Island Med Student

I was very inspired by Ali’s last post about creating a vision for the future. So, here’s an abbreviated list of my life goals:

1. Finish med school at the top of my class and become a skilled emergency physician/family practitioner/neurosurgeon/pathologist/trauma surgeon/pediatrician. (Perhaps you can see the problem here.)

2. Write a Pulitzer Prize winning book about something very important.

3. Come up with a successful solution to the problem with healthcare in the U.S. and internationally. (Specifically, finding a way to provide affordable universal healthcare to everyone, and at the same time loosen the health insurance and pharmaceutical industries’ grip on our current faltering system, which seems to only make the wealthy even wealthier and sentences the less fortunate to perpetually worsening conditions.)

4. Give birth to 3.5 healthy children and raise them all to be exceptional people, all while continuing medical school and building my career. (This would most likely involve concurrently discovering a way to not require sleep.)

5. Travel to every continent and many different countries on a regular basis (and also learn the language(s) of the various places I visit).

6. Convince the world that a war on “anything” is never a solution, but rather serves to propagate the futile and infantile belief that declaring and “winning” a war is a sane approach to any problem.

7. Run a successful animal adoption society from my farm (which will include many acres of wildlife, and also be situated in a large metropolitan area).

8. Orchestrate the mass destruction of all televisions and convince the world’s population that they would actually be better off without “American Idol” and commercials for drugs that they probably don’t need, but for some reason seem to desire after watching the beautiful lady who started taking the advertised drug suddenly be whisked away to a lush, green field with butterflies and chirping birds (see also #3).

9. Learn as much as possible from those who are much wiser than I.

10. Create a recipe for fat-free and calorie-free peanut butter cheesecake that tastes exactly like the real thing.

Click Here To View the Original Post on Medscape

Yesterday, my organization (Physicians for Human Rights) co-sponsored an event to celebrate World Diabetes Day. We took a 30 minute bus ride to Vieille Case, a village here in Dominica. Student volunteers took blood pressures, blood sugars, weights, waist and hip circumferences, and nutritional assessments. We also took good histories and then counseled residents on ways to improve their diets and increase their daily exercise, and we educated them on diabetes and its many complications. I had a wonderful time and learned a lot about some of the factors that contribute to residents here developing diabetes and hypertension. For example, many Dominicans actually get their food shipped to them from relatives in other countries. They end up eating a lot of high fat and high sodium foods. There are also many misconceptions about diabetes. For example, we interviewed some residents who thought that diabetes was a communicable disease. The lady that I interviewed told me she didn’t eat pineapples because she was told they could kill you.

Anyway, I have a lot that I could write on this subject, but I’ll leave it at that for now. Thanks to Micah for taking some awesome photos.

Click Here to View the Photos

The next time that I decide to be President of an organization, and volunteer for like eight million things at the same time, all while trying to maintain good grades in med school, keeping my partner happy, and caring for two very energetic puppies, can someone please SLAP ME?! I’ve been feeling just a teensy bit overwhelmed lately. I’m one of those people who dips her spoon in too many kettles (um, I forgot how that phrase goes). Anyway, the moral of the story is that med school is hard enough as it is. I committed myself to a few too many extracurricular activities this semester, and I’m starting to feel the burn.

Today I volunteered to train first semester students to take radial pulses and blood pressure. I actually really enjoyed the teaching, but when you add up all the hours in the day, I just don’t have enough time to get everything done. I also tend to be a micromanager, I think. As president, I really should be delegating many tasks that I end up doing myself because I’m so anal about certain things. I’m really trying to get better at that, though.

Anyway, such is life. Just gotta make it to December 20th (my last exam) alive.

On Saturday I took a boat ride trip to Les Saintes, a neighboring French island. This is actually my third trip there. I had the time of my life. I mean seriously, it was fabulous. I drank good wine, swam in the most gorgeous and serene spot on the island, rode through the streets on a scooter, and hung out with my bestest friends. Yesterday (Sunday) I recovered in bed and tried to cool my sun burn.

Today is back to reality. I’m behind in my studying since I took the weekend off. Huge, massively overwhelming exams are on the horizon, and I still have so much clinical skills practicing to do.

I’d much rather be back on the beach sipping yummy red wine. Does anyone know of a job that involves drinking wine on Caribbean beaches all day long? Perhaps I’m in the wrong profession.

Anyhoo, click here to view the pics. (My camera battery died early, so I didn’t get to take too many.)

Sir Arthur Conan Doyle is a famous writer who is best known for his crime fiction novels based on the character, Sherlock Holmes. Holmes was a detective who used his astute abilities of observation and deductive reasoning to solve many difficult cases. What you may not know is that Conan Doyle was also a physician. He employed the same detective skills used in clinical diagnosing to help Sherlock Holmes solve the crimes in his novels. By paying careful and methodical attention to all the details of a crime, he was able to quite successfully solve many crimes that might have otherwise gone unsolved.

I find this concept to be quite fascinating, and I’m only beginning to understand exactly how to use similar investigation techniques in the practice of medicine. During all of my basic science coursework, I tried to understand mechanisms and relationships, but there was also a lot of rote memorization. To answer many of the questions on exams involved little more than regurgitating medical factoids, and occasionally solving problems using equations or other pre-conceived algorithms.

In the second year of my basic sciences, the material has become much more integrated. I’m nearing the end and most of the exam questions are based on clinical scenarios. One of our professors warned us in the beginning that some students find this transition to be challenging. They’re so used to simply regurgitating information or relying on simple recall, that they become boggled and overwhelmed when presented with an entire clinical case. Not only are the questions more clinically relevant, but they also often require you to take into consideration many more aspects. For example, you might have to connect all of the signs and symptoms of a patient, use that information to come up with a diagnosis, and then determine what the best treatment option would be.

