Island Med Student

Tina Alexander from Lifeline Ministries here in Dominica just shared with me the story of Stanley, a five year old accident victim who is currently in the ICU at Princess Margaret Hospital.

“He desperately needs to be moved to Martinique, because no one can underwrite the EC$68,000 needed to provide a bank draft, which must be presented in advance. This only covers 8 days in the ICU. They hope that the man who hit him on Sunday will be able to get the money reimbursed from his insurance (they only pay after they see how much it is going to cost in total!) but there are no guarantees.”

If you can help in any way, please contact Tina Alexander at lifeline@cwdom.dm.

I took my pathology lab exam today. I kicked myself in the butt because I remembered the right answer to one of the questions when I got home, but I think I probably did okay.

As a follow up to yesterday’s post, the owner of the goat ended up picking her up and taking her into their house. I gave them some antiseptic wash to use. I think she’s going to be just fine. They buried the other goaty. Thanks Maci, for your offer! Don’t be surprised if I end up having to take you up on it in the future.

When I finished my exam, I came home and started studying for pharm. My motivation to study level right now is about a 1 on a 1-10 scale. I hate memorizing drug names. It’s pretty much the most un-fun thing to study. Why does the human body have to have so many damn channels? It’s like memorizing all the channels on TV, and which shows come on at which time. I just don’t care.

Anyway, I’m sitting here forcing myself to do it. It reminds me of drinking cough medicine. I turn into the biggest wimp of all time. I simply HATE swallowing disgusting medicine. I’m a little baby about it. I have to bribe myself with candy or juice to get the job done. Maybe I should make some juice, and use it to swallow all this pharm. A succinylcholine grapefruit blend!

Yesterday, I took an oral clinical skills exam, which will allow me to progress past the basic sciences and delve into the clinical world. It was an absolutely nerve-wracking experience. The exam is split up into four rooms. Two rooms involve completing a clinical task, one room involves examining someone with a particular complaint, and one room has a simulated cardiac patient that you must examine and diagnose. I’ve been practicing my skills for months now. I felt pretty prepared going in, but it seems like my brain went out the window when the exam came.

To add fuel to the fire, I was the very last person to go in my group. That means I had to wait for several hours while everyone else completed his or her examinations. I sat in a room, trying to not chew what’s left of my fingernails off, while they called people one by one into the rooms. Talk about stressful!

In my first room I was asked to do a complete examination of a patient’s pupillary reflexes. I had to remember to test both the light and accommodation reflexes. Simple enough, right? Well, I think I did okay. Then the examiners started asking me all kinds of secondary questions like what is an Argyll Robertson pupil, and what pathology would you see in someone who has multiple sclerosis. Luckily, I knew all the answers, and I think I passed that exam.

The second room was the cardiac simulator patient. By this point I should have been getting less nervous, but for some reason I was getting even more nervous! We only have six minutes to complete the exam, and I spent almost a minute trying to find the mannequin’s radial pulse, only for the examiners to finally tell me that his radial pulse wasn’t working! I then proceeded to auscultate the heart. Under any other circumstances, I could have identified the problem as a systolic murmur, but I was so nervous that I blurted out “diastolic murmur!” I realized right away that I was wrong because they started asking me what the problem could be if it was a systolic murmur. Luckily I was able to come up with some causes. Then it was on to the next room!

I entered the room and was asked to perform a pelvic exam on a patient complaining of right lower quadrant pain. I’ve practiced doing a pelvic exam many times, but I suddenly panicked anyway! I explained the procedure, and positioned the patient in the lithotomy position. Then, I switched to the model to do the actual exam. Usually, we don’t use lubrication on the models, but the examiner asked me to anyway. After inspection, I inserted my fingers to begin the exam. Well, since I was the very last person that day to perform the exam, there was already tons of lubrication inside. I could barely feel what anything was! In addition to that, the model was somehow distorted (I still don’t know what it was), and I thought for a moment that there was a foreign body inside! I proceeded to do my best to describe what felt like an octopus (no, I definitely did not say what I thought it was) and finished the exam.

The very last room was a gentleman with the complaint of angina. Although I forgot a few things along the way, I think the exam went pretty well. However, the man had significant bradycardia, and it was somewhat difficult to describe the sounds. But I think I got the secondary questions correct, so I hope that made up for my small mistakes.

After I walked out of that room, I felt like a huge weight had been lifted off my shoulders! My heart rate began to slow down, and I could finally take a huge breath in and out. I still have seven more exams to go in the next three weeks, but luckily they are all multiple choice written exams, which are much easier for me to handle.

Over the next few hours, I went over everything I did and said during the exams in my head. I realized what I forgot to do, and I knew the answers to questions that I hadn’t been able to answer at the time. Why couldn’t I remember all that stuff during the actual exam?! It was probably because I was so horrified during the entire experience. I don’t get pre-exam anxiety when it comes to written exams, but for some reason, I turn into a bumbling idiot before oral clinical practical exams. Do any of you out there seem to have a similar problem? Maybe you’ve figured out a way to calm your nerves before an oral exam? I’d love to hear any suggestions you may have!

