Getting a plan

I am scheduled to take a few more board exams soon.  I get so nervous for exams and I hate taking them...I guess I picked the wrong profession because I will be taking exams for the rest of my professional career!  I was finally able to get my electives for the rest of the summer scheduled after my exams.  It was a huge weight was lifted off my shoulders!  One of the difficult things about being a Caribbean medical student (at least at my school) is that we have to schedule all of our electives on our own.  I had a hard time getting my rotations scheduled and I am thrilled to be scheduled until September.  I decided to apply for a few rotations at non-affiliate hospitals for next fall in adult and pediatric hematology and oncology.  I am trying not to get my hopes up for these rotations, as these hospitals are some of the best in the United States, if not the world, and it is difficult for anyone who isn't affiliated to get one of the handful of student spots available for students at non-affiliated schools. But, you never know unless you try and I am trying.  I probably won't find out if I get a spot at one of these hospitals until June, at the earliest, so I am hoping for the best and preparing for the worst.  I have been spending a ton of time working on getting my summer rotations scheduled and filling out applications for rotations the non-affiliate hospitals.  It is such a relief to be able to solely focus on my studies.

It's a bit surreal: next fall/early winter, I'll be finished with medical school.

Interns Give Me Hope

As many of you probably know, the end of June/beginning of July is an exciting time in the medical world: it is residency and fellowship start time.  Statically, this is when you do not want to be in the hospital!!!  There is a statistical difference in the error rates due to all of the newbies in the hospital.

Anyway, as a medical student, the idea of being an intern is exciting and a little intimidating.  I know that I will be ready when the time comes, but sometimes I wonder how anyone is ready to be a doctor.  No matter how many years of training you have, when something is new (your intern year, your fellowship, finally being an attending) it is a little intimidating.  The other day I heard a few interns that gave me hope: they didn't know exactly what to do either!  One had told the patient that they were going to hold his warfarin, the other had written a scrip for the warfarin and a third had told the patient that he would check with "the team" and get back to the patient with the plan.  I think they decided to talk to the resident before making the final decision.

I can do this.  I too can be an intern and work my way things to figure out what needs to happen....this is just another example that physicians in training are really in training and I am not expected to know everything in just a year and a half.

Dancing and Computers

We were suppose to get together with some friends on Saturday night, but one of them called to see if we could move our get together to Friday night.  I slept horribly last week, so I wasn't too thrilled about going out Friday rather than Saturday, but I pulled myself together and got ready.  I knew I would have a great time once we were out, but I was just tired. 

We ended up going to Brix 46, which is a little neighborhood lounge in the Mary Brickelle Villiage in  Miami's financial district.  It was so much fun!  Farley and I went out with our friend, the PA student from OB/GYN last week, and we wanted to go out with her and her fience.  We also wanted to set up one of our fellow medical students, who also knew the PA from OB/GYN.  It just happened that the PA's friend was in town and wanted to go out so it worked out perfectly.  The music at the lounge was a mix of Latin and Hip Hop.  It was super fun, despite my inability to dance.  I was the DD for the night, which may have made my dancing even worse! Overall the night was a blast.  We were out until 3:00am!  I don't know about you, but that is extremely late for me.  I haven't been out that late since my OB/GYN rotation, and I don't think that really counts.  It was 4:00am before I got to bed and I slept most of Saturday away.  I didn't mean to, but after not sleeping well all week and staying up so late I ended up sleeping much more than I thought that I would.

I did manage to get some studying done Saturday night, so I was happy.  I headed to bed and then got up for Mass Sunday morning.  Farley's computer has been giving him fits and it finally bit the dust late Saturday night, so after Mass, we headed to Best Buy to find him a new one.  It wasn't on the plan for the weekend, but I am so glad that he was able to find something that works for him (and it was on sale).  While we were there, I had my a "tune up" done to my computer and I think it is working faster now. 

Luckily, we have a study day for tomorrow, which is great because I didn't get much studying done today.  I cannot believe that I only have five weeks left in Miami before moving to New York City.  It is hard to believe that the time has flied by so quickly!!! 

Monday, May 10

First thing Monday morning, I had orientation for my Internal Medicine core rotation. It was a fine orientation, but I really wanted to get home and see my Mom so it felt like it lasted forever. The other problem was that I had lost my voice. I felt pretty good other than having a little bit of a sore throat and the laryngititis.

Luckily, we got out of the orientation early. Farley and I had a few errands to run before coming home. Mom was still at the beach when we got home, so I decided to go sit with her (I couldn't really chat) and Farley took a run on the boardwalk. It was a beautiful day.

I have been wanting to go to happy hour at one of the many restaurants on the boardwalk north of my apartment so we decided to walk to dinner. We left the apartment a little after 6:00, which is a great time to walk on the boardwalk because it is starting to cool down a bit, but it is still light out. Here is a picture of one of the hotels with the sun starting to sett behind it.

We settled on Carrabba's Italian Grill, but I believe that the restaurant on the boardwalk is actually called Carrabba's Seaside Grill or something like that. They didn't serve the Italian menu, but had some great sandwiches and amazing coleslaw. The restaurant is on a beautiful deck, which is decorated like a tiki bar. Here are some pictures.

It was dusk when we walked back from dinner yet there were still tons of people out running and walking on the boardwalk. The most interesting person I saw on the boardwalk was holding a pet lizard and petting the lizard as he and a woman walked down the boardwalk. I am not sure what type of lizard it was, but it was rainbow colored and fairly large (the body was about the size of the man's forearm). The most humorous part was that the man and woman were walking like it was completely normal and the lizard was very alert and looking around with excitement in his eyes like a child at Disneyland. Mom and Farley completely missed the lizard when we walked past this couple! They did look back and see the giant tail, so they knew I didn't just make this up, but I really wish they would have seen it! Here are some pictures of the walk home.

We decided to go down to Wallgreens on 23rd street to pick up some more sore throat medication. When we were walking past the Gansevoort South Beach Hotel, there were many expensive cars (as usual). My Dad loves cars and since he couldn't come down with Mom for this visit, we had to get a photo of us in front of the pair of matching Bentleys. Look in the background!

