Affectionally known as "Puffy" the rental car...

Note: I started this blog post on June 17th, but hadn't had enough time to complete it until today--it's a long [post!



We rented a car while we are in Florida and it is a Dodge Caliver. I've never been a huge Dodge fan and honestly I'm a loyal Subaru driver through and through, but I can't justify the cost of shipping Zoey the super Subaru to Miami for just 4-6 months. The Dodge is doing okay; however, we have nicked named the car "puffy" it sounds like it has COPD (chronic obstructive pulmonary disease) when we are driving. I hadn't driven since before I left for Dominica in January of 2008, so driving Puffy in crazy Miami traffic has been a bit nerve wracking, but I'm back into the swing of things despite some of the worst and most rude drivers in the nation. The Miami area just lost their reining title of the most rude drivers in the nation, which they held for the last four years, to NYC so I think the Miami residents are trying to increase their rudeness to regain their title in 2010.


The most interesting thing about Puffy is that it has a crazy base in the sound system. Obviously it is the factory radio, but even at low volume, it shakes the rear-view mirror! The problem with turning off the radio is that then we have to listen to Puffy try to push itself forward.


We are doing our clinical rotation at a federally funded network of health clinics. Last Sunday (14th) after class we drove out to the main clinic to see where we would have to be for orientation. While zooming down the express way, I noticed the SUV in front of me driving rather strangely. Then I saw the driver of this SUV yelling at the van (towing a boat) int he center lane. All of the sudden the brakes lights emerged and the driver of the SUV swerved toward the van. The SUV driver then reached across to the van, while still maintaining a speed of over 60 miles per hour, and handed the passenger of the van...a 12 pack of either toilet paper or paper towels. Only in Miami.



So Monday, the 13th, we left for the orientation far too early and had about an hour to study for our upcoming exam. I knew that we were doing the reverse commute, but in light our our first clinical experience neither Farley nor I wanted to risk being late. We left over an hour and a half early for a twenty minute drive and it only took twenty minutes. We had a lovely orientation that only took until about 11:30 (I was bracing myself for an all day event) and an old-school physician gave us some sound advice about medicine before handing all of us his card and saying we could call anytime with a question about anything. He said he'd be glad to advise us if we ever needed it or even just to listen if we are overwhelmed with the job and responsibilities. There are not many people who would offer up their time to a group of strangers--we met a very special man that day.

After the orientation was finished, we headed further south to Homestead to find the clinic. We had our handy directions and we followed them to a tee. There was just one problem: we ended up in a residential area that opened up into the middle of a field and the road ending. So we drove around thinking that and we just passed the clinic, then looked with the GPS on my cell phone, which gave us the same directions. Finally, we called the clinic which was closed on Monday so we ended up talking to someone at the place our orientation (main clinic for the group of community clinics). We were told we had to pass 123rd street. Well, we were at the wrong end of town so we drove until we were at the other end of the road (yes, we went from one dead end to another) and we finally found the clinic. I think Southern Florida was designed by a crazy five year old sometimes; for example, the clinic was located on 312 SW Street also known as NE 8th Street or Campbell Street. To make matters worse, the address that we were given from school was missing a zero, which was how we ended up at the other end of town. After we finally found the clinic, we grabbed a late lunch in Homestead then drove home.

Tuesday, we left bight and early to get to the clinic in Homestead. It took about 40 minutes or so to get home on Monday, so we decided to leave an hour and a half early Tuesday to make sure we were on time. Despite taking the reverse commute (from Miami down south to Homestead), we felt it was necessary to leave extra early because you never know in this town what is going to happen with this town's traffic. We took W. Snapper Creek Road (Farley and I like to call it Whipper Snapper Creek road, but I think it is probably West Snapper Creek Road) and merged onto the turnpike. We went about a mile before we saw the cars starting to back up on the turnpike. I thought that we might be coming up to one of the poll booths, but we couldn't see one. Rather, they were making all traffic move off the turnpike, which was resulting in the backup. This was all occurring near a construction site, so I was extremely frustrated that they didn't have signs up on Monday because we would have planned an alternative route had we known they were scheduled to shut down the turnpike. However, this was not a planned closure of the turn pike.

