"I need a hero"

We are starting pulmonary physiology today. I'm not a fan of the music of the 1980s, but as the good doctor walked into class, I could hear Bonnie Tyler's, "I Need A Hero." You mus understand: pulmonary physiology is VERY difficult. It is embedded in physics (things like gas laws)--YUCK!!. If I wanted to do physics, I'd be a physicist. Thank Goodness this isn't the first time I've seen pulmonary physiology, as it can be very confusing to keep everything straight. However, once you get past the yuckiness, it is very clinically relevant (and obviously important--if you don't breathe you can't live). How do you set a respirator? How do you help an asthmatic? Breathing not only exchanges oxygen, but also carbon dioxide and helps regulate the pH balance in the body. The respiratory system is very important.

Our professor told us some interesting facts, for example, if humans didn't have lungs and we had to absorb all of our oxygen via our skin, than we could only be 1mm thick (1 mm = 0.039 inch). All of the branching in our lungs (due to the bronchials and aveoli), is 90 square meters or the same size as a tennis court . Isn't that amazing?

Epilogue--April 3, 2008
I saw Dr. MD/PhD in respiratory physiology SMOKING on April 1st. I thought it was an April Fool's Day joke; but, apparently, it wasn't. I guess everyone has their vices. I'm just surprised that a respiratory physiologist (and I think he is a pulmonologist) is a smoker. Then again, if I'm stressed out, I suspect getting an MD/PhD is enough to drive you nutty. Maybe he needed a good smoke during school and is now addicted--not my place to judge, but geeze its funny.

Medical School is like a bumpy, winding Dominican road...

At one moment, your on top of the world. You think you know everything, you feel so smart and then you realize....you just mastered one lecture and you have three other lectures from today to master before you get to go to bed an do it again tomorrow.

The concepts are not the hardest part of medical school. It is the volume of information. Before starting medical school, I heard that it is like trying to take a drink of water from a fire hydrant, and I think that describes it very well. There is just so much information. It would be nice to have more hours in the day to relax and enjoy learning the information. Sometimes there is so much to do, that learning is a rush, "I've only got six hours before bed and I have to review five hours of class, go to lab and preview the lectures for tomorrow--eek!" The rush to learn isn't fun but the learning and information (for the most part) is interesting and fun.

I've known this for a while, but despite all the things I'm learning: I'm really no help to anyone yet! I just don't know enough--yet. I can tell you about normal cardiac function; however, if you have anything abnormal--you better look elsewhere because I don't know much about fixing problems, yet. I can diagnose people on t.v. medical shows (we are studying embryology and there is always a premature baby being born on t.v.), but I don't really know what a physician would do to help heal the person--yet.

The best way I can describe medical school to you is like a bumpy, winding Dominican road. You don't know what is coming around the next bend (literally there are many, many blind turns on the island roads) and there are ups and down. It isn't easy, which I knew, but I don't want to be anywhere else but in medical school.

A taste of practical medicine

"The student begins with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, as means to an end." -- Sir William Osler, Aequanimitas, 1905

I've been doing a little practical medicine the last few days. Before I get ahead of myself, I didn't perform surgery nor cure anyone of cancer; however, I did learn to suture, join the newly forming oncology club and educate local Dominican women about breast cancer and cervical cancer.

First on Thursday, AMSA (American Medical Student Association--which is part of the American Medical Association) held a suture clinic for it's members (we learned discontinuous stitches). We took over the anatomy lab. There were slabs of flesh--I know it sounds disgusting, but do you really want a medical student to practice sutures on a living person? I think slabs of cadaver flesh are a much better idea. We had a rounded needle (people said it was similar to some type of fishing hook) forceps (tweezers with grips) and a needle holder (actually we used a hemostat, which resembles a set of scissors with a locking clamp replacing the blade, since it is used for dissecting/surgery and most of us have them for anatomy class). One of our professors, who is a surgeon, led the suture clinic and taught us the discontinuous suture technique. She is such a prim and proper lady, who always looks so put together; I, on the other hand, had my hair in a knot on the top of my head and was in scrubs while clumsily, working with my needle.