A Jam Packed Week

We worked for about 60 hours in five days this week and it wasn't that bad. In fact, it was really fun. There were many deliveries, cesarean-sections, and surgeries so the hours flew by. I was planning on posting about the days, because they were so awesome individually, but I haven't had a chance to sit down and compile my thoughts on the week until right now. At this point, the days all melt together. Here are some of the highlights:

• On Monday, I got to assist in delivering my first baby. It was one of the most incredible experiences of my life. It was a beautiful baby girl. Happy Birthday Beautiful!
• On Thursday, I did the history and physical on a patient who was being admitted for the delivery of her first child. I spent a lot of time with her and got to know her just a little bit. On Friday morning, the nurse said that she was delivering and so I ran into the room to watch the delivery. The doctor let me assist again! Another beautiful baby girl!!
• Friday morning, I got to scrub in and assist in my first surgery. The patient was having a hysterectomy because she had a uterus full of benign leiomyomas (uterine fibroids), which can cause increased bleeding and a ton of pain. I have felt benign leiomyomas during pelvic exams and seen in the cadavers during anatomy. The leiomyomas themselves basically feel the same in all three situations; however the uterus feels different in a cadaver than it did freshly removed from this patient. Obviously, the cadavers are processed and they are very similar but a little tougher/harder. There are some medical schools who are no longer using cadavers to teach anatomy. I cannot imagine how they learn the anatomy (it is all so twisty and it is in 3D). In ways, watching the surgery was like being back in the anatomy lab because I have seen the insides before. There are little things like the thickness of the vessels (even just feeling the vessel) tells you if it is an artery or a vein. I think there are somethings that are best learned by touching and doing rather than reading. Anatomy is one of those things, despite how much I hated the anatomy lab.
• Also on Friday, I got to scrub in and assist in my first cesarean section. Happy Birthday Baby Girl!
• Had a patient with premature rupture of the membranes (PROM). PROM is one of those things that is all over my OB/GYN text book so it was interesting to see a case. I know that sounds horrible, but this mom is close to term so they are just having her hold off delivery for a few more days. Both Mom and baby look good. I have had a chance to see a patient with PROM, which makes remembering the syndrome and remembering how to treat it much easier. For the rest of my life, I will remember this woman's face and her name. These patients make such an impact on medical students. I wonder if they know how much they mean to us.
• Saw a cerclage removed. A cerclage is a super stitch that is placed in a pregnant woman who has cervical incompetence. I had read about cerclages and wondered how a regular old stitch would hold together a cervix. I was wrong: a cerclage is no regular stitch. It is a super stitch. Watching a stitch being removed may not sound exciting, but I am glad I got to see it.
• I saw not one but two patients with polycystic ovary syndrome! This is another syndrome that we hear a lot about in school, not just in the third year OB/GYN and endocrinology text books but in the second year pathology. I even had a question about polycystic ovary syndrome on my boards last November.
• I saw a diabetic and hypertensive pregnant lady. These are major problems in the United States and again it was a great learning experience to see how the doctors managed this lady's problems. Last night I was reading in my OB/GYN book about pregnant ladies with diabetes and hypertension and it was so helpful to have seen a patient with those problems. It just makes things make more sense.

I have always had OB/GYN on my radar, but I've never known if I could handle the surgery. I just don't think I am cut out for surgery. I was a little grossed out by the first few surgeries that I saw. Just observing the room and watching the surgeons, who have to be rather aggressive to perform surgery, is a strange feeling. It is sort of like watching a surgery on t.v. I kept thinking about the surgery from the patient's prospective--Thank God for Anesthesiology! Anyway, once I was actually at the table, my perspective on the surgery completely changed. It was amazing! During the surgery, I was trying to figure out what and why the doctors were doing what they were doing (In medical school, one doesn't learn how to perform surgery step by step like a surgical resident. In medical school, we learn to stitch and staple, proper technique for scrubbing into surgery and similar things). When I say I assisted, I really mean that I held retractors, gave tension to the thread when the doctor was stitching and suctioned blood out of the field. All in all, I was surprised how much I liked the surgeries.

On the other hand, I knew that I would love delivering babies. I have got to say that it is one of the most exciting things I have ever done in my life. Once the little heads are out, it takes a little bit for the shoulders to come out, then the babies quickly arrive, like a ketchup packet being stepped on. I have cut the umbilical cord in both deliveries that I assisted and I am here to tell you that the umbilical cord feels a little rubbery. For those of you who do not know, the deliveries are not that bloody until after the baby is born. The uterus has lots of blood in it as does the placenta so during the delivery of the placenta things start to get bloody.

I am still very interested in hematology and oncology, but this OB/GYN rotation is making OB/GYN seem like a very viable option for me. I am still not 100% sure I want to do surgeries nor am I sure about the crazy hours that OB/GYNs work, but I love this rotation.

Saturday

We are suppose to go into the hospital today, but we just don't know when. Dr. Hardcore thought it would be an afternoon thing, but as we already know, the Moms and Babies have a big say in what time things happen. I slept in until about 10:30 then tried to get some stuff around the house done. I wanted to go take a walk or perhaps jog on the boardwalk, but I am a little afraid to venture too far from the house. I also didn't want to be all sweaty in case he calls and I've got to get to the hospital quickly. Thus, I haven't done much at all today. I started my stuffing for my turkey and I did a little laundry. It is almost 4:30, so I suspect that we will be getting a call soon, but you never really know. It has been really nice to lounge around today, but I also feel like I can't get too into something (such as going to the beach or working out) because I don't want to be caught in the middle of something when we get the call.

Five New Lives

Yesterday was my first day on call.  I knew that the first time would be exciting and that in reality it isn't all it is cracked up to be.  Dr. Hardcore didn't think any of his patients would deliver until the afternoon, so he told us not to worry about reporting early in the morning unless he called.  At 5:45, I heard a familiar sound and jumped to grab my cell.  He had a lady about ready to deliver and we had to rush to the hospital.  I was so excited!  I ran to go wake up Farley so we could change and hit the road.  We were walking to the car by 5:50 and at the hospital by 6:10, which was just in time to miss the delivery.  But, that was okay because he had two other women who would soon be ready to deliver.  We waited while he finished some paperwork then when he was giving us a lecture on fetal heart beats and contractions I got really, really hot.  I was about ready to ask if I could go sit down and the next thing I remember is Dr. Hardcore and Farley kneeling down next to me with the entire nursing staff surrounding me.  Yes, I faint.  That will teach me to get up and moving so quickly without eating anything.  I was lucky enough to faint at the shift change so all of the day and night nurses were there.  It was so embarrassing.  Nothing was even going on at the time.  No disgusting ER/Grey's Anatomy type scenes.  We were just standing around talking about fetal heart beats.  Apparently I moved my hand in a weird way and Farley stepped over (we were standing next to one another) and he grabbed me so I didn't even hit the floor, I was placed there.  Then I was given a wheel chair, orange juice, a donut and coffee.   