We followed traffic off the turnpike then followed the closest, main road that was near the turn pike. It was moving as fast a molasses. I'm not 100% sure where we got off, I think we were in Kendall, which anyone familiar with Miami could tell you is the next "town" away from South Miami (thus we didn't make it very far). We tried to get back on the turn pike twice, but all of the entrances were blocked by police officer and cars. Thankfully, we had my cell phone with GPS. The phone figured out where we were and Farley used the map to guide us to Homestead. For those of you not familiar with Florida, Homestead is about halfway from Miami to the Florida Keys so we had a long ways to go since in Kendall we were still in the greater Miami area. As we were zigzagging though Florida trying to call the school or the physician's office, we saw beautiful farmlands and a whole different side of Florida. It was so green and I think the drive would have been much more enjoyable if it hadn't taken about two and a half hours to make a forty minute drive. We finally arrived at the clinic. I was extremely nervous because it was our first day with this physician and we were over forty minutes late! Thankfully, she had heard that the turnpike was closed while getting ready for work and expected us to be late since we were coming from Miami. Apparently, a 23 year old police officer died in a dump truck accident on the turnpike in the early morning hours. It wasn't clear exactly what happened so they closed an extra large stretch of the turnpike to do a thorough investigation of the fatal accident.

After Doctor told us her expectations (go interview the patient, do a physical, and report back to me), we were sent into see our first patient. Thank goodness Farley speaks some Spanish because my two weeks of medical Spanish wouldn't have cut it in this clinic. If he hadn't spoke Spanish, we would have just shadowed Doctor for the two weeks (except when there were English speaking patients). In fact, we were really luckily that Doctor let us do so much. Many of our colleges have just been observing the physicians, which is still a learning opportunity, but being able to participate is even better. In the afternoon, we even figured out that a patient we were interviewing was bulimic, which was an interesting find during our first day in the trenches. We had a nice lunch break then left for home after 6:00pm. Because of our schedule, we didn't make it to the board review course that night, but I would have been to tired anyway.

Wednesday the 17th, we had a full day of lectures in downtown Miami. I've never been so happy to ride the train! We had some great lectures and my least favorite professor also spoke that day. In case anyone has forgotten, I really don't like neuroscience. I think taking neuroscience was worse than taking Latin in high school. Neuroscience is like a language that I'm not quite fluent in. It is just an area that has never been a big interest to me. Now don't get me wrong, there are some really cool things in neuroscience and I have enjoyed some of the lectures. However, when I think about all of the spinal tracts and where they cross or trying to figure out where a brain lesion is based on symptoms, it makes me feel like I'm also going to have an aneurysm. Anyway, we had a professor come down from Yale to lecture on neuroradiology. Given my distaste for neuroscience, I wasn't exactly excited for this lecture: I was wrong. He was wonderful! I know he is a radiologist that specializes in neuroimagning, but I wish he could just teach all of neuroscience. He was so much fun and he made the 2D images jump out as if they were in 3D. It was great! We also had a lecture on endocrinology, which was wonderful as usual (the professor is really easy to learn from). After our full day in Downtown Miami, we headed back to South Miami, grabbed a bite to eat, then headed to Medical Spanish.

Thursday the 18th, we were back in Homestead with Doctor. Thankfully, no one died on the turnpike and we arrived early. We had an interesting day and there was an extremely interesting patient that I interviewed. She had a wide array of symptoms and I think that there is really something wrong with her, but I can't put my finger on exactly what. I'm sure I took way too long interviewing her because I was trying to put her sequel of symptoms together, but alas, I'm just a medical student and she was being referred to a specialist to get to the bottom of her problems. I think she might have had a problem with her pituitary, but it wasn't a clean cut case so I'm not 100% convinced that her pituitary is the answer to her problems. Thursday, I remembered to take my Medical Spanish book, so I was able to help Farley interview patients in Spanish--he interviewed and I looked up words as needed. We actually got out of clinic early and headed home to study for our exam on June 26th.

On Friday the 19th, Doctor was on vacation so we were working with two nurse practitioners. They looked very young to me and I think they must have been right out of school. We did the same sorts of things with the nurse practitioners: we interviewed, performed physical exams, and reported our findings to the nurse practitioners. The reason I'm pretty sure they were fairly fresh out of school is because they were carrying along books with them (like us) and they took as long if not longer with patients than we did. As a general rule with medical students (and I assume all medical professional) we take a long time to do things because we want to make sure we remember to do everything, to ask every question and to not miss anything. It wasn't as exciting of a day, but we only got to stay until noon because we had class in the afternoon and then our Friday evening board review course.