Click Here To View the Original Post on Medscape

What do they all have in common? Nothing, other than the fact that they’ve been my life for the past 24 hours. Do let me explain.

I made it through my clinical skills exam yesterday. I’ll be writing a whole article about the experience for Medscape, but let’s just say that it was interesting. I was nervous as all hell. I ended up getting “examine the pupillary reflexes” and “do a pelvic exam” as tasks. I then had to do a cardiac exam and diagnose mitral regurg on a mannequin with a heart beat, and perform an entire exam for someone presenting with angina.

After the exam, I celebrated with my friends. Neha, Manny and I all decided to dye our hair. I have almost two months until I have to be “professional” again (aka, in the hospital), so I decided to celebrate by changing my hair color. It’s a funtastic shade of bright pink right now!

When we returned home last night, I suddenly heard the sounds of a goat crying in distress. Micah and I were horrified to discover several dogs attacking two goats across the street from us. One of the goats was barely hanging on, and we realized that his wounds were fatal (deep neck puncture wound). The other goat was severely shaken up, but her wounds were less severe. I ended up carrying her in a towel to the fenced in yard of a neighbor, to keep the dogs away. Today, I cleaned her wounds and got her to drink some water and eat some grass. I think she’s going to be okay, but I am so scared to return her to her home. Unfortunately, her owners don’t have a fence, so they keep her tied to a tree. This means she’s basically bait for the neighborhood dogs. I don’t know what to do. I want to kidnap her and import her back to the States to live on my parents’ goat farm, but Micah doesn’t seem to agree with this idea (nor did he like the “let’s adopt her and house train her” idea).

If that wasn’t enough excitement for the day, a few minutes ago the house started shaking. A cup fell off the table, and I thought the world was coming to an end for a moment. Our dutch neighbor ran out into the street in his underwear, waving a kitchen knife around and mumbling something in Dutch. It turns out that I just experienced the biggest earthquake of my life. It was rated a 7.3 on the Richter scale. It was pretty freakin cool. I hope no one on the island was injured.

Anyway, today is “study for the path lab tomorrow” day, so I have to get back to mitotic figures and glomerulonephritis. But first, I’m going to go check on the goaty. I think I will name her Jasmine.

MGK commented on my last blog entry and asked me how I plan to tackle my upcoming exams. Of course, being the huge geek and OCD having person that I am, I have an extensive plan. Here’s the abbreviated version, to avoid boring you all to tears (actually, it probably will anyway).

Tuesday, November 27
Study pathology from Mini 3 / practice ICM techniques

Wednesday, November 28
Introduction to Clinical Medicine Practical Exam

Thursday, November 29
Study pathology from Mini 1 and 2

Friday, November 30
Pathology Lab Final Exam

Saturday, December 1
Review high yield path / do USMLE practice questions for path

Sunday, December 2
Study Pharmacology from mini 3

Monday, December 3
Pathology Shelf Exam
Review Pharm Mini 2 and 3

Tuesday, December 4
Review high yield pharm / do USMLE practice questions for pharm

Wednesday, December 5
Pharmacology Shelf Exam
Review Micro Minis 1-3

Thursday, December 6
Review high yield micro / do USMLE practice questions for micro

Friday, December 7
Microbiology Shelf Exam

Saturday, December 8
Review ICM Minis 1-3

Sunday, December 9
Review high yield ICM / do USMLE practice questions for ICM

Monday, December 10
ICM Shelf Exam

Tuesday, December 11 – Thursday, December 13
Review all Mini 3 material / do USMLE practice questions for all

Friday, December 14
Mini 3 Exam

Saturday, December 15 – Wednesday, December 19
Study ALL subjects (yes, ALL, including from previous classes) / do USMLE practice questions

Thursday, December 20
Comprehensive Basic Science Exam

Friday, December 21
Recover from hangover / get on a plane to Washington DC

I’ve actually been reviewing / doing questions for the USMLE Step 1 for months now, so I feel like I’m in pretty good shape. But I still have a lot that I’m fuzzy on.

Bet you wished you hadn’t asked, eh?

It’s official. I have received all of the basic sciences formal instruction for my medical education! I have no more lectures in basic sciences. For the next three weeks, I will be studying and reviewing all the material that I have learned over the past 15 months. I have 8 exams to take, including a huge exam that will cover all of the basic sciences and allow me to sit for the USLME Step 1. It’s been a long road. I still have so much to review. I definitely don’t know everything, but I sure do know a helluvalot more than I did 15 months ago. Body, grant me the strength to make it through the upcoming marathon exams.

On an unrelated note, Micah managed to surprise me and acquire mussels for dinner tonight. Mussels are one of my very most favorite foods. They don’t exist in Dominica (that I know of). He managed to smuggle them into the country and cook them for dinner tonight. MMMMMM, mussels! They shall give me the strength to divide and conquer! Carpe diem!

Today, all across the US, shoppers are descending on malls and shopping centers. People will be spending large sums of money that they oftentimes don’t have, to buy things for people on their”lists.” Families will incur untold credit card debt. People will no doubt become angry, frustrated, and hostile as they continue on their safari to find”good deals” and “the perfect present.” This shopping day after Thanksgiving has been given the ominous name, “Black Friday.”