After that humbling experience, it was time to deliver a baby!  The first Mom was so quiet and calm (she had an epidural).  She pushed that baby out like she was doing something as mundane as washing dishes.  It was unbelievable.  She had a lovely little boy.  Then we went to the Mother Baby unit and rounded on some patients.  Then the second call came. This Mom also had an epidural, but she wasn't calm at all.  She was screaming so loudly and thrashing in the bed.  The doctor had to clam her down and get her to push rather than twist and turn.  Once he was able to do that, Mom number two pushed out a little girl.

Somewhere in the midst of the rounding and baby delivering, we saw an anesthesiologist who was coming to give a woman an epidural.  The nurses and Dr. Hardcore started asking him questions as to if he was feeling alright, but he claimed that he just had the flu.  He was shaky and Dr. Hardcore ask him to please call one of his partners to come in because he looked so ill, which he promised to do.

After delivering baby number two, Dr. Hardcore let us go home for a few hours.  As we were all walking to the parking lot, Dr. Hardcore informed us that the anesthesiologist had a stroke!  It was a really good thing that he was int he hospital at the time because he could get treatment quickly, but I will be keeping him in my thoughts and prayers.  I hope that he is doing better today.

We left the hospital at about 11:30 and went to Target to grab a few things before heading home (namely, trail mix for the car and powerbars/luna bars for early morning call).   After getting home, I had lunch and took a nap.  I work up in time to take a shower before getting the next call at 3:47 pm.  Farley and I quickly changed and were out the door again.  Unfortunately, we hit rush hour and, probably because it was Friday, everyone and their dog (literally) was trying to get on or off Miami Beach.  It took us 40 minutes to drive to the hospital (we can usually do it in 15-20 minutes and obviously even quicker than that at 5:45).  After getting to the hospital, we had to park (a long ways away because we are the lowest in the hierarchy of the hospital).  We then rushed to the labor and delivery unit only to find the P.A. student.  Dr. Hardcore wasn't there yet.  Another medical student met up with us.  He is rather famous at my medical school because after taking his Step 1 boards, he was diagnosed with T-cell Acute Lymphoblastic Leukemia and was Philadelphia Chromosome positive.  For those of you who don't know, this is a horrible, horrible diagnosis, especially since he was in his mid-20s at the time (in someone younger than 10 years old, it would be better, but still a really bad diagnosis).  Anyway, he had immigrated from Cuba several years ago, but he hadn't been here long enough to qualify for medicaid and our school's insurance had lifetime caps (but no more, Thank you Mr. President and Congress!!).  Anyway, this guy needed a bone marrow transplant to live and was on some crazy expensive drugs because he was Philadelphia Chromosome positive.  I am happy to report that he had his bone marrow transplant two years ago and if you hadn't known that he had been sick, you never would have guessed it.  He has been out of school for two and a half years fighting his cancer.  He is a little nervous because he tried to keep studying while he was treated for cancer but really could not.  I think he will do great in this rotation because he is focused and kind.  He is a super nice guy and I am sure that he will teach us a lot about medicine because he has experiences as a patient that I do not.

Anyway, while we were waiting for Dr. Hardcore and discussing our colleague's story, another OB/GYN asked if we wanted to watch a c-section.  So, the PA student and I went to watch.  It looks to aggressive and  painful.  No wonder if takes at least six weeks to recover....it looked horrible!  After the beautiful baby boy was out, they just lifted the uterus up and stitched it up.  It was so strange to see the uterus out of the body and then they put it back in.  They finished stitching her up and the pediatrician took a look at the baby.  Both Mom and the baby were doing well.

Shortly there after, Dr. Hardcore arrived.  We headed into deliver another baby.  This was the only mother whose significant other was at the hospital at the time of delivery.  I think it was the most exciting delivery of the day because this baby was so obviously wanted.  Mom, Dad and maternal grandma were so excited her for birth.  This little girl was absolutely stunning.

After her delivery, we all headed back to the OR for another C-section.  This time Dr. Hardcore was doing it.  Dr. Hardcore uses a different technique where he has these rubber circles that are attached by what I think is plastic in between them.  basically, you get a tall cylinder without the ends and that is inserted into the surgical site.  It helped open up the area and then he just lifted the baby up through the cylinder.  He then sutures the uterus in the body rather than lifting it out of the body.  Apparently there are advantages and disadvantages to both methods of performing c-sections, but this way sure looked nicer on the mom.  I am sure, in actuality, that they are both as painful post-operative, but it looked nicer.  Dr. Hardcore let one of us step up to the table and we all decided that that should be our cancer survivor since he wants to be and OB/GYN and he is only with Dr. Hardcore on the weekends (he is with a doctor who only does gynecology and so he is with Dr.  Hardcore on the weekends to do the obstetrics).  The cancer survivor looked so happy to be helping with the c-section and then after the c-section, he assisted in the tubal ligation.

So, it was about 8:30 pm and we were sent home for the day.  In summary, I saw five new babies born, three vaginal deliveries, two c-sections, one tubal ligation, there was one anesthesiologist who had a stroke, one cancer surviving medical student, and I was the one medical student to faint.  All in ten glorious hours of hospital work.  This is going to be an exciting six weeks.

Third Year Clerkships

I received my schedule for the rest of my third year of medical school. As I already knew, I will be in Miami completing my core clerkships in Family Medicine, Obstetrics and Gynecology, and Internal Medicine before moving to New York City to do my Psychology rotation. Today, I found out that I am going to be able to stay in New York City to do my Surgery rotation and my Pediatrics rotation. To top it all off, all of my rotations are separated by only a weekend, which means that I started this grand adventure in my third year clerkships on February 15, 2010 and I will finish my third year clerkships on January 14, 2011 (assuming everything goes according to plan). I am really lucky that I got everything back to back; however, that means I only have a weekend to move to New York and I really don't get a break between the rotations. Oh, and since I will be in the middle of my Pediatrics rotation next December, I will not be able to come home for Christmas next year. I knew at some point in my medical education I'd miss Christmas with my family, but I didn't know for sure when. On an exciting note, on January 15, 2011, I will be a 4th year medical student!! It is amazing to think that in less than two years, I will have finished my medical doctorate!

Pet Peeve: Student Doctor

I'm not sure it if is just me, but I hate when medical students refer to themselves as "student doctors." Part of that might be because we had a professor who told us that student doctor isn't an appropriate term and that if we were overheard calling ourselves that, we'd have to deal with him . I haven't met a student yet that has anything good to say about this professor so I think the threat of having to talk to him is enough to whip people into shape. When medical students call themselves a student doctor, it implies that they are a doctor. The vast majority of medical students do not start medical school with a PhD or other doctorate and thus are not doctors. If anything, resident and fellowship level physicians are the closest thing to student doctors, as they have earned their MD but they are completing their training and specializing before they are considered independent, attending physicians.