We returned down to Homestead on Saturday for another day of clinical fun. Doctor was again off, but that day we were reporting to a Physician's Assistant (PA). This PA was great and we learned so much from her. She spoke less Spanish than Farley but more Spanish than me, so I think we were a help to her because it was easier for Farley to speak to some of the patient than it was for her. She actually let us see a couple patients, asked us questions, made us return to the patient to ask some follow up questions, then sent them on their way without seeing them herself. Granted, it was only one or two patients that had follow up appointments with Doctor in the next week or two, but it was still exciting to be impressing the PA enough that she was comfortable sending the patients on their way. If she thought we were idiots, she would have seen the patients herself. We got to help decide on therapy to give to a patient with hypertension (we chose a calcium channel blocker) and we discovered that a little girl with a cold actually had a bacterial infection rather than a viral infection so she needed antibiotics. The PA gave us lots of great tips on counseling patients and talking to them about their health. We really learned a lot from her. After finishing up at noon, we headed back home to study for the exam.

On Sunday the 21st, we had a full 8 hours of board review. One of our professors from the island returned to teach--it was so nice to see him again. There is a physician on staff as faculty in Miami that is the same speciality as the professor from Dominica. The difference between these professors is amazing. It is obvious that the professor from Dominica really cares about his patients and the struggles of the families trying to care for an ill family member. The professor from Miami tends to mock his patients to get a laugh out of students while he is teaching, which really upsets me. It was great to have our Dominica professor back who really tries to show compassion and empathy to his patients.

Monday the 22nd, we didn't have to go to clinic but we did have to attend a small group lecture with the same professor from Dominica. We also had Medical Spanish and had to study for the upcoming exam on Friday.

Tuesday, we were back in Homestead. By this point, I think we were finally starting to be helpful to Doctor. In just one week we were starting to get faster at our interviews, ask better questions, quicker physical exams, and I think Farley was starting to get more comfortable with interviewing patients in Spanish. It was starting to get fun. We better knew what to look for and we knew what question Doctor wanted us to ask. For example, if a patient is over age 50, has he/she had a colonoscopy? If the patient is female, ask about her periods and if she is over 40 has she had a mammogram. Those are just little obvious things, but when you have a million things popping into your head and you are trying to make sense of everything, it is easy to forget the obvious. Because of our exam on Friday, we didn't have to go to board review class on Tuesday night!!

Wednesday as usual we had our lectures in Downtown Miami. I was feeling pretty down about the semester by Wednesday and really wasn't in the mood to sit for eight hours in a lecture hall. This semester is extremely disorganized and it is very frustrating. I really anticipated it to be the best semester we've had since we get to see patients, but in all honesty, seeing patients in the only good this this semester has had to offer. The rest has been in such a disarray that even the good lectures that we've had, and we have had some, get lost in the unnecessary mess of the semester. I just want to do my time, pass my exams, and get out of this semester. I'm not the first to complain about this semester, apparently most students are very frustrated with the organization and set up of this semester and many students say this was their least favorite semester. I didn't know that until this week--all this time, I thought it was just me. Anyway, we had a lecture on Hematology Wednesday that couldn't have come at a better time for me. I decided to go to medical school with the intention of become a hematologist and oncologist. The Hematologist that spoke to us was so engaging and I just loved the lecture on bleeding disorders. When I worked in pediatric hematology and oncology clinical research, I didn't really like the hematology aspect, but I didn't know as much about it as I did about the oncology part. The more I learn about hematology, the more I like it. I don't know if I like it more than oncology, but I think hematology is enthralling. The rest of the lectures were so-so, nothing too exciting but noting too boring either. After class, we had Medical Spanish.

