goes to Everythinghealth.

From the neighborhood, I know it is not the best but I was just so excited that my neighbors had Christmas lights that I had to post this.

And finally, the 12 Days of Christmas lyrics and fun to get you into the Christmas spirit. I know it is bit pre-mature but its my blog and I'll post if I want to!

A Mocha kind of day...

2010-12-04T23:42:00.000-04:00

So with only 11 days left on the island I am feeling a bit nostalgic. I spent the majority of my day studying at Mocha Jumby. It was my primary place of study 1st term and while I've been spending much less time here this term it still holds a special place in my heart. They seem to remodel every term but the coffee and food has been consistent and while I have to admit I'm looking forward to Starbucks and discovering new coffee houses for Step 1 studying I will miss this place too.

So to Mocha Jumby and the girls I met here first term I raise my coffee cup!

And some pics of Mocha today, because this is my pictorial countdown after all.

only a dozen to go...

2010-12-03T19:50:00.001-04:00

Today marked the last official day of Basic Sciences. Two years of medical school is over (or will be as soon as exams are written next week.) Everyone was a little sad as small group came to a close today. I grabbed all my first year group members from Anatomy lab and we took a picture because it seemed fitting... oh how time flies. Anatomy lab and first term seem both forever distant and remarkably recent.

It is strange to reflect back over the past two years, upon how much we have learned and upon what is next. Third year and clinical rotations means we will all be scattered among many different hospitals and states and save the exams and after exam partying I likely won't see many of my classmates until graduation. I am not sad that basic sciences is over. My love of sitting in a classroom and doing small group busy work is not exactly why I came to medical school. But I WILL miss all my amazing friends and future colleagues (tear.)

Well enough of this reflecting... I'll be stateside in just 12 days and it can't get here soon enough. Now it is time to study my weekend away, for the last time ever in Grenada!

And b/c I heart Dr. Dasso- here is random question he put up during the pre-exam pharm quiz yesterday. Enjoy!

enough fingers and toes

2010-11-29T21:49:00.000-04:00

Okay so there are now less than 20 days until I leave Grenada. I told you I was bad at keeping track... I started with good intentions but then somewhere between day 30 and now I got busy and lost motivation to take a picture and figure out a Grenada memory each day.

But never fear, I'm back and here is a quick recap. I have been trying to stay motivated to study... it has been a loosing battle. However, I've shipped a large portion of my stuff, donated and sold everything I don't plan on taking home. We took the NBME today and tomorrow starts the final week of classes. Yep just one more week of class, and two exams to go. That is all that stands between me and home for the holidays. I literally cannot wait!

Some pics to make up for lost time...

Christmas comes to Grenada early (this was the week before Thanksgiving at the campus bank.) Also Christmas carols are now regularly played on the busses. Raggae Christmas of course, gotta love it!

Cheers and sunset from my old balcony with a good friend. I love good friends and Stag and random inspirations to watch the sunset... I will miss this!

Yep, you read that right- "Don't Hate, Appreciate" on the same van that has a Baby on Board decal along with the Playboy bunny. Gotta love Grenada! And I've been looking and a few other noticed Reggae bus decals to add to the list including: "Street Smart", "Overcommer" and "Not Lucky but Blessed." See Grenadians are thankful, as am I. And to celebrate American Thanksgiving I made pumpkin cheesecake. Yum!

And now a picture of my Chrismtas lights because I love all things Christmas (almost as much as my husband.) Who I will see in less wake-ups then my fingers and toes. How very exciting!

Happy Holidays!

first signs (leaving 29 days of island pre-Christmas to go)

2010-11-16T22:05:00.000-04:00

Christmas is coming~

On my way to the grocery store, walking through the mall... what did I see?
but a wreath and some hollly and a Chrismtas Tree!

On the speakers overhead, carols filled the air-
Old Saint Nick is watching, so you'd better beware!

Here in Grenada, Thanksgiving has past,
so we are allowed to have our pre-Christmas!

hay is for horses and 30 days left

2010-11-15T22:21:00.000-04:00

So I took the weekend off. Well not exactly off off, but off from blogging. We had a lovely 8 hour exam yesterday testing everything taught in the past 2 years. While the stuff like path and pharm are pretty recent and therefore memorable, subjects such as neuro and anatomy are less so. Good times.