When I'm working with a patient, I try to go out of my way to let them know that I'm only a third year medical student. I'll even explain how much schooling I have and how much I have left to complete. I don't want to mislead someone into thinking I'm a physician; I think that is dishonest and unprofessional. I know a lot of medical information, but I am not a physician yet. At this point, I do not deserve the title "Doctor" and I'm not ready for all of the responsibilities that accompany that title. When I am a physician, if I hear a medical student call himself a "student doctor," he will get an earful from me or I'll just send him to go see that mean professor from my medical school. The threat of going to talk with that mean professor will keep anyone from misbehaving.

Bagger!

Farley and I take turns buying groceries and today it was my turn. We loaded up everything onto the conveyor belt and said hello to the Cashier and to the Bagger. As we said hello, the Bagger replied, "Well this should be interesting, who is going to pay?" I got out my wallet and the Bagger then looked Farley in the eye and declared that "men should pay for food." I told him it was my turn. Then the Bagger told me that, "Men should pay for food and women should stay home and cook." I don't think there is anything wrong with women staying at home, but obviously, that isn't for me. I looked at him and informed him that was I halfway though medical school and I wouldn't be staying at home anytime soon to cook all day, besides I owe so much in student loans I couldn't quit now even if I wanted too (which I don't). Then Bagger looks at me and said something like, "Well what does he (Farley) do all day?" When I replied that he is halfway through medical school too, I don't think the Bagger knew what to say next. At that point, I needed to finish paying and Farley had to deal with him. After we left the store, Farley and I discussed Bagger a little more. I think Bagger probably had a low IQ making him slightly mentally retarded (I'm not typing that to be politically incorrect, but it still says mentally retarded in medical text books not special needs). Also, I'm not just saying that because he thinkgs women shouldn't work; I really think using the medical knowledge that I have obtained since starting medical school that Bagger has a low IQ (and Farley agreed). If Farley and I are correct, I'm very happy that Bagger found a job and that he is able to be somewhat independent. If not, well, I wish he would stop irritating people in line and the nice cashier lady.

Many times Farley and I have been out and people asked what we do. We usually try to respond that we are in school and inevitably we are asked about what we are studying. When we say that we are third year medical students, there have been several people (in Miami) who have actually said, "That is wonderful.. He is going to be a doctor and you will be a nurse!" Nurses are great and it is a wonderful profession, but I didn't go all the way to a Caribbean medical school to be a nurse. It really irks me that people assume because I'm a woman I can't/won't be a physician. Living in Miami is like living in a different world sometimes.

Two months, two weeks, and a number two pencil

To become licensed as a physician in the United States, one must pass the USMLE steps 1, 2, 2CK and 3. That is just to be eligible to apply for a license; it doesn't include all of the testing that physicians do to be considered board certified in their respective speciality. That is a whole other set of hoops to jump through and the process varies depending on the speciality. Obviously, one must complete a residency (and fellowship if sub-specialized) to be eligible to take the boards. I'm years (of if I go into hematology/oncology close to a decade) away from those exams, so I'm not as informed about all of the nuances involved.

Anyway, there is a little saying that to prepare for Step 1 you need to study for two months, for Step 2 you need to study for two weeks and for Step three you just need to bring a number two pencil. I've also heard that generally if you study for more than 2-3 months for Step one you will start to become inefficient and things will go downhill. Farley and I scheduled 2.5 months to study just for that reason. Today, I was grateful that I only need to keep up this pace for another month. No matter how nervous I am to take this exam, since it is such a monumental aspect of the early part of my career, I know that I couldn't keep up studying at this pace for more than 3-4 months. Many physicians have told me that they are not sure they'd go back to medical school again if they knew what they'd go through. Most of them said that the first two years are the worst, culminating with USMLE step 1. They added that the third and fourth years are better because you spend more time with patient, rather than just book learning, but that the intern year and the rest of residency are extremely challenging. I know that I have some of the most toilsome aspects of medical training ahead of me--clerkships, intern year, residency and maybe even fellowship--but I know exactly what those physicians were talking about. I'm glad I went to medical school, but if I had to start again from scratch knowing what I know, it would be a more difficult decision. Medical school is mentally, physically, spiritually, emotionally and even financially exhausting. It isn't going to get any easier from here, maybe more rewarding, but not any easier.

Better than I could have imagined in my wildest dreams...

Back home in Washington, there is some exciting news. The University of Washington has some medical students, as part of the WAMMI program, that do part of their training in Pullman. I guess it was just announced that they are expanding the total class size at UW's medical school and moving the Pullman campus to Spokane. It also sounds like students at the Spokane campus maybe able to do all four years of their training in Spokane. Also, the long awaited Doctor of Osteopathic Medicine school opened in Yakima, WA and welcomed their second class this August. There are definitely are more medical school seats in Washington than when I left for Dominica. This got me thinking about how my life would have been different if I would have gone to medical school closer to home. Obviously, it would be awesome to be closer to home, friends and family. I wasn't able to come home to say goodbye to grandma or attend her funeral and at least two weddings--and I'm only in my third year of medical school. However, there are a lot of great things I've been able to experience because of attending a Caribbean medical school. I have a lot of amazing stories to tell my children and grandchildren. Sometimes things in life don't work out as we imagine, but they turn out better than we could ever imagine. Here are some of the interesting, exciting and humerous things that have happened to me.

• Meeting Farley. I don't know how I would have met him without going to a Caribbean Medical school and I can't imagine going to medical school without him. Besides being my partner, he is my travel buddy. Here is a picture from the day we first landed in at the Dominican Airport. Note how close the plane is to the Atlantic Ocean. Not much room for error. They have since remodeled the airport; however, they still have limited flights (like no flying at night and they can only have small plans land).