I’ve been quite excited to find out that I actually enjoy these types of questions much more than the simple recall or mechanism type questions. I learn and understand medicine much better in the context of a real patient. Instead of just memorizing that myasthenia gravis involves antibodies that block acetylcholine receptors, I can understand how a patient might realize that they are having problems chewing, or brushing their hair. I can imagine them coming into the hospital and me noticing that their eyelids are drooping. I still know that the problem is with their receptors, but it all makes much more sense when connecting this piece of information to a real person.

I don’t think that Sherlock Holmes ever solved a crime on the basis of a single clue (correct me if I’m wrong). Rather, he paid attention to all of the details, and used that knowledge to synthesize a hypothesis about what may have happened. This is what I like about solving the clinical scenario questions. Instead of questions like, “what is A?” the questions are more like, “patient has A, B, and C, but not D; which diagnosis would be more likely?”

So far, I’m still in the beginning stages of learning clinical diagnosing skills. I’m not yet expected to be able to solve very complex cases, or treat patients without supervision. But I’m happy to discover that I truly enjoy the investigatory aspects of medicine. I guess the clinical scenarios are the light at the end of the basic science tunnel.

Click Here To View the Original Post on Medscape

I made it through the last exam. Actually, I won’t be shy, I totally kicked that exam’s arse. I’m quite proud of myself. Afterwards, I celebrated my success with my good friends at the Tomatoe’s Cafe. Halfway through the party my friends and I went to Best Buy in Portsmouth. No, it’s not THAT Best Buy. It’s the Dominican version–basically a store with all kinds of strange and exciting things. We purchased fun clothes and then went wig shopping afterwards. When we showed back up at the part in our new wigs, it made for some fun adventures.

That explains the current state of my brain. I’m sure all you med geeks out there can understand. I’m done. I’m finished. No more studying for me. I’m going to go gather up my puppies and go for a nice run. And when I return I might go to the beach and/or make a yummy dinner. Oh yes, and I shall drink my celebratory glass of wine (yes, I celebrate before and after my exams).

My exam is tomorrow morning at 8:00 am. I’ll see you all on the flip side.

“Dominica received its independence from Britain on November 3rd 1978.

Every year, the country commemorates this date with a season of cultural activities which can last as long as four weeks. These celebrations portray vivid examples of the island’s cultural influences. The traditional dances display European traces in Hill & Toe, Waltz, and Quadrille; and borrow from African native dances in Bèlè.”

Unfortunately, rather than celebrating the day, I have to study like a good little med student drone. The entire island closes for this holiday. It’s pretty interesting, actually. I’ve learned the hard way to stock up on things like electricity and toilet paper before holiday weekends. I think it’s funny that although the whole island is pretty much closed, the Chinese food restaurants and restaurant owned by Canadians do remain open (but not on Sundays).

Anyway, I’ve got to get back to vomiting and non-inflammatory diarrheas.

I’ll be finished with my basic science coursework in less than two months. I then have one semester of “Introduction to Clinical Medicine” that I can take in Miami or here in Dominica. After that, I’ll be starting my clinical rotations in US hospitals. After much consideration, I’ve decided to stay here for one semester and do the program at the local hospital. There are many reasons for my decision. Some of them include: not wanting to move all the way to Miami only to stay there for three months, preferring the study environment here versus Miami to prepare for the USMLE Step 1, and most importantly, the clinical experience that I’ll get here versus in Miami.

The hospital here is less equipped with various medical technologies. (I’ll explain why that’s advantageous in a moment.) Also, I’ll see a much broader range of pathologies in Dominica. For example, I will likely see more congenital defects at the hospital here because, unfortunately, many women don’t get proper pre-natal care for various reasons.

In order to be accepted into the program here, I had to write a short essay explaining why I wanted to stay instead of going to Miami. I thought that it would be nice to share it with everyone. There are some people who think I’m crazy for wanting to stay here and live for another three months, especially considering the lack of air conditioning and many other amenities at the local hospital. But I honestly don’t mind putting up with all of the inconveniences if it means that I’ll be a better physician in the end. The following is my essay on why I want to stay:

Sir William Osler once said, “If you listen to your patient, they will tell you their diagnosis.” In my experience thus far, I’ve found this simple statement to be astoundingly true. While I don’t discount the importance and value of modern technologies such as MRIs and CT Scans, I’m a firm believer that a proper history and thorough physical exam will many times lead you to an accurate diagnosis. I have almost completed all of my basic science coursework and I am finally ready to enter the world of clinical medicine. I’ve evaluated my options for my upcoming fifth semester, and I’ve decided that I’d gain the most valuable experience here in Dominica at Princess Margaret Hospital. Although the hospital has less in the way of technologies as compared to the States, I know that many of the physicians there have been practicing in Dominica and other countries for many years. The wisdom and skill that they have gained without relying heavily on technology is profound. I can only hope to acquire a small fraction of that wisdom while learning at Princess Margaret. While I have the rest of my medical career to learn how to use advanced medical technologies, I want to hone my history taking and physical exam skills before I move on. I truly believe that the patient can tell you their diagnosis if you listen carefully enough. That is a skill that I believe I will learn here in Dominica, and that’s why I’d be honored if you accept me into your fifth semester program.

Click Here To View the Original Post on Medscape

What did I do last night to get out of studying? Why, I made another video, of course! And since I have more footage of my puppies than anything else, they are the stars. Here is “Rock That Candy Shop: The Scope and Molly Music Video.”

Enjoy.