Anyhow, the weather yesterday was nice, it was actually cool, it almost felt like fall. And I saw horses on the way to the exam. I don't think I've seen horses in Grenada before... I've seen goats, cows, stray dogs, lizards, coakroaches, crabs, but no horses. Until yesterday. I'm not sure why it made me so happy but the horses coupled with the weather made me feel like I was somewhere else... not a tropical island.

As for things I'm thankful for and/or will miss upon leaving:

Flip flops-I have 10 pair here which I admit, is kind of ridiculous but I do love my shoes. And since there is rarely a reason to wear anything else it is footwear of choice on all days.

Random facts learned in lecture- Did you know that cabbage can cause goiter? I mean, you would have to eat a lot of it over an extended period of time, but still... I thought that was a cool factoid. I wonder if other people get excited learning about such random things.

Only 33 days remain to spend time with my amazing friends

2010-11-12T18:41:00.000-04:00

"Lots of people want to ride with you in the limo, but what you want is someone who will take the bus with you when the limo breaks down." - Oprah Winfrey

Classic Rock is the kind of friend that will ride the bus with me. Just last week she missed Unity Ball (aka our med school prom) to do biochem with me. For 13 hours. The day after exams ended. Yep. Talk about a good friend...

This is her in Carriacou (another place I will miss) at Bogles Roundhouses where we were staying for a Hash earlier in the term... (If you ever go to Carriacou I recommend eating or staying at Bogles. Roxanne is a great cook and the cottages are nice too.)

I am so glad that we are almost to third year, and finally being in the hospitals will be great, but I will miss my friends and classmates from Grenada. We are all going our separate ways... so this is my continued reflection on friends I will miss when MS II is over.

my kayak mornings, only 34 left (sigh)

2010-11-11T15:31:00.000-04:00

On of my favorite ways to start the day is with an early morning kayak. Lucky for me, Miss P was also in the mood and so we went for a kayak followed by breakfast at the University Club. By 9:30am I'd gotten my exercise in, breakfast, some sunshine and water time. I WILL miss these mornings once I'm stateside.

Are you sick of the water shots yet? Too bad, I'm not...

Stag opportunities last for only 35 more days...

2010-11-10T23:52:00.000-04:00

So, the official beer of Grenada is Carib, but I've never really enjoyed it. There is another option however and that is Stag. I will miss my Stag. Perfect with pizza at Prickly Bay or after a powder puff football game. My drink of choice post exams and for all around good times. Cheers!

Confessions of a Med Student Part III

2010-11-10T20:01:00.000-04:00

This is part three of the series Confessions. Reflections on my medical school infancy and childhood can be found here: Part I and here: Part II.
----
Part III. The Third Term Breakdown.

One class. 5 subjects. 6 credits. 6 weeks.

aka. Psychiatry + Biostatistics + Epidemiology + Health care policy + Law and Medicine + Bioethics cont. = Behavioral Science and Medicine.

Maybe because I was a psych major in college, or maybe because I tend to like the non-science part of medicine- recall first term, my favorite class was the one most students couldn't stand (bioethics)- but for whatever reason I really liked third term. Because it was so many different subjects you couldn't really get bored or bogged down with any one thing. Perhaps I'd seen 80% of the material at some point in my prior education. I wonder if that is how the undergrad biochem majors felt during first term. Or how the students with master's degrees in neuroscience felt during 2nd term. In any case, I enjoyed what was for me by far, the easiest of terms. And I got to enjoy the island a bit too. I went sailing. I fully lived my weekends. I had friends over. I went out. I baked. And I planned and anticipated fourth term.

Fourth term is known to be the hardest of all terms at SGU. You hear rumors. Like- the average of the 2nd exam is a failing grade, 1/4 of the class above you had to decel and 100 students are retaking the class. It is hyped up to be the big bad fourth term, the mountain you must scale and the raison de etre of medical school, it is pathology. All of pathology. Taught in 4.5 months alongside microbiology and clinical skills because just one class at a time would be humane. Be scared. Be very scared. Or so the rumors go... (you'll have to wait for Part IV to find out my take.)