You have to clamp the needle into the needle holder, which is much harder than it sounds as you must clamp a particular location and it must be at a 90 degree angle to the needle. You must get this just right so that the curvature of the needle will be at the correct angle so that you can poke through the skin, not going too deep, then poke out at the right spot. You need to be about 1 cm from the incision (at least for the type of suture we learned) and you need to have the tension of the stitch just right (or you get edema--fluid build up in the tissue spaces). As if that isn't hard enough, you have to do several other clumsy things: you must release the needle, wrap the free end of the string around the hemostat three time (clockwise), grab the free end of the string with the hemostat while grabbing the needle with the forceps then pull everything (but not too tight). You then have to do this two or six more times and each time you must switch the way you wrap the string: counter clock wise or clockwise. THEN you have to make sure that the knot is on the same side of the cut so that it looks nice (I think there maybe a medical reason why they must be on the same side, but I don't know for sure). Since we learned discontinuous stitches, we had to knot off every stitch. Suturing is such an art--I can't imagine being a surgeon. The professor teaching the clinic came and critiqued our stitches. To my dismay, my stitches were "a little loose, but beautiful technique." She even said that she would let me put a few discontinuous stitches in a patient--what a compliment!! I was awkward and very slow, but I think it was easier than learning to knit. If I had a chicken breast and a few hours, I could massively improve my suturing skills.

On Friday, another exciting thing happened: the inaugural meeting of the Oncology Club. I can barely stand myself. I just love oncology, which probably sounds very strange, but I think it is about the most intellectually interesting thing imaginable. How the body grows out of control and how the body tries to compensate is so interesting. I also think the treatments are incredibly interesting--oncologist try to kill the cancer and also inadvertently kill the health cells. Management of the side effects of chemotherapy in and of itself is complicated without getting into the surgical, radiological, and psycho-social aspects of cancer treatment. Needless to say, I joined the newly formed Oncology Club.

On Saturday, Farley and I participated in an AMSA sponsored Women's Health Fair. The clinic was on the street corner near the market form 7:00 until 12:00. Farley took blood pressure and I educated women about breast exams and HPV/ cervical cancer (HPV = Human Papillomaviruses). The women were very open to learning about monthly breast exams and practicing their techniques on the dummy (who had two lumps). In fact, some of the women decided to do a breast exam in the street so they could go see the doctor, who was at the clinic, if they found anything. Now, given that they would do a breast exam in the street, it might be a shock that NONE of them let me talk to them about cervical cancer. They ran away so fast, I couldn't even tell them to get their yearly pap-smears, After working at the Health District in HIV/AIDS and Reproductive health, very little embarrasses me; however, I can understand how talking about sexually transmitted infections on the street corner (with men all around) could be very uncomfortable. I think they would have been interested in the information in another format.

Here is another picture of beautiful Dominica:

Caribbean Sunsets!

After class, Farley and I decided to go down to our local black sand beach and do some yoga at sunset. It was a beautiful sunset with amazing clouds distorting the colors. The sun really looked like a ball of fire yesterday. I took probably 50 pictures, so I'll share a few with you. As I took the pictures, you can watch the sun set. If you really like my sunset pictures, I can email more to you (but it might make you jealous that you don't live 50 feet from the Caribbean Sea).

The above picture was from right after we finished the yoga. It was so beautiful and there were several sail boats in the bay.

The second picture is from when the sun dived behind the clouds close to the sea. A small portion of the sky line lit on fire. It is strange how just beyond the sun setting area of the ocean, the rest of the rest of the sky looked like the normal sea sky blue (I'll show you in a later picture.)

In this picture, you can see the sun shooting out from behind the clouds and the sky is really on fire. I zoomed into the sun set area, but it really was only red in this one relatively small spot on the horizon. Being on the sea, we can really see sun set. It truly looks like the sun is diving into the sea.