• Speaking of traveling, I've done a ton of it in the last three years. Obviously, I've been to Texas twice to visit Farley's family and we hopped over the border to Mexico once. Of the Caribbean countries, I've been to Puerto Rico, Dominica, St. Lucia and Barbados. I have had lay overs in Martinique, Antigua, and technically Barbados on an overnight layover. We had to stay somewhere, so we stayed at the closest and most reasonably priced hotel we could find--it wasn't our fault it was a wind surfer's paradise and we were right on the Atlantic Ocean! Seriously, who gets to have overnight layovers in Barbados and stay at a beach resort? I may in fact be the most brilliant person ever--I'm still going to be a physician when I'm finished and I've spent my first two years of medical school living 50 feet from the Caribbean sea and having layovers in the tropics. Not too shabby, except for the insects, brown water and other hazards of living in a third world country, but third world living just builds character! After our first year of medical school, it was so expensive to come home that it was actually cheaper to go to Argentina for a week than to go home. Looking back, I can't believe that Farley and I did this, but opportunities to travel don't always arise and one has to take every opportunity she gets. When we traveled to Argentina, we had a lay over in Panama. I couldn't believe the Panamanian airport--there were NO Panama hats to be found. In fact, there was one restaurant and two hot dog stands in very large Panamanian airport terminal. On a bright note, this terminal was basically a mall of European designer stores and chocolate stores! I ate a lot of chocolate with my hot dog in the airport. But unlike in the USA, the airline gave us two meals, two snacks, and free wine (but since I don't speak Spanish and Farley was asleep, I didn't know the wine was free) on the six hour flight from Panama to Argentina. Guess, I didn't need a hot dog and chocolate after all. Below is a picture from April 2008 of Farley and me waiting for the ferry to go to St. Lucia. The ferry ride could have been lovely if I hadn't have been so seasick!

• Strange Critters on the island. Before classes started we went to the Cabrits (the national park that we could see from our apartments) to hike. It was a lovely day, but everywhere we went, there was a ruffling of the leaves and ground covering. I thought it was just the geckos at first: I was wrong. We were surrounded by galliwasps. Click on the link to see a picture of them on Farley's blog. They look like geckos, but they have really small legs and they move more like a snake. Another exciting creature was this insect found near the study space right before the first exam of medical school. Just trying to go to the bathroom was an adventure, you never knew what you'd see on the way:

• Getting caught between a crab and a four cows. Yeah, that really happened. We were having a date night first semester after an exam (it may have been our first exam that semester) and then we were trapped between a feisty crab and four cows. See here is the blurry picture of the scary crab to prove it! I didn't dare take a picture of the cows since they were lining up in an aggressive, military-like formation.

• Lizards. Giant Lizards that fall from the sky...or my third story apartment. Or that just decide to hang out in my apartment looking out the window. How about the one that decided to drop his tail as Farley was escorting him out and a gust of wind made the tail fly through the air toward me before it started flopping on the floor. If that wasn't enough, how about the lizard that died hanging upside down from my balcony ceiling. To top it off, that was just in Dominica. One of them, which I named Leo the Lizard, moved into my apartment the last time I lived in Miami. Lizards can't get enough of me.

• Animal herds: In Dominica they let the animals run free. I talked a lot about the cows, since they were everywhere. Heck, one even chased me as I was trying to go study. Now, that doesn't happen every day! But it wasn't just the cows running free in Dominica. There was a pack of dogs that went all over. I a little afraid of dogs since I was chased by two baby pit bulls when I was a toddler and I was bit by a dog in my pre-school years; however, these Dominica dogs were so harmless they didn't even scare me. They were, nonetheless, annoying. They'd brush up next to you as you carried your lunch and they'd try to get you to pet them (there are a lot of insects, bacteria and parasites on that island and I'm sure there were some creepy crawlers on those dogs--I sure as heck didn't pet them!). There was a cat that lived near my apartment and would try get people to feed her (I usually set something outside my door). I was most surprised by the goats running free in Dominica. Who would have thought that there would be goats in the Caribbean.
  

• Natural Disaster. Now so far, we have been extremely lucky and there have not been any horrible disasters anywhere I've been. However, there was one tropical depression in Dominica while we were studying there. The sea come up high and flooded the lawn near our apartment. The only good thing was that I got to take a nap (it happened near a test and I was extremely tired, so it gave me a few hours to rest). I can joke about the tropical depression because no one was hurt and the only damage reported was the dock near our apartment. Overall, if the only thing damaged was a dock, we were all lucky.

• Who could forget the time that I fell down the hill in Dominica and was covered in mud. I think I should have learned that going to my apartment if I forgot something while studying on campus, was almost always a bad idea. I would end up being chased by cows, attacked by insects or slipping on mud. That is how I earned the nickname "mudslide".


• Living in a Third World Country. It is amazing how much we take for granted in America. Living in Dominica reminded me that in many places of the world, water isn't safe to drink out of the tap, there are insects, parasites and bacteria with your meals, and the power will come and go. All of these things were very difficult for me to adjust to; however, I think not being able to get a hot shower with clear water had to be the most difficult. If it rained a lot in Dominica, the water would turn a brownish color (like really watered down coffee). The filtration system couldn't keep up with the demand when there was a lot a rain, which happened frequently as Dominica is a rain forest. First semester, the water heater worked but something changed along the way. I soon learned that if I wanted a hot shower, I needed to hop in between 4-7 pm because otherwise, it was extremely cold. I'm not even sure how the water got so cold as Dominica is almost always between 84-92 degrees. Don't even get me started on the insects in Dominica, I still have scars from the mosquito bites! However, Dominica has it's redeeming qualities too--some of the best sunsets in the world.

• Bats. I don't know if I've every blogged about the bats in Dominica. Usually, Farley and I saw them when we were walking on the trail at night either coming or going to campus. It was the most strange thing in the world because out of nowhere there would be this slight gust of wind and a black thing in front of you. Then it was gone. They really make little or no noise at all. Obviously, I was frightened as they'd fly by because I'd be so shocked and I hate all creepy and icky things. But they have sonar so they never hit us. One night in early 2007, however, I did come face to face with one of these flying, ugly creature. I had my wooden panels covering my windows open. I stepped out onto my balcony to enjoy the cool night air. The light from my room bled though the wooden panels and I heard an odd noise. I looked up and there was a bat lost and unable to navigate out of my balcony. Besides the wall of windows, two walls the ceiling and the floor were cement. The other side was open except for the railing and about a one foot hangover of cement. I think all of the cement towards the ceiling, where he flying around, had his sonar all messed up. In case you have not had the honor of meeting up with a bat face to face, let me tell you bats are really ugly. Clearly, I made a mad dash for my door, shut the wooden panels on my windows and hid--as if the bat was going to penetrate though the walls and attack me. I believe that there are only fruit bats in Dominica, but you know even fruit bats can have histoplasmosis or rabies!

• Living in Miami. There are few places in the world as unique as Miami. In fact, I think it is more essential to speak Spanish in Miami than it was in Argentina! This city is a mix of money, cars, beaches, model-like people on the beach, heat, humidity, Spanish culture, retirees, colleges and universities, insects, lizards, crazy drivers, and to my shock farmlands less than an hour away. But obviously, the thing I love to complain about the most is the drivers. I think I've mentioned before that Miami lost it's title of the country's rudest drivers, which it has held for the last four years. Yes, the rudeness of Miami drivers even impresses those from L.A.