So in summary: third term is created to torture you before fourth term starts. Since four and half months away from home is not long enough third term ensures that you will be on the rock for a full six months and I think this is why it gets a bad rap. That and people have to do math. And read. Or so my theory goes. As for me, third term was finally a step in the right direction and a great start to what is the 2nd year of medical school.

Stay tuned for fourth term. What doesn't kill you makes you stronger. Or something like that.

36 sunsets to go...

2010-11-09T23:39:00.000-04:00

The sunset over the Caribbean Sea is enough to give me pause, every time.

I'm so happy when I'm actually in the right place to enjoy it for a moment and reflect on the two years that were medical school in Grenada. I am getting excited about almost being an MS III and being done with the classroom, more or less... I mean I know there will still be lectures but not every day and not for hours and hours at a time. I just wish the next month would hurry up already. But while I'm here I'll try to enjoy the 36 sunsets I have left.

my Caribbean Sea doesn't expire for 37 more days

2010-11-09T00:12:00.000-04:00

In a sort of random chain of events I found myself at La Source this afternoon with my sister-in-law. And yes I will miss the beautiful, warm turquoise waters just minutes from my apartment and the off chance that I can end up at one of Grenada's top resorts for the afternoon in lieu of pharm and pathophys.

I was too busy enjoying the pool to take a picture, but this is from another beach on the North side of the island taken last term on a day not so unlike today...

... and yes I am aware that I go to medical school in paradise.

Brothers & Sisters - watching with 38 days to go

2010-11-07T22:53:00.000-04:00

So, I have to back up for today's memory. During first term I met a classmate and we were instant friends. Every Sunday night I would go to her place off campus and I would enjoy off campus living, complete with oven to bake in and TV to watch. We would normally have dinner (something baked), do some anatomy questions and then watch a mutual favorite TV show- Brothers and Sisters. And so it was, our first term tradition.

But she is Canadian and was worried that an SGU education may leave her stranded in the USA so when she got accepted to a US medical school she decided to attend. And although she didn't come back to SGU we've kept in touch. Every Sunday night that we are both in school (provided one of us doesn't have an exam the next day) we Skype and I watch Brothers and Sisters with her, virtually. It is one of my favorite med school rituals. And just another example of a friend made, gratis SGU. And the best part is I don't have to leave the friendship in Grenada. So today is reflecting on things that Grenada has given me instead of things I'll miss. But I will miss the school kids in their uniforms.

I know these picture are not the best but if you look carefully you can make out two boys in the first one, the older brother leading the way. The sisters had matching school uniforms and backpacks. Both were taken on the way to the Hospital last week. I love Grenada kids in their matching uniforms. And Brothers & Sisters always make me smile. And now it is almost time to tune in for my show....

the days dwindle: reflecting on friends far (day 40) and near (day 39)...

2010-11-07T00:35:00.001-04:00

Un-inspired is hopefully over.

T-40: More good mail, this time in the form of a lovely pink box with yummy fall treats (think snickerdoodle cookies and home-made maple pecan granola.) Thank you dear K! The PERFECT thing to open after a week of difficult exams.

T-39: Happy feet, because your feet are happy if you are!

And my feet are very happy here because I have such an amazing friend...

41 more days of random

2010-11-05T00:02:00.000-04:00

i won't miss it all, but i will miss a few things.... like the random animals around campus and the island. you never know when you'll run into a goat or bull for that matter. and well it wouldn't be a day without seeing a gecko.

case and point....

hoping uninspired doesn't last (42 more days)

2010-11-03T23:32:00.000-04:00

it is the middle of exam week and studying pharm tends to kill my soul. i ~~forgot~~ wasn't inspired to take a picture today (so here is one from my stockpile.) the view is one of my favorites from campus. i use to walk this way every day and take it all in on on my way to class. living off campus this term i have a different view, but sometimes i miss this one...

43 days left to hang my laundry

2010-11-02T14:50:00.000-04:00

Today is laundry day and here in the Caribbean we dry our laundry on clotheslines. I am not sure if I will miss it, to be honest I like my towels fluffy but hanging clothes out to dry is kind of fun. I'm not green enough nor do I have space to do this at home so it is another thing that happens only here....

And because I'm studying today and just had to create a MCQ for clinical skills I'll leave you with this.