Thursday, we headed back down to Homestead for another day with Doctor. We had a rather uneventful morning. The last patient we saw before lunch was rather interesting. Farley and I spent our drive to the bank and than to lunch debating whether the patient had a drinking problem (I think the patient did). Farley needed to stop by Bank of America and since we had a longer than normal lunch, we decided to go during lunch. When we arrived, I was going to stay in the car, reading notes until he was finished. Farley insisted that I come inside with him in case the banking took a while and he "had a feeling" that I should just come inside with him. While he was working with the banker, I noticed a young woman come into the bank with a small child (1.5-2 years old). The little boy was a cutie and caught my eye, than I returned to my readings. About two minutes later, I heard "do you feel like you are going to faint?!??" and saw the customer next to you the young lady put the child on the floor and help the young lady to the nearest chair. A worker picked up the child and brought him to his mom, then started asking her questions. At that point, I decided to head over. Farley likes to say I "swooped in", but in reality, I just walked over and said, "I'm a third year medical student. Can I help?" At this point, everyone said yes and moved out of the way. She was breathing, but her breaths were in the normal range, she was maintaining a normal level of consciousness, but her hands were contracting and she was loosing feeling in her arms and legs. I couldn't really feel her pulse well because her hands were in such a tight contracture. One banker called her mom and another called 911. Right before all of this happened, Farley had been taken to the back to get his picture taken for a new debit card and when I saw him return I waved him over. At first I thought that she might be getting ready to have a grand mal seizure, so I was trying to get as much information out of her as possible in case she lost consciousness. By the time Farley came over, her hand wasn't contracting as tightly and he was able to get a pulse, which was on the upper limits of normal but not tachycardic. She had extreme abdominal pain and I thought she might have an appendix about to burst, but come to find out she was about 6 weeks pregnant. Obviously, my next thought was an ectopic pregnancy, but she didn't have the risk factors and when we got a better description of the pain it didn't really match ectopic pregnancy pain. Farley asked if this had happened before and it had when she was pregnant the first time. We talked to her for so long, I probably could have written her up for one of my patient notes! I have no idea why the ambulance took so long especially in this medium sized town. The hospital was only 3-5 minutes away and I'm not sure where the ambulance company is located, but it took them WAY too long to get there. I'm not sure if they were slower because her vital signs were stable, but I wasn't impressed with their speed at all. In fact, Farley and I pretty much figured out what was probably wrong with her (in the back of my mind I already had a list of tests I would order if I was the MD in the ED that day). Farley and I tried to report what happened to one of the three paramedics, but in all honesty without disrespect, I don't think he knew what we were talking about. We have a lot of clinical knowledge, we don't have anywhere near the experience of these paramedics, but we know a lot and we have detailed medical vocabularies. Some of our everyday medical words, would not be known (or even necessary) or a parametic. The parametic's job is to stabilize the patient and transport the patient to the hospital: not analyze why the patient is ill. Don't get me wrong, they do some analysis of patients: "Was antifreeze next to a patient who passed out?", or "Is this patient taking "the little blue pill" and in the middle of a heart attack?". But the primary job is not to analyze, it is to stabilize the patient and get the patient to the hospital as soon as possible. I think that our patient in the bank was having complications from her morning sickness, not eating or sleeping much in a week, anemia and fear--her boyfriend of three years just dumped her, she is now pregnant with his second son and she talked about being scared to support two children on her own. I'm pretty sure there was nothing serious wrong with her medically and that she will be okay, but young woman was understandable overwhelmed. I don't even remember her name, but she has been in my thoughts and prayers.

After all of that excitement, we headed for a quick lunch then back to the clinic. Farley has been teasing me about being so excited, but I got to perform my first pap smear on Thursday. It was very exciting! I've always been most interesting in (1) hematology/oncology; (2) pediatrics and (3) Ob/Gyn so to have the opporunity to perform a pap smear in my second week of clinicals was exciting. I've got to admit, I was very scared because I didn't want to hurt the patient. Putting in the speculum wasn't as easy as I thought it would be and after scraping all over the cervix and into the external oz, which is the canal from the vagina to the uterus, I could understand exactly why pap smears are so darn uncomfortable. While I was learning about women's health, Farley was having his own great learning experience in Cardiology. He was interviewing a patient who had had several heart attacks and had even had quadrupal bypass surgery. Farley got to listen to abnormal heart sounds on a real patient rather than just on a simulator machine. He asked if ordering an EKG would be appropriate since this patient was new to Doctor, and she agreeded. It was the most crazy EKG, I've ever seen and it was good practice to analyze it. Obviously, Farley's patient is headed back to the Cardiologist.

On Friday, we had our dreaded exam. I didn't feel like I had enough time to study for it because we've been running all over the greater Dade county. There were 70 multiple choice questions and two essay question (we were told there would be one, so I was suprised there were two). I think the 70 multiple choice questions went okay and the second essay was fine, but I'm not so sure about the first one. The essay were cases that were given over several pages with about 10 or so short answer questions for each case. The first essay was okay until the last three questions. Every possible diagnosis I could think of had been proven incorrect by labs and physical exam in the case. Anyway, I'm sure it went fine, especially since I haven't talked to anyone who was very certain about the first essay quesiton.