• Rainbows: Living in Dominica really makes one have to be an optimist to survive. Medical school is so tough, let alone living in another country--a third world country--and being so far away from not only family and friends but also convenience, such as grocery stores. To survive, you really have to keep a positive outlook even when things don't go your way, both with the living situation and with school. I've never lived somewhere before that there was always a rainbow at the end of a storm other than Dominica. You could practically see a rainbow every day and usually there were two or three together in the sky. I think this is a cheesy metaphor for medicine. When times get tough, and they will, you've got to look for the light at the end of the tunnel, for the rainbow at the end of the storm.
  

I guess the bottom line is that things sometimes don't end up as I predict or think I want. But I'd never dreamt that all of these amazing things would happen to me. Being willing to take a risk and run off to the Caribbean to fulfill my dream of becoming a physician, is the best risk I've taken so far. Who knows what risks and opportunities will present themselves in the future!

Pharmacology Nomenclature is NOT fun

For the last few days, I've been doing my pharmacology review for the USMLE step 1. I know it doesn't exactly sound exciting; nonetheless, I'm excited about it. I think this is the third time I've reviewed pharmacology. The first was, obviously, on the island. The second was last semester (5th semester) during the UMBR course (University Medical Board Review course) that was offered in the evenings. There is a lot of memorization in pharmacology and I think multiple exposures are helping me remember the classes of drugs and the little unique things about each drug.

In medical school lectures, exams and the licencing exams, pharmacological agents are known by their generic names. At times last semester, I felt really dumb because patients would name off their medications and I wasn't sure what class some of the drugs fell into. The reason is that most people know drugs by the trade name (brand name). For example, other than a health care professional, who would know that Benadryl (trade name) is also known as diphenhydramine (generic name)? Honestly, who is going to refer to Benadryl as diphenhydramine--it's too hard to spell let alone pronounce. However, one advantage to the naming system of the generic drugs is that classes of drugs sound similar. Let's consider beta blockers, which are drugs that can be used for several different cardiovascular problems, such as hypertension and some types of heart arrhythmias. All of the generic beta-1 blockers end with -olol. If the drug is a non selective beta blocker (meaning, for example, it blocks beta-1 and beta-2 receptors), it has a slightly different ending, such as -ilol. As far as I know, the trade names, have no rhyme or reason. For example, some beta blockers:

• Acebutolol's trade name is Sectral
• Atenolol's trade name is Tenormin
• Bisoprolol's trade name is Zebeta
• Carvedilol's trade name is Coreg
• Metoprolol's trade name is Lopressor or Toprol XL
• Nadolol's trade name is Corgard
• Nebivolol's trade name is Bystolic
• Propranolol's trade name is Inderal LA

One day last semester, a patient told me he was taking Coreg. I felt so dumb that I didn't know what it was. I knew it was a heart medication because of the commercials, but I didn't realize it was a beta blocker. I sure as heck know what a beta blocker is! This is just one example of how confusing all of these drug names can be, especially when you are still learning. Thank God for pharmacists! It is a bit ironic that I'm finally feeling really confident with my pharmacological knowledge and in a few months I'm going to have to start seriously learning all of the trade names. Up until now, I've left learning the trade names on the back burner, as it isn't on exams and there is only so much room in my brain for information. However, next semester when I see patients full time rather than part time, knowing trade names will be more important since, as already mentioned, most people know trade rather than the generic names. I'm also going to start learning some important economic information--which drugs are available generically and which are not yet available generically. As obvious as it sounds, if patients can afford their medications, they are more likely to stick to the treatment plans and drugs available generically are much more affordable than those that are not. Thus, over the next few years I'll have to start learning what is available generically so I can suggest those medications when applicable. However, some of the newest and best drugs are those that are still under patent and therefore not available as generics yet. Oh, and every hospital has a different formulary (drugs they keep in stock)! It seems in health care, whether you are trying to learn medicine or receive medical care, you can't win for losing.

Name Game Anatomy Answers

Last week, I posted a question:

In the following list of words (lettered A-H because supposedly we get up
to 7-13 answer choices on the USMLE) try and guess which word is NOT a name
for something found in the adult human body (I'll do an embryo quiz later):
A. Olive
B. Lumbricals
C. Pyramid
D. Chordae Tendinae
E. Kasseri
F. Pylorus
G. Supinator
H. Gastrocnemius

I suspect that some of you might have thought the answer was olive or perhaps pyramid, but you'd be wrong. Now, I know that those aren't really fair as there are olives outside the body and there are pyramids outside the body, but they are also found in the body.

A: The olives are found in the brain stem. There are superior and inferior olives. The superior olivary nucleus is involved in hearing and the inferior olivary nucleus is involved in transmitting information to the cerebellum. The cerebellum helps your brain coordinate movements (like walking in a straight line or touching your hand to your nose with your eyes closed).

B: The lumbricales are little muscles in your hand that help the fingers abduct and adduct. To abduct your fingers is to spread them out and to adduct is to push them together.

C: The decussation for the pyramids are the part of the lower medulla (part of the brain stem) where approximately 80-90% of the corticospinal tract fibers cross sides of the body. Basically, this meas that the primary motor cortex in the cerebral cortex sends down a signal for something to move (this is voluntary movement of skeletal muscle). This signal travels down the brain, but when it reaches the brain stem (lower medulla), the signals from the right side of your brain cross over to the left side of your brain stem and continue to travel down the left side of the spinal cord to control muscles on the left side of your body. Obviously, this happens on both sides of the body. This is one of the reasons why people have contralateral (opposite side of the body) problems after having a stroke. Also bear in mind, different spinal tracts that carry different information (like tracts that go up the body with sensations of pain, vibration, pressure, and proprioception) cross at different places and some things even cross twice in the brain. I have the upmost respect for anyone who can be a neurologist because I think it is incredibly, incredibly difficult and I really don't know much since I'm only in medical school.

D: The chordae tendinae are found in the heart. I think they might be my favorite part of cardiac anatomy. They are cord like projections (Farley says they look like floss) that are found on the mitral and tricuspid valves, which attach to papillary muscles. In other words, the chordae tendinae help close the mitral and tricuspid valves and prevent regurgitation of blood (basically, you want blood to flow in one direction and the chordae tendinae help the valves close so that blood can flow backwards).

E: Ah, the answer to the question is E! Kasseri is a Greek cheese of medium consistency made with unpasteurized goat's milk. From what I've read, it has to be unpasteurized because that ensures the correct flavor of the cheese. Kasseri is suppose to be similar in texture to Parmesan, but not as creamy. I've never thought of Parmesan as creamy, but I guess I'm just not an expert on cheese.