A 48 year old woman presents to your office with goiter. Upon palpation the gland feels nodular and there is no tenderness. No bruits are heard upon auscultation. Patient denies any previous illness such as an upper respiratory tract infection but does have a history of rheumatoid arthritis for which she takes NSAIDs. Lab tests reveal decreased TSH levels and increased T3 and T4 levels. Antibody tests come back positive. Nucleotide scanning reveals decreased uptake. What is your patient at an increased risk of developing?

Plummer’s Disease
Hoarse voice and dysphagia
Non-Hodgkin’s Lymphoma
Hypothyroidism secondary to treatment
Toxic Adenoma

44 more days to bake (with ample room)

2010-11-01T22:34:00.000-04:00

If you've read more than a post of mine you'll know that I love to bake. And what does a baker love? Counterspace. And now that I live off campus I have an abundance...

I think it just might be one of those things I will miss. My counter space at home is not so plentiful.

Confessions of a Med Student- Part II

2010-11-01T22:26:00.002-04:00

So the week before last I told you all about how much I adored biochem, not! But I survived it and so it was on to term 2.

This week I'll reflect on the term that was 2nd. (Genetics, Parasitology, Physiology, Neurology, CPM)

It started off with Genetics and Parasitology and truth be told these were well taught and interesting. Each one was only one or two hours of lecture a day, worth two credits each and only two weeks long. It was compact, doable and a great way to start the term. Good times.

Side Note- I got a toaster oven. Now you might be wondering how this fits into term 2. But it made all the difference for me. I love to bake and having only a stove in my on campus apartment wore on me during first term (not that I would have had time to make anything but the option would have been nice.) Anyhow I made it my goal to get a toaster oven 2nd term and I think that it was one of the things that kept me sane. That and the hammock that I ordered for my balcony. Some people need to run, I need to bake. I like making something from raw ingredients and I love to give away my baked goods, which I did a lot of during the term. Now back to the classroom aspect....

The true fun began when we started Neurology and Physiology. We also had Community and Preventative Medicine to balance things out. In full disclosure, I am interested in Neuro and have past experience in the area so I expected to enjoy the class and was a bit disappointed. The team taught approach made Neuro seem like 5 different classes: there was neuroanatomy and then neurotransmitters and then the neuro clinical exam. And each subject was taught by a different prof which would have been fine except it was as if they never talked to one another. Each lecturer didn't seem to know what we had already learned so I found it frustrating and a bit disorganized. On the upside small groups were fairly useful, we worked through cases and identified structures on plastic brain models. And they did attempt to bring it all together at the end with comprehensive cases but by that point it was too late to be making integrations.

Physiology on the other hand was under the auspice of Dr. Holroyd who I would easily nominate at Professor of the Year. Entertaining in the way that only someone from Australia can be and well presented material, it was almost fun to go to class. Our 10 minute breaks would be filled with Dr. Holroyd's music and as he turned up the volume he would add the visualizer via the projector for full effect. You felt like you were at a rock concert instead of in medical school. But it wasn't easy. I had to work very hard in both neuro (anatomy again, ugh) and physio. Some of my classmates would talk about how physio was all just common sense, I never felt that way, but it was important to the basics of medicine and I felt like we were given a solid background. I frequently look back at my physio notes, they are golden.

So to sum up term 2: Much better than first term. Got a toaster oven. Classes really depended upon the lecturer of the day. Dr. Holroyd was/is amazing.

So all in all it was an interesting yet difficult term.

Next time I'll tell you all about on one of my favorites, term 3!

hashing through 45 more days

2010-10-31T23:50:00.001-04:00

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?

2010-10-30T12:31:00.000-04:00

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)

2010-10-29T18:27:00.000-04:00

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

2010-10-28T16:54:00.000-04:00

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

2010-10-28T00:00:00.000-04:00

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

2010-10-26T00:42:00.005-04:00

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

2010-10-18T11:53:00.000-04:00

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

2010-10-17T16:24:00.000-04:00

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)

2010-10-15T07:50:00.002-04:00

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!)

