Island Med Student

Everything is so surreal right now. I’m riding in the passenger seat of a rented SUV on a major interstate highway, headed to a major international airport in Baltimore, Maryland. Do you ever have one of those moments in life where you pause and think, “How did I get here?” Well, I’m having one of those moments. There are hundreds of cars all around me. The highway has five lanes, and even has painted markings. At any moment I could stop and buy just about anything I could imagine. I could eat almost any type of food that exists. There is a McDonalds and Starbucks on almost every corner. I am in America.

For those of you who have lived for years in a less developed country, and then moved to a country of excess like the States, you can imagine what I’m going through right now. Culture shock is an understatement. I’m having a grand mal culture seizure right now. I’ve spent almost the entire past week traveling by bus, plane, and car to my home in the States. I somehow managed to get all my worldly possessions and my two dogs home safely. It wasn’t an easy undertaking. During my road trip, I stopped at a Target (a huge discount super store) and cried when I walked through the doors. The amount of stuff to buy was overwhelmingly unfathomable.

I completed one “transition” semester of short rotations in Dominica. I’m officially living in the States for at least the next few years. I’ll be taking the next month to study for the USMLE Step 1, the medical licensing exam for the US. Two weeks later I’ll be starting my first official clinical rotation in Washington, DC. After that, I’ll hopefully be starting more clinical rotations in Baltimore, Maryland. So, at least I do have a rough draft of a plan.

Honestly, though? I don’t really feel like my plans are all that solid. I still feel so jumbled up from all the moving. I feel homeless (technically, I am right now), carless, and pointless. Being in between homes, cars, and schools is a very dissociative experience.

As for my education, I’ve completed all of my basic science schooling. I’ve had an initial introduction to the clinical world, but I really haven’t yet begun that journey. So, once again I’m sort of in limbo with that too.

I feel like I’m teetering on the brink of something huge. Behind me, I see all the work that I’ve done to get here. I see Dominica, and a monumental pile of information that I’ve learned to get to this point. In front of me is the United States of America, and all of the clinical experiences I have yet to have. There’s a part of me that wants to take the easy way out and go running and screaming back to Dominica. But the responsible side of me knows that I must press on ahead. Luckily, there is actually a large part of me that is very excited to be starting a new adventure. So, here’s to the end of one journey and the beginning of another!

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Here is the video, as promised. I don’t like the crappy quality of YouTube, so please forgive it. I’ll soon have my own video page and won’t have to use YouTube anymore. In the meantime, please enjoy the video!

After living in Dominica for 2 years, I’ve probably gone on over 300 runs here. I’ve run up and down hills and mountains, past waterfalls and through gorges. But, the run that I’ve done the most is from my apartment to Cabrits National Park and back. It’s about a 6 mile run, and I love every second of it. I run through Glanvillia, then through Portsmouth, and then past the beach all the way to Cabrits. When I get there, I drink some water and turn around and run back. I love the run because I get to see so many beautiful parts of Dominica, and I also get to say hello to a lot of my Dominican friends. Pretty much every run I’m guaranteed to stop and talk to at least one person. However, since I’m always running, I never brought my camera with me to take pics. So, the other day I brought my camera and walked instead. I made a photo album of the pics, and I’ll be making a video soon, using the video footage that I shot. Enjoy! I know I do almost every day!

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Okay, so if I were actually faced with a real life code, I’d probably pee my pants and run screaming in the opposite direction for a doctor. But, hypo-the-tically I can actually run a code as a team leader. Over the past two days, I’ve had my Advanced Cardiac Life Support (ACLS) training. I know everything about identifying various heart rhythm abnormalities like atrial flutter, ventricular fibrillation, and supra-ventricular tachycardia. I know how to use a defibrillator, and when to give shocks and at how many joules. I know which drugs to give like epinephrine, atropine, etc, and I know the dosages and maximum quantities you can give. I also can place advanced various airways like combitubes and endotracheal intubation.

We practiced a million times, and eventually I memorized all the algorithms, and got over my fear to the point where I could manage anything they threw at me, including a dummy that was in asystole for like 10 minutes!

So, I’m now officially certified, and ready to be thrown into the mix at US hospitals. After the training, I took some more pics of Princess Margaret Hospital, and shot some video footage that I’ll be posting soon.

This is it. I’ve done everything I need to do. Only 4 days, 19 hours, 25 minutes, and 16 seconds until I leave Dominica!

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Okay, this is totally pointless. If you have 30 seconds to kill, or if you like sheep, do watch it though. I just made it because I’m totally bored. Shouldn’t I be studying or something?