F: The pyloris is bottom part of the stomach that leads into the small intestine. It has different cells which secrete acid and enzymes to breakdown food. It is also very famous (at least amongst medical students) for pyloric stenosis, which is when newborn babies have projectile vomit. Pyloric stenosis is when the connect between the stomach and the small intestine is too tight and the little baby cannot keep food down and they are always hungry. Apparently, the term projectile vomit is very serious as babies with this problem have been known to send vomit several feet across the room! Babies are usually diagnosed at about three weeks old (although it can be up to about 5 months old). I can't imagine a three week old causing such a mess!

G: The supinator is my favorite muscle in the upper arm because the name tells you the function: it supinates! To supinate the arm is to bring the arm and hand into a supine position. Or you can think of it as twisting, like to open a bottle of wine.

H. The gastrocnemius makes up the majority of the calves. It is the biggest muscle in the calve and is involved in helping us stand and walk. It also contracts and looks shapely when one wears high heals. It sometimes can cause involuntary, painful contractions (charlie horse)--I had one a couple weeks ago when I didn't stretch well after working out.

So that is the end of the first Name Game. I'll post another couple in the next few weeks. I hope you got the answer correct and that I was able to tell you something new and interesting about the anatomy!

Let's Play the Word Game: Anatomy

This week I've been reviewing anatomy for the Step. When I say I'm reviewing anatomy this week I really should elaborate. I'm reviewing microscopic and macroscopic anatomy and development, which really means that I'm covering histology, anatomy, neuroscience and embryology. It has really reminded my why I have no desire to become a neurologist. I feel like neuroscience is a language that others speak fluently and I do not. It is like someone understanding enough Spanish to go on vacation or study abroad, but that person doesn't feel like they know enough about the language to understand all the nuances of Spanish poetry. That is how I feel about neuroscience. I understand, but unlike many of my peers, I'm not all that excited about it. I think part of my distaste for neuroscience is that all of the anatomical names are really big and hard to pronounce or it sounds more like a little girl's name and than anatomical name. In fact, Farley and I have noticed a trend across all medical nomenclature: some of it just doesn't seem to fit in. Thus, I've decided to do a series of blog posts that I'm going to call the word game. I'll give you a set a words and I want you to try and guess which word is NOT part of the medical nomenclature. Basically, which one of these is not like the others.

In the following list of words (lettered A-H because supposedly we get up to 7-13 answer choices on the USMLE) try and guess which word is NOT a name for something found in the adult human body (I'll do an embryo quiz later).

A. Olive
B. Lumbricals
C. Pyramid
D. Chordae Tendinae
E. Kasseri
F. Pylorus
G. Supinator
H. Gastrocnemius

I'll post the answer and explanations to all the answer choices in a few days! Let me know which you think is NOT found in the body.

"I know the price of success: dedication, hardwork and an unremitting devotion to the things you want to see happen." --Frank Lloyd White

It's only a week into my USMLE Step 1 preparations and I'm already starting to feel tired. I think it is easy for people doubt themselves and question, "can I do this" whenever one starts working to achieve a new difficult and challenging project. Last night, I started feeling overwhelmed with the amount of work to do and started wondering if I can do it. There are times that it is really easy to sit down and study for hours and other times when it is not so easy--last night and this morning, it hasn't been so easy. I took a little study break last night and while looking around online I found a few words of encouragement:

"The greatest danger for most is not that our aim is too high and we miss, but that it is too low and we reach it."--Michelangelo

"Don't bunt. Aim out of the ballpark. Aim for the immortals"--David Ogilvy


When I started doubting myself last night, I thought something on the lines of "don't make your goal so high--then you won't feel overwhelmed." Then I saw the above quotes. It really made me think twice about lowering my goals. I've set my goal so high that realistically, I might not be able to reach it. But, who cares? So what if I don't reach that extremely high goal? Even if I miss my goal, I'll still score higher than what I thought I could initially score when I started making goals last May. I've decided to keep my goal sky high and do everything I can to reach it.


"First say to yourself what you will be and then do what you have to do."--Epictetus.


This really describes my medical school path. I first wanted to be a physician at age six when my maternal grandmother was dying of colon cancer. I didn't get into medical school right after college so I gained priceless experience as a clinical researcher. Then I took a huge risk and moved to a third world Caribbean nation that I'd never heard of before. I didn't just survive the experience, I thrived. I never expected that I would have done so well in Dominica--heck I don't even go camping! I really don't want to move back, but overall, life in Dominica was pretty great--excluding the bugs, brown and cold water and lack of groceries. If you want something enough, you just do what you have to do to reach your goals. Sometimes I think about the future--such as the USMLE, moving to Chicago, Washington D.C. or New York City (most likely New York)--and I get overwhelmed. But, I have to remind myself that I've done it before and saw success in my first two years of medical school. Besides, I decided I'm going to be a physician and now I'll do what it takes to get there--I've already done so much!


"Some give up their designs when they have almost reached a goal, while others, on the contrary, obtain victory by exerting, at the last moment, more vigorous efforts than before"--Herodotus


Strangely enough, just admitting that I feel overwhelmed at times has already made me feel more confidant. I know I can do great on these boards and I know that I have the motivation to work hard to achieve my goals. Speaking of hard work, it is time to exert "more vigorous efforts than before!"

Medical Students say the darnest things!

I was reviewing neoplasia (cancer) last night and Environmental pathology today for my Pathology lab final tomorrow afternoon. As I was reading of the horrors of cigarettes smoking, a funny comment popped in my head.

We have a class called PBL (problem based learning), which is a small group of 8 students and 1 professors. We meet weekly for two hours to discuss a case (the cases always correlate with what we are learning in class). Each case last us for 2.5 sessions over a three week period. In that time, we decide based upon the case what we would do if we were responsible for the patent's care. We have to diagnose the patient, come up with a care plan, and justify everything we are doing by using sound evidence based medicine. Each week we also have to research a topic that the group wants more information about. Some examples of things we research:

• "How to stage a small cell carcinoma? Which is the preferred imaging technique? How much does an MRI and CT cost and will an insurance company pay for a patient with small cell carcinoma to have an MRI or CT ?"
• "What are the leading causes of Lung cancers? How do they differ pathologically? What are the prognoses"
• "What is the mechanism of action of drug X and what are it's indications, counter-indication, drug interactions and other important pharmacological data?"