After the exam, we headed to school to look at previously well graded SOAP notes (a soap note is a short medical note). Somehow, two hours after the exam had finished, the clerical staff had not returned and according to the secretary they usually don't return at all after the exams. This really irratted me as they didn't have to take an exam and they are notoriously difficult to get in contact with when we have questions. It is just another reason why this semester is so frustrating. They could have at least left the SOAP notes with the secretary so we could have done some work. Since that turned out to be a bust, I decided to take a well needed nap before heading to the gym. After the gym, Farley and I went to the grocery store and then had a late dinner while watching the Bachelorette online. Boy, do we have opinions about who she is picking!

Saturday, we headed back to Homestead for the last day of our rotation with Doctor. I had a lot more fun with Family Practice Medicine than I expected. We had such a great rotation with Doctor and learned so much from her. We needed to find a patient to write another paper on and Farley was able to do a great interview on a pediatric patient--in Spanish-- and I had enough time to do a throughal physical so we can start writing the paper. I even got to do a second pap smear and this time I got to do the pelvic exam too. The pelvic exam was difficult because the patient was overweight. Part of the exam is moving the cervix around with your fingers in the vagina so your hand that is on top of the pelvis (between your hips on your low abdomen) can push down and the doctor can feel the size of the uterus, feel for any lumps and try to capture the ovaries or see if any pain is illucited with trying to capture the ovaries. I really couldn't fell anything other than her cervix becuase she was pretty overweight and I didn't want to push to hard and cause her pain. I'm still greatful for the experience though.

After we finished our last day with Doctor, we ran into Target on our way home. We moised around a bit and window shopped. One of my favorite things do to is to take relaxing bubble baths and read a novel (or even notes). Adult bubble bath can be rather expensive, so I had this brillant idea just to buy the baby bubble bath! I think the Johnson and Johnson Bedtime Bath (for babies) works even better than the expensive adult bubble bath and it smells so good! I liked it so much that I decided to buy the matching baby loation and oil. I can't believe how soft my skin is and it wasn't that expensive.

Farley and I have been wanting to try the boxed wine at Target for a long time. We were curious about the taste and since it was one sale, we bought the smallest container--with four juice box sized wines. After heading to the gym, we had dinner than walked over to Sunset Place to watch a movie: The Proposal. The critics didn't like it much, but Farley and thought it was really funny; perhaps it was the glass of boxed wine we each had during the movie? I don't know. After the movie was out, we walked around the mall and headed into the bookstore for some window shopping. It is so much fun to live so close to Sunset place because we can just stroll over and we don't have to worry about parking and we can both enjoy a glass of wine because we don't have to drive!

We headed in fairly early on Saturday night because we had class on Sunday morning at 9:00am. We covered renal and skin pathology in our board review course. Luckily, we only had class for about four hours. I wanted to head to Bath and Body Works to get a candle since there was a sale going on so we drove down to Dadeland Mall. We have been wanting to go to the pool and read novels but it always rains the days that we actually have enough time to go read for a while. Thus, we window shopped at the mall before heading back to the apartment. This was our 15th day in a row of classes and I needed a nap. I slept for about 2 or 3 hours before awaking to realize that it was already 6:15 and I hadn't started my beef stew yet! We decided to go ahead and make the stew so we ate a late, but really wonderful dinner.

Today was the first day in a long time that we didn't have to be up and going by 6:30 or 7:00, nonetheless, I was up by 7:00. We were suppose to have two things to do at school today, but one of them is moved to tomorrow so we only have our Medical Spanish today. I guess you could say we kinda have today off, but I really don't consider it a day off since we have to get dressed up and head to class, even if it is just Medical Spanish. It is an obligation and we are required to attend. We also have class tomorrow and Wednesday (as well as night classes), but then we have four days off in a row. Completely off!! Now, I know we will still end up studying, but we don't actually have to be anywhere for school. Farley and I haven't had more than one day off in a row since starting the semester so I'm super excited to have a little down time, even though we still have studying to do.

I think that is enough for one post. I'll be impressed if anyone reads this whole thing...it's really long!