I have lived here in Dominica for close to two years. In ten short days I will be leaving my home and returning to the States to start my clinical rotations. I know there are a lot of students out there who have lived, worked, or gone to school in so-called Third World countries. For me, it’s been an experience that I will treasure for the rest of my life. For those of you out there who haven’t lived in underdeveloped countries, but are considering doing so for school or as a volunteer, I thought I’d compile a fun list of things that I’ve learned while living here in Dominica. Enjoy.

1. Having a rooster for an alarm clock. No matter where you live in Dominica, you’re likely not far from a rooster. Mine wakes me up religiously at 6:00 every morning, whether or not I ask it to. I guess I’ll have to go back to the electronic variety in the States.

2. Using Chinese food restaurants as convenience stores. In Dominica, almost everything closes on Sundays. If you need food, soda, or other beverages, your only option is to get them from the Chinese food restaurants, because they are the only businesses that are open.

3. Not having an address. They don’t have a mail delivery system in Dominica, and although I think the roads might have names, they don’t have any road signs. My address is “Banana Trail, Portsmouth.” If I’m getting food delivered, I specifically say that my apartment is past the green house on the top of the hill with the dogs that bark loudly, and across from the black and white goat.

4. People carry machetes instead of briefcases. Pretty much everyone here owns a machete, and it’s commonplace to carry it around with you. Instead of the bland briefcases that I’m used to seeing everyone toting around, people walk down the streets with sleek and stylish machetes.

5. Traffic jams because of runaway cows, sheep, goats, or other livestock. I was quite used to traffic jams in the States, but I’d never seen a herd of goats causing traffic mayhem as they run down the street with a torn rope around their neck dragging behind them.

6. Electricity is a luxury. No seriously, it is. The electricity usually goes out at least once a week, and I’ve seen it off for days at a time. You eventually learn tricks to live without electricity like having lots of candles, and making sure you have a gas stove. If you don’t have a huge exam to study for, it can actually be pretty fun. If you do, then you try to avoid the temptation to burn the house down.

7. Being kept up all night because of mosquitoes. The mosquitoes can get so bad here that they literally buzz you out of your mind! Even with netting, mosquito spray and special candles, the little buggers will find their way to your ear at 3:00 in the morning.

8. Eating expired food. Shipping things to Dominica can be tricky for a variety of reasons. It’s not uncommon to see food on the shelves of grocery stores that has been expired for over a year. I guess eventually you just get used to the taste of stale food.

9. Hitchhiking is safe. Actually, it’s not only considered safe, it’s pretty much the only way to get around. If you stick out your thumb, either a transport, a person driving a pickup truck with an empty bed, or just about anyone else will stop quickly and take you where you need to go. Even young children use this method to get to and from school everyday!

10. Taking showers in brown water. The water here is very unpredictable. After it rains, it will turn off for hours and then if you’re lucky, it will come back on. But it’s frequently a lovely shade of beige, and loaded with sand. It might sound unbelievable, but you really do feel cleaner after a muddy shower!

If any of you have lived or currently live in an underdeveloped country, please do add to the list!

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I spent the day at Princess Margaret Hospital taking a Basic Life Support (BLS) course for healthcare providers. I was certified in the past, but my certification had expired so I had to take the class today. Basically, I spent the day doing chest compressions, giving respirations, and using an automated external defibrillator (AED) on a variety of non-alive patients of various colors and sizes.

I’m kicking myself in the butt for not bringing my camera with me. Since I had no camera, I got creative and used my laptop to snap some pics and a short video, but they’re of low quality. Thursday and Friday I have my Advanced Cardiac Life Support (ACLS) class, and then I’m audi TT! Next time I will be bringing my real camera!

Many people have written me asking about whether or not they should do their 5th semester here in Dominica at Princess Margaret Hospital. My personal opinion? YES! I thought it was an absolutely fabulous experience, and I think it’s better than going to Miami. I’m sure some people disagree, but this is my own opinion. Here are a list of positives and negatives with regard to staying:

Positives:

1) I think that the experience at PMH is much more hands on. I think a combination of the laws in Dominica and the doctors who teach at PMH makes the learning more interactive. I saw many patients. I was allowed to perform many procedures like starting lines, putting in catheters, doing digital rectal exams, and intubating. From what I’ve heard from students in Miami, you just don’t get that much hands on experience there.

2) You get to see more stuff. Again, from what I know from Miami students, here at PMH you see more stuff. I saw many operations, procedures, histories taken, etc. The exposure is awesome. Not only is there more exposure, but I think you see a broader range of pathologies. I saw someone with tertiary syphilis. You probably won’t get to see this in the States.