After the sun dove into the sea, the clouds maintained their pink/orange color and the sail boats continued to mosey around the bay.

Finally, I'll show you that most of the sky line wasn't this gorgeous pink. It was a crazy sunset--usually the whole horizon changes colors, but yesterday there was this spot of color and just a little bit of color across the rest of the horizon.

Thank you to everyone who sends me emails and comments on my blog. I'm sorry if I don't have time to write back to you quickly. The time is so different down here--I feel like I'm in a time warp: hours go quickly, days are long but weeks are short and months are even shorter. It is so wonderful to hear from all of you; it makes me feel like I'm not so isolated on this island half way around the world from my friends and family. I hope everything is going well up north. I hear that is is getting warmer--42 degrees (which is probably 20 or 30 degrees cooler than the water of the Caribbean Sea).

It is a good thing we went to the beach last night, apparently a storm is coming in today and there will be 15 foot waves. I'll have to watch from my balcony, but the school warned us not to go into the water as it will be very dangerous (the school even said if you are an experienced surfer DO NOT go into the water). Should be interesting (as long as there isn't a tsunami!!).

Pay Back STINKS!

My least favorite professor (for reasons I won't expand upon) gave a histology lecture on the circulatory system. Now don't get me wrong, there are some things that she does very well: she is a good lecturer, her power point presentations are well put together and for the most part she has a wealth of knowledge. Her training is in cellular biology and I'm sure she is more than qualified to give a lecture on the cells of the circulatory system; however, it obviously is not her area of expertise and it showed. She also tends to ask incredibly detailed questions about things that she does not stress in her lecture (she is also told us NOT to know the details about things and test us on them). Anyway, people asked her a lot of questions--very detailed and well thought out questions. It was obvious that she didn't know this information in as much detail as she knew the previous topics she taught because she was getting very flustered and kept saying things were very complicated, Physiology would address, or even "ask Dr. Yin." I guess she knows how I feel when I try to answer her questions on the exam!! Pay back stinks....especially when you are lecturing in front of 480 students and being video taped. Maybe if she didn't ask nit picky questions about things she didn't stress, students wouldn't be asking nit picky questions during her lectures. The only thing I'm afraid of is that we asked things she didn't think to ask before and that we screwed ourselves for the next exam---she doesn't need any ideas!

We had our Histology practical exam on Thursday and our second big exam yesterday. I think it was okay, but I don't want to jinks myself (remember 47% of our class failed EVERY subject on the last exam). Obviously, I want a 4.0 but (obvioulsy again) medical school is HARD and I just need to pass.

Here is one advantage of studying in the Caribbean. Sitting on your balcony overlooking the ocean, and since there wasn't a cool breeze I brought my fan outside.

"What a lovely day to have a slice of humble pie"

It is almost test time again. Monday we get to battle with genetics, muscle (in both histology and physiology), ECGs, blood, plasma proteins, clotting factors, hemophilia A, B and C, sickle cell anemia, the anatomy of hands and legs, medical ethics, writing a cardiology history and embryology. Honestly, there are other things, but I can't take a long enough study break to write them all down. I think I'll do okay. I think I'm ready, but boy, they could make this bad. Let's hope they just make it challenging; I can handle challenging.

I can't get Lesh Nyhan Syndrome out of my head. For those of you who don't know, Lesh Nyhan is a TERRIBLE disease. It is a congenital defect of purine metabolism with the clinical symptoms of gout and central nervous disorders. Specifically it is characterized by mental retardation, self-mutilation of the fingers and lips by biting, impaired renal function, and abnormal physical development (predominately in young boys). We haven't even talked about metabolism this semester (I believe we do it next semester in more detail than I had last semester) so I'm not sure why Lesh-Nyhan Syndrome is on my mind. For some reason, Lesh Nyhan is in every medical review book and I hear is often on the boards----as a wrong answer choice (probably because it is very rare). Nine times out of ten, if you see Lesh Nyhan Syndrome, it's the wrong answer choice.