2010-10-13T09:35:00.001-04:00

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

2010-10-10T07:33:00.000-04:00

"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

2010-10-08T18:29:00.000-04:00

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

Perd mon temps

2010-09-16T19:48:00.001-04:00

Today was my fifth clinical/ hospital rotation visit and today my group went to the neighborhood of Perdmontemps. In case you don't speak French, Perdmontemps means "I'm wasting my time." I have to say, it is one of the more unique town names I've come across. I only wish the translation didn't have any literal truth to it for anyone involved today.

It was a good 35 minute drive up and down and around the island to St. David's Parish. I had been prepped by my roommate and other classmates but still, first impressions were not much. We pulled up to an unassuming cement building just off the road with a sign that said Perdmontemps Health Clinic. As we entered there were at least 30 patients crammed into a small waiting room. There was small window and door on one side of the waiting room (the pharmacy) and on the other side a small divider was set up, behind it a nurse took vitals and triaged the patients. There was a make shift lab area and two examining rooms. Two other assistants helped organize the patients and there was one doctor. This was at 8:35am in the morning. When I later asked our patient if it was always this busy she said yes. She told me that she had arrived extra early this morning, much before 8am so that she could be patient #1 (and as a reward for coming early she got to see 5 medical students and hang out at the clinic for several hours instead of just a few minutes, lucky her!)

We were escorted into one of the examining rooms where our preceptor and physician, Dr. Drum came in to greet us. He gave us a brief run down on how public health care in Grenada worked and how patients were seen in their neighborhood clinics on a set day, once a week. Medical care is free but patients pay a nominal fee for prescriptions. Each neighborhood has its own clinic and the doctors rotate through different clinics much like traveling circuit pastors use to do in rural areas of the US. He then brought us a patient, instructed her to let us ask whatever we needed to ask and left us to do our interview and exam....

And so we did. Now our patient was diabetic and hypertensive and she took medications for both. But she explained that usually when she came to the clinic (she said she came every three months for check ups) her visit was only a few minutes long, and since she was coming so early this morning she didn't take her meds or eat breakfast beforehand. Dr. Drum came back to check in on the group once but he was so busy seeing other patients that it really was just 5 medical students and our patient for over an hour. As the time passed on she started complaining of being hungry and wanting to leave and I began to wonder exactly why she should continue to let her blood sugar fall at our learning expense. (Of course, me who ALWAYS has a snack in my bag of some kind, had only water today.... And no one in my group had anything either. Our white coats are not yet the hold all bags and walking storage units that they will soon become.) Finally we were finished and our patient was threatening to walk out so I went in search of Dr. Drum on behalf of her blood sugar. Dr. Drum came back. I presented the patient. (He critqued me and I didn't fell all warm and fuzzy, but he ended up giving my 5/5 for presentation skills so I guess I did okay.) We presented our clinical findings. He made us demonstate our technique and any pathology had to be examined and appreciated by all five of us. This was not a waste of my time, but I felt complicit in a relationship that I am not sure the patient wanted to be a part of, she was clearly ready to go at this point but Dr. Drum felt that he still had teaching to do. When we finally finished and she bolted from the room we had been there for over 90 minutes.

We (as 5 students) had seen one patient. There was a waiting room full of patients to be seen and we still had plenty of time left before the bus would be back to pick us up. A group member asked Dr. Drum if we might be able to see another patient and he replied that we should have taken more time with our given patient. (Now I think that 90 minutes is more time then we will ever get in the US healthcare system and more time than we needed. We could have subjected her an entire complete physical, instead of a focused, but to what end? She didn't even want to be examined by us. And she certainly didn't want to sit around and be reexamined again and again. I didn't ask if this wasn't a "Perdmontemps" for the patient, but I wanted to.)

I am grateful for the opportunity to see medicine at a community level in Grenada. I am thankful to Dr. Drum for allowing medical students to come to the clinic and see patients with him. He also comes to SGU and is a preceptor in our clinical skills course so I know that he cares about students and is a physician educator. But I also feel more than just a little bad "using" patients to learn when I don't think they they really benefit from the encounter. Maybe this is something that I will have to accept and come to terms with. But as of now I am still wrestling with how to be a medical student that has something to give. I don't want to simply take.... I know that more often than not what I will have to offer is time, a listening ear... and hopefully I can be a good conversationalist for whatever time we have together.... the patient has so much to teach me. I only hope I can give something in return.