3) There are less students here. Less students seems to mean that the doctors have more time to teach. You’re not competing with hundreds of other students for the doctors’ time.

4) You have more time to study here. Again, this is compared to what I know from Miami students. They seem to have more required classroom time, which means less time to study. I can promise you that I had more than enough time to study for 5th semester classes AND plenty of time to study for the Step.

5) It’s cheaper here and there is less traveling involved. This is self explanatory. Not moving means less money spent. It’s cheaper to live here than in Miami. Moving sucks. Not going to Miami means one less move. (You still might move to Roseau, but this is a lot easier than moving to Miami.)

Negatives:

1) You’re in Dominica. Some people simply don’t like living here. If you can’t stand living here for 12 more weeks, I guess you should go to Miami.

2) They have official Step Review courses available in Miami. I’m not sure how they work, but I know they exist. They have review classes here given by Ross professors, but it’s not the same. If you think you absolutely need the courses, you might want to consider Miami. I personally prefer studying without the courses, but that’s just me.

3) PMH is less equipped than the hospital in Miami. There is no MRI at PMH and the CT scanner breaks sometimes. So, you won’t have as much exposure to some technologies. Some people think this is bad, I actually think it’s good. You have to rely more on your history and physical exam skills here. I think it’s a good opportunity to brush up on your important skills. You have the rest of your medical career to learn how to interpret MRIs.

That’s all I can think of for now. I’ll add more to the list later if anything comes up. Let me know if you have any questions!

Last week I completed my very last clinical rotation for this semester. My group rotated in the psychiatric ward of the hospital. I met a lot of intriguing patients with all-too-familiar stories. Before medical school, I worked for three years at a state psychiatric hospital. In fact, the experience at the psych hospital is what gave me my first thirst for medicine.

Having met so many psychiatric patients in the States, I was very interested in discovering the kinds of patients I’d find here in Dominica. Surprisingly, the patients’ stories, experiences, and struggles with mental illness were strikingly similar to the ones I’d seen in the States. The ward was also set up comparably to the hospital I worked at and psychiatric wards that I’d seen in the States. The treatment team still consisted of almost the same group of people: a psychiatrist, a psychologist, a nurse, a social worker, and a nursing assistant. The pain and frustration that the families were experiencing was also sadly familiar to me. I immediately recognized their wrinkled and fatigued faces and knew that they’d encountered endless challenges and setbacks while trying to help their loved ones.

There was only one thing that I noticed that was prominently distinctive about the psych ward here in Dominica: the patients were not verbally or physically abusive towards the staff. Not only were they not abusive, but they were relatively pleasant. The patients actually listened to the nurses and doctors. They rarely defied them. The chief psychiatrist confirmed my observation. He said that it was exceedingly rare for a patient to attack a staff member and that the majority of patients respected the staff immensely.

I can’t emphasize how shocked I was by this revelation! For three years I came in to work prepared to deal with abuse. I worked on the acute unit and most of the patients were very unstable. I was continually verbally abused, and physically attacked on more than one occasion. We did everything we could to ensure a safe unit, but sometimes the abuse was just inevitable. All of the staff were on constant alert. We knew that at any moment a patient could take their rage out on one of us.

Not only were the patients aggressive at times, but they rarely listened to the advice or encouragements of the staff. Getting a patient to take their medication voluntarily was a daily battle. Convincing them to take a shower or change their clothes was no easy task. There were definitely some cooperative patients, but most patients downright hated the staff.

The contrast between the trustful Dominican psych patients and the distrustful American patients is profound. A common phrase uttered by Dominican patients is “yes, doctor.” The first time I heard it, I didn’t think much of it, but over this semester, I’ve heard it over and over again. It’s almost like a patient mantra. At first I thought they were saying it mockingly, but I’ve since realized that they actually mean it. They really do put all of their trust into their doctors’ guidance.

I’m so fascinated by this that I’d love to research how the differences in patient trust have evolved. I’d really like to know how the cultural aspects come into play. And the big question I have on my mind is how patient trust in their doctor might affect patient outcomes. Are the trusting patients more likely to be compliant with their treatment plans, and hence have better outcomes? Or is a little distrust important in keeping the patient super vigilant? How much do you think patients should trust their doctor?

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It’s true. I’ve lived on this island for 589 days. Now, I only have 16 more to go before I return to the land of excess milk and honey, processed food, pollution, big cars, and bad health. I have very mixed feelings about the whole thing. Anyway, today I have my very last practical exam ever!! It’s going to be the most difficult one to date, but by now, I kind of feel like a pro at them. Thursday is my last written exam of the semester. I can almost taste the sushi!