When I say my prayers at night, I'm ever so thankful that I don't have any major health problems. Since starting medical school, I'm more shocked every day that we have healthy people. There are so many things that can and do go wrong. It almost seems like a healthy person should be the exception considering how many things must work out.

Speaking of prayers, I've got a big exam--I better get back to the books.

"Coffee is the lifeblood that fuels the dreams of champions." --Coach Ditka

I guess you can say that I am a champion with a dream....okay maybe I'm just tiring to make it through the semester. I'm still enjoying medical school (unlike many of my peers), but boy I'd love a weekend to sleep in and only study for a couple hours a day (without guilt). I don't think that is going to happen until at least the end of the semester. Moreover, for the rest of my life, I'll be habitually studying so it's good I don't hate it. I'm just tired, which I will probably also be for the rest of my life. We haven't covered hormones yet, but I think my stress is increasing hormones that are making me tired. I love to sleep but I've never been one that can take a 20 minute nap; however, a twenty-minute- nap is now my treat if I've done a good job. This is very unusual for me, but I think it is just the stress and trying to keep up the quick pace, while continuing to be mentally sharp. I believe that 70% of your glucose (a form of energy in your food) goes to your brain, but I can't find the reference. Perhaps that explains why I'm eating more and loosing weight!

Blackout!

I've heard a lot about the power outages in Dominica. I came down with 4 flashlights, a lantern, and several candles, even though my apartment is equipped with a generator. When leaving the study area last night (in the parking lot just about a football field away fro my apartment), the island went black. I've never been anywhere so dark; I couldn't even see my hands. Luckily, I picked up my 5th flashlight, which is on my keys and I could easily flip it on.

The generators at school kicked in about 5-15 seconds within the black out and the generator at my apartment kicked in just after the school generators. I was impressed. We'd been told that some apartments have generators, but don't run them (which is why I brought down a lighting store with me).

I think it shocked me a bit more because I was outside when it happened. If I had been inside, I think I would have just assumed that it was a blackout as it probably wasn't as dark in there since laptops would have kept running on their batteries. I wish I could better describe the feeling when the power went out. It was something else!!

I had grand plans for last weekend. I've been so on top of my studies and I planed on a super study weekend---things don't always go as planned. I went to a peer study session,which are sponsored by the school and a student, who is further along in studies that has a 4.0, reviews information/tutors for anyone who wants to go. They are free,you get study/exam tips and fun!). At any rate, I got a sinus headache right before heading to the meeting. There was a campus event so it was very, very loud on campus. My headache grew and grew. I had light sensitivity, vertigo and I was off balance. I'm not sure about the light sensitivity but I believe the vertigo (feeling like you are spinning) and off balance comes from one of your cranial nerves being compressed, which runs through your facial sinuses (we don't dissect the face and learn all the cranial nerves until next semester or I could explain much better). I went right home, took a shower and went to bed.

Saturday, I slept in, still had a headache, but was better. However, Sunday all heck broke loose. I had a bit of a headache, but nothing like Friday night. I went to lab and got REALLY, REALLY hot. I excused myself to sit down for a minute at which time, I started sweating buckets, felt faint and nauseous. Yup, I was sick, sick, sick. I spent the rest of the day in bed. I got up for a study session in the evening and felt much better Monday. However, I've been SO tired all week. It seems that the flu is going around and I'm just glad that I didn't get any more sick than I was. I'm sad I had my study time cut, but it could have been much worse. I'm also lucky that I was ahead of myself because despite my shortcomings this week, I'm still not behind (I'm just not where I want to be). Sometimes I wonder if I can really cut it as a physician: even when I'm well I love to sleep!

Oh, here is another picture of beautiful Dominica. This is inland from the school and sea. You can see the rain forests and the mountains.