Half a Dozen Moons

2010-09-14T05:45:00.000-04:00

This sounds crazy even to write but if all goes well I will be celebrating being done with my boards in just six months from today! Dr. Boyfriend has a conference in San Francisco and Napa is maybe my favorite place on earth so we decided that I'd write my Step 1 and then join him in paradise for a post-exam Valentine's and two year anniversary of sorts. It means that I will only have one week off between finishing 5th term and starting to study, but I think that is okay.... The promise of good wine will keep my super motivated. That and dinner reservations at French Laundry.

For some reason this term is not flying by at usual Grenada speed but maybe it is just because it is my last and so everything just feels bitter sweet. I have been osculating between sick of the island, ready to go home and thankful for this opportunity, mindful of my good friends here and not sure if I want this year to be over.

Even so, 5th term is okay... at this point in my education 80% of what we cover is review so that feels nice but the objectives that say know (aka remember) everything since day one of medical school are kind of anxiety producing. I for sure do NOT remember all that anatomy. Histology was a distant blur and Biochem, what's that? So basically it is the term to review (restudy) all that has past you by. On the bright side, at least pathology and physiology for the most part are forthright in my brain and I actually feel like SGU did a good job with preparing us to pass our boards. I'm happy with my education. I mean maybe I should wait until after I get my Step 1 score back but so far everything seems to be coming together. Except maybe the 900+ drugs I am suppose to know for pharm. I study and study and study and they just don't seem to stick. Class IB anti-arrhythmics versus the types of diuretics you can use to treat heart failure vs keeping the macrolides straight from the aminoglycosides is perhaps the answer to why I've had so many migraines this term. (But at least I can tell you the MOA of my triptan of choice and the top prophylaxis for migraines, right?)

Oh well. 6 months. That seems scary, exciting, stress-inducing, light at the end of the tunnel soon!

Feeling Fine with New Shoes and Wine

2010-08-26T20:20:00.000-04:00

Fifth term is picking up the pace and life is in full swing. I've been busy, but I love it.... here are a few highlights.

Tuesday: I made from scratch, pumpkin soup and cornbread with my neighbor. We then had family dinner with the roommates. And of course I did the pre-requisite class, small groups, study time, etc.

Wednesday: I managed to buy a new pair of shoes and a cute top to wear to the Hospital. This was in between studying all morning, reviewing 90 questions from Exam Masters and 4 hours of class. I also went for a sunset walk and swim. Not too shabby of a day....

Today: My hospital group was assigned a local GP to follow and I examined a 7 year old, interviewed a young man for his annual work physical and saw textbook anemia in a women with Hb of 5 (don't ask me how she was even walking around). I ran home to change at lunch and on my way stopped to visit my local wine store. I chatted up the owners and staff while picking out 2 bottles of wine for the weekend. I then sprinted to class for 4 hours, followed by powder puff football practice, woo hoo! I think I can manage 3 good hours of study time before I call this day done.

Tomorrow: I have the morning free to study and then my first (mini) test of 5th term. Depending how that goes I'll open the wine or hit the books again. The weekend is almost here and I cannot wait to study without distractions (yes I know I am a med school dork, but I'm okay with that because I have new shoes!)

Reflections on a Sunday in 5th Term: Hot & Humid but with a View

2010-08-22T13:48:00.000-04:00

I love the sound of the rain on our tin roof in my new off campus apartment. I hate the humidity and bugs that come with the rain. On the upside, living off campus means a wonderful balcony overlooking Lanse Aux Epines and the marina and it is breathtaking, worth the bugs and humidity for sure. (And my room has a/c, I just feel like a hermit always running into my room to escape the heat.)

I'm here in my (cross my fingers, nose to the books) last term and week 3 is about to start. I think I've grown complacent, I still enjoy the island but the goats wandering into the middle of road and the chance to swim in the amazing Caribbean Sea whenever I want have somehow lost their luster.

Fifth term is.... well, busy.... lots of exams, small groups, plus hospital rotations and class 3 or 4 or 5 hours a day. I might have time if I stopped going to class like more than half of my colleagues but I don't really enjoy sonicing and I figure it can't hurt (well as long as I put in the study time despite the time suck) so that is about all I have to say about 5th term. I started my clinical rotations in Peds and I loved it! Physical exam and reflexes on a 3 day old, what's not to love?!?