Interestingly, the American concept of buying gifts for people this time of the year began around the concept of Christmas. The Christmas holiday was used as an impetus to “share and give” with loved ones. However, the current holiday season has somehow morphed into something much larger. I know Muslims, Atheists, and Jews living in the US who all celebrate this time of the year by purchasing presents for their loved ones. It’s no longer a religious holiday, but rather is a celebration of consumerism, wrapped in a lovely “spirit of giving” package.

Now, please don’t get me wrong. I am very fond of the concept of giving. However, as you may have guessed by now, I’m not as much into the concept of frivolous purchasing of things, simply because that’s what everyone does. With all the advertisements on television, the Internet, and just about anywhere you can imagine, it’s difficult to avoid the message that we should all be out frantically searching for gifts right now. Americans seem to have lost the original meaning behind giving, and have given in to the retail industry’s pressure to buy without restraint. Of course, I’m not the first person to make this observation, but it seems to be getting worse each year.

I spent the last holiday season here in Dominica, and I managed to avoid all that craziness. There aren’t as many signs of the impending holidays here as you’d see in the States. There are no decorations on the light posts, no Christmas music blaring through all the hallways, no special Starbucks cups to celebrate the season. In addition to the lack of visual or auditory clues, because our med school does not honor any of the American holidays, I don’t get any days off. My days continue to be filled with endless hours of studying, and I’m completely oblivious to any holidays. Because I’m originally from a much colder climate, even the weather serves to blind me from the truth. It’s in the 40′s (F) in Washington, DC (my hometown), and it’s in the 80′s here in Dominica.

However, this year will be different. I will be returning to the States to visit at the end of December. I’ll be suddenly launched from the world of med school exams and palm trees into the world of family, Christmas music, and malls filled with frazzled shoppers. It will definitely be a difficult adjustment.

Reflecting on all the madness that is going on in the States today on this Black Friday makes me all that much more appreciative of what I have. I’ve been forced to live quite minimally here in Dominica. Even if I wanted to go on a shopping trip today, my choices would be quite limited. There simply isn’t much to buy. In addition to that, there are so many incredibly poor Dominicans around me, that it just doesn’t seem appropriate. I know that when I leave my apartment, some local residents will go through my trash to find things that I have thrown away, but are useful to them. What I consider to be living minimally, the average Dominican would consider to be living like a queen. Trying to understand the lives of people so much less fortunate than I, has given me the best gift that I could ask for. I am able to appreciate what it really means to be fortunate. I’m honestly very glad that I’m not in the States today to witness the hysteria of shopping and spending. I’m quite happy to spend the day studying for my upcoming exams and being thankful for all the things I have.

Click Here To View the Original Post on Medscape

I always have lots of ideas of ways to give back to the community. Unfortunately, due to my busy schedule, I often feel like I don’t have enough time to really make a difference. Today, I got to live out a dream. I had the idea to provide a meal and party to the residents of the Grange, an elderly home in Portsmouth. After a lot of planning, we had the event today. I’m so grateful to everyone who volunteered to make food and/or serve. You all made it possible! Everyone had so much fun. Micah, thank you so much for your help! We made little turkey decorations for each of the residents. I found lots of old calypso music, which the residents absolutely loved. The food was amazing. I had many students come up to me and thank me for having the event. That, combined with the thanks from the residents and staff, and all the smiles, is what really made it all worthwhile. I can’t think of a better way to celebrate Thanksgiving when so far away from family. Today was one of those days that makes happiness tangible.

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This is my second Thanksgiving in Dominica. Once again, it feels nothing like Thanksgiving. It’s in the 80′s here. I don’t get the day off. My family is no where to be seen. I will probably not be eating turkey (or tofurkey).

But I still do have so much to be thankful for. I am in good health. I have a loving family that I will be seeing soon. I have a loving partner, Micah. I’m living my dream of going to medical school. There is a beach less than five minutes away.

Anyway, happy Thanksgiving everyone!

Note: The pic was taken several years ago around this time of the year. It’s the street outside my house in Arlington, Virginia. It seems so many miles away!

I’m in a strange mood right now. I had one of those days that starts out really fabulous, then gets better, and then suddenly gets worse. I had my second visit to the hospital of this semester. It was awesome. I went to a geriatric clinic (I have a million things to write about that) and then we got to see two really neat clinical cases. One was a healthy 27-year old male who had a severe ventricular septal defect. He had a thrill that you could literally feel by just hovering your hand over his chest. Yet, he somehow had absolutely no symptoms. The second case was a man with an upper motor neuron lesion. I never truly understood what “hyperreflexivity” or “lead pipe rigidity” meant until today. It was amazing. And he still managed to drive his car!

Then, when I came home, things started going down hill. I realized how behind I am with my studying, and found out that all the clinical rooms are booked until my exam. How am I supposed to study? Anyway, I don’t want to go off into a rant.

The point? I had an amazing day today, and learned a lot, but I’m so busy and frustrated that I might explode. More to come….