Here is hoping for inspiration to blog more often and that fifth term flies by so I can go study and take my boards and start 3rd year already. Senior-island-itis... who me????
Happy Sunday!

P.S. I found a new favorite med blog and my title is a clue, any guesses?

A Boston Love Letter (aka- 4th Term Antidote)

2010-07-21T11:05:00.000-04:00

So if you know me then you know that I love, love, LOVE Boston. As Dr. Boyfriend points out it was my first real city to fall in love with so it has a special place in my heart. (And bonus we met and fell in love there too.) Anyhow, I spent the weekend in the Boston area and got to relive all my favorite Boston memories with a good friend from undergrad. Drive down Charles River.... check. Blueberry Ale from Boston Beerworks.... check. Red Sox game at Fenway.... check. Hands down the best frozen yogurt anywhere (and I would know, I've looked- no one else makes carrot cake blended fro yo) from Angora Cafe..... CHECK! Rewatching "Good Will Hunting" after a local grown veggie meal and nice bottle of wine with good friends..... Priceless. (Thank you K and R!) It was a wonderful, nostalgic, blissful weekend.

And as if it can't get any better it was sandwiched between camp which deserved its own post and my family coming to California to visit. So in short, life it good.

I have not studied half as much as I had planned to but I still have 2+ weeks until I go back to the rock and there is something to be said for downtime and enjoying life outside of medical school. I'll be back to the grind soon enough so I'm really not beating myself up about not doing First Aid Questions every day as I had planned.

So here is to summer, great friends, a loving family, Boston memories and new beginnings in California. I am truly blessed. Life is good.

Sunny California

2010-07-01T18:25:00.000-04:00

Summer Break- Day 2. I'm here with a new West Coast address. Fourth term ended without much fanfare. Five weeks to unpack our apartment, explore a new city, see my family, go to camp, and enjoy not studying (well, maybe in moderation.) Then I'm back to Grenada for a final term. With time I'm sure I'll have something to say about Term 4 but right now I'm just enjoying my new city. It's summer break, woo hoo!

Oh and another thing...

2010-06-17T16:25:00.000-04:00

As if Forensics wasn't bad enough, it also includes physics (my all time least favorite subject, ever).

This is one of our Pathology Objectives: Describe how changing the Delta V (change in rate of momentum) can improve transportation safety.

Really! I'm not making this up. Most of what we learn in medical school is medicine, or at least closely related. And while I don't minimize the importance of safety I think this one is better left to the transportation and vehicle engineers. It is not like I'm going to be a human bumper for my patients. Though I suppose if one was fainting onto the tile floor I could use this law of physics to soften his fall, or something.... (sigh.)

On a semi-related note, this is pretty cool and since bike helmets prevent brain injury I'm safely back to the subject of neurology which I am quite happy to talk about and study.

I need this term to be over, I think I'm getting grumpy....

The Anatomy of Tears

2010-06-15T21:17:00.000-04:00

I cried today.... it was part sadness: I miss my husband, this term has been long and I am ready to go home. He graduates from residency tomorrow and I won't be there to share it with him. His Birthday is this this week but I'll be here, studying for my path final. Sometime things don't work out like you want. And I know that I'll be home soon but right now it just doesn't seem soon enough.... and so I cried.

It was part anger: we finished pathology with forensics and there is something despairing in how humans treat one another. The last two days have included lectures on child abuse, rape, homicide and suicide, all complete with pictures so I started to doubt the humanity left on this earth. ( I expected forensics to be fun, like solving cases on "CSI", but the problem is they are all true cases and pictures of real people.... It was the opposite of fun. It was emotionally draining and terrible and I have ruled out Medical Examiner, Forensic Pathologist and possibly ER based upon how I've felt these past two days.)

I tried to turn my day around, I ran out of class and came home for lunch but found myself looking at pictures of the oil spill, haunting, sad, heart-breaking pictures. The highlight of my day was an actual mid day conversation with Dr. Boyfriend and skype let us both be on video for the first time in forever, so that was nice. But then I had to go to lab and hear more about terrible, horrible things that humans do to one another. I tried to redeem my day again and went for a swim at with a plan to watch the sunset, but locals kept bothering me, peddling their necklaces, mangoes and company. I escaped to IGA and stocked up on a few things for the final two weeks I'm here.... But when I got home the new iphone Facetime video flashed across my computer and the music and the orchestration was just too much, so I cried. Tears of sadness and disappointment in mankind.

I know that I will see things and do things that will make me feel this way again. Medicine does not always provide a happy ending and that is a reality I have chosen by coming to medical school and embarking on the life a physician. I just hope that the sun comes out and the encouraging days outnumber the heart-breaking ones. And when they don't or when I need to, I'll cry....

I feel like burnt toast, oh and Path Pictionary VI

2010-06-09T19:36:00.001-04:00

Okay, so this Path Pictionary has taken away my desire to post anything of substance. I guess I'm just tired. Term 4 is not so bad.... I mean I like Path, it is interesting, yada yada but I'm tired and want to go home.... every day has become a chore to get through. I feel like all I do is sleep, study and drag myself to class, lab, etc. I miss being a real person....

But soon, so soon, I'll be back in the US with my husband learning a new city and having a nice summer break before coming back her just one more time. Crazy how fast time has gone by, sometimes it seems like just yesterday that I was packing and planning to move to Grenada.

Now if only these last two and half weeks can go as quickly as the past year and half has..... But I digress, I'm done whining (for now).

For your Pathology fix I present the last installment of Path Pictionary: Brain and Bone

A. Diagnose by weather or fruit.
Patient complaint:

MRI shows:

B. Sticks and stones....

Path Pictionary V

2010-06-02T23:19:00.000-04:00

Each set of pictures describes one pathology. The subject is endocrine.

B. Hard as or hard.

Think Nuclei!

Word of the day: Adnexa/ And Path Pictionary IV

2010-05-28T18:00:00.000-04:00

Adnexa.Love that word. As in uterine appendages.

We just finished female genital tract today and I am sorry to actually feel this way but it is SO interesting... Now please don't get any ideas, I don't want to be an OB or GYN. One in the family is plenty... I saw what residency entails. I don't want to be an OB/GYN but I have to say.... it is pretty cool. I mean Chorionic villi, fascinating! I want to study again.

Okay, my fling is over. (Well after A.)

How about these?
A.

Path Pictionary III

2010-05-25T22:56:00.002-04:00

Okay so this one should be easy!

----
And now for a couple of two picture ones.

(Hint- think renal again, more pictures to maybe help with the words.)

________ and ______

AND

-----
And for this one, good luck! It is on the order of "Butterflies on a fence" as in I really don't know how this describes the morphology but it what says.... And what was stressed in class and lab. I checked, this one is even and objective! Crazy huh? Don't ask me how the pathologists come up with these things.

(Hint- Think along the same lines as the P'eau de Orange...)

Alternatively the same thing is can also be described by this kind of pattern.

Thanks for playing... Plenty more Path Pictionary to come. Promise!

Spice Queen and the Wonderful, Adventurous, Very Good Day

2010-05-24T08:23:00.001-04:00

It was a wonderful, adventurous, very good day!

First I slept in. I love to sleep, especially when I wake up before my alarm clock tells me too.

Then I read the paper and a few blogs. I love to read.

Gypsy picked me up and we met a bunch of friends at her apartment complex to load the vehicles. I got to sample the rum punch and enjoy the view of Prickly Bay Harbor.

Then we drove up the East side of the island, until we got here.

It was the most serene, beautiful, amazing beach. We swam and some of the boys surfed, we ate, we enjoyed the beach. It was a good day.

Then we drove some more. And saw some very old planes. It was a very good day.

We kept driving until we got here.

It was the most heart-breakingly beautiful, black sand beach I'd ever seen. Long and quiet with gray clouds overhead and nestled between a cliff and the ocean. I swam in the choppy waves and was happy.

Then it was dinner time so we headed to the restaurant and celebrated with dinner for the B-day boy. It was a wonderful, very good day.

By now it was dark, but our adventure was not yet over. We saw a leatherback sea turtle come onto the ocean and lay her eggs. We even saw a baby turtles that has just hatched before they went into the ocean for their first time. It was a wonderful, adventurous, very good day!

Path Pictionary II

2010-05-22T01:45:00.000-04:00

Okay, here is another one. Think renal!