To some extent PBL is like the children's book series "Choose Your Own Adventure" for medical students. Anyway, one day we were having a discussion about small cell carcinoma of the lung (extremely bad lung cancer) and some of the causes. Obviously, a huge risk factor is smoking and our fictional patient was an ex-smoker so I was discussing it. Here is a recap of the discussion:

Nicole: ....thus, we can conclude that Mr. Doe's smoking contributed a significant role in his development of small cell carcinoma.

Medical Student 1: I think that is a just the doctors way of not having to do any research. Why is everything blamed on smoking. Perhaps we are missing some great advancement in the treatment of cancer by blaming the majority of cases on the patients' smoking. It just seems like a cop out.

Nicole: Well, the research I found all concluded that ... (stopped mid sentence by Medical Student 2)

Medical Student 2: (looking Medical Student 1 right in the eye) Just cause you smoke doesn't mean that smoking is not bad for your health. There are decades of research to back this up. It isn't just lung cancer, it is bladder cancer, oral cancers, emphysema, and cardiac diseases just to name a few health problems. Oh and it makes your teeth yellow and gives you wrinkles!

Medical Student 1: How did you know I smoke?

Medical Student 2: You have been smoking in front of the library throughout the day, seven days a week since January.

Medical Student 1: But I'm a closet smoker, no one is suppose to know. Does anyone else know I smoke?

All Medical students: Yes

Professor: (with Caribbean accent) Perhaps you are leaving the door to the closet a little too open. You better close the closet door tight, if you don't want people to know you are a smoker.

Medical Student 1 continued to defend smoking through and though. Most students down here who smoke at least admit they know it is bad for them but they are addicted or that they are having a hard time stopping because of the stress of medical school. Medical Student 1 made me laugh week after week because he fought every time it was brought up (and seemed to believe) that smoking really wasn't that bad. Maybe he should go work for a cigarette company rather than finish school. He could make a great lobbyist--he really believes in the product!

Rest In Peace, H.M.

H.M. was a young man when he underwent an experimental surgery to try and fix a seizure disorder in 1953. They fixed the seizure disorder, but he had anterograde amnesia; oversimplifying it, he couldn't remember after the surgery. He agreed to participated in neurological research and did so for 55 years. Anyone who has taken a course in neuroscience (and probably neuropsychology) knows who H.M. is. In Neuroscience last semester, we talked about H.M. in several different lectures about differing yet related topics. He was involved in so much research that I'm sure that there are entire books written on H.M. If I didn't have exams coming up, I'd explain more about him and what we have learned. Let's put it this way, H.M. is so significant that his brain is being perserved--like Albert Einstein. There are two interesting articles about H.M: the New York Times talked about his life and Slate talked about amnesia in general.

As a medical student and former clinical researcher, I express how much I appreciate everyone who has so shown such altruism as to allow themselves to participate in research, like H.M. There are not enough words to thank the selflessness of those who donate their bodies so students can learn in the cadaver lab or so someone else life can be saved with a transplant surgery. So with much gratitude, thank you H.M. and may you rest in peace. Your contributions to neuroscience and medicine are so vast, so remarkable and unforgettable.

Question and Answer Period

Since this is the time of the semester that professors have Q and A sessions, I decided to have a Q and A session on my blog. If you have questions that are not answered, send me an email or post a comment and I will add them to my post!

1. How often do you go to the beach?

Not as often as I would like. We have to study all the time and unfortunately, there isn't enough time to go hang out at the beach even though I live about fifty feet from the beach. Oh, and a microbiology professor informed us this semester that the beaches in Dominica are full of hook worms. Hook worm larva are able burrow themselves into intact flesh!!! There are hook worm species that affect humans on the Dominica beach (yup the burrow into you, then move into your blood supply, and finally they form a home in your gut). There are also hook worms that primarily affect dogs and cats (those will just burrow into your skin and swim around without causing disease). Thus, I really don't wan to go to the beach much anymore.

2. Why is your hair so long?

Great question Uncle Al! There isn't anyone on the island that cuts white girl hair, that is besides Farley. Do you blame me for letting my hair grow out?

3. Are you EVER coming home?

Yes, I am leaving Dominica December 18th, spending the night in the Miami area and arriving in Spokane on the 19th about 3:00pm (assuming the flights are on time). It costs so much to get home that Farley and I could have gone to Paris or Rome for two weeks (and have eaten bread crumbs) for the same price. It is a good thing we didn't check out travelocity.com before booking our flights home.....

4. How long will you be home?

Thanks for asking! I get to be home for THREE WEEKS!! I'm so excited. I leave home on January 9th to meet Farley in Miami, then we go to Barbados for the night and finally we will get back, to Dominica on January 11th. If we wouldn't have gone with the travel route that has us staying in Barbados for one night, we would have had to leave home a week earlier. I guess we will just have to keep a stiff upper lip in Barbados!

5. Why does "doctor school" take so long?

That is a great question from my favorite little 5-year old! Doctor school takes so incredible long because we have to know how to make people feel better (and fast if possible). There is so much to know to saves lives or even to alleviate pain. Besides, little one, they have to make sure that I "know stuff."

6. Is doctor school as much fun as kindergarten?

Another great question little one. The short answer is yes and no. There are days that we learn some amazing, amazing things and I'm so excited that some day I'll be a physician. Other days, I'm tired and wish that doctor school didn't take so long.

7. Are you afraid of living in an apartment with no glass on the windows?

No, since I live on the third floor and the only thing on the other side is my balcony and about a 4o foot drop. There is 24 hour security and I close the wooden slates at night (mostly just to keep the bugs out). If I lived on the ground level, I would be afraid.

8. How is your view?

It is beautiful. I can even see part of the next island over, Iles Des Sainte which is part of Guadelopue, on a clear day. Does that make me qualified to be the Vice President? Here is a picture of the Cabrits (two little mountain things at the other side of the bay) with a cruise ship in the foreground and far, far in the background you can see Iles Des Sainte (just a two hour ferry ride). The first picture is a close up and the second is from further away so you get a better idea of the proportion. Oh, and yes, these are pictures taken from my balcony.

9. What is the best part of living in Dominica?

Beautiful sunsets, fresh squeezed juice for a $1.00 for 16oz and the opportunity to travel. I'd tell you about the negatives, but I'm trying to make a positive blog. Speaking of positive, here is a picture from the hall at the end of my apartment overlooking over the sea (looking south rather than north toward Guadelopue) .

Dancin'

Farley has brought me over to the dancing side. He thinks it is imperative to dance before each exam, as he explained last February. Well, I hate to admit it when he is right, but I've had an overwhelming dance crave come over me while studying for the exam tomorrow. I even had to download Thriller because I think, with practice, I might be able to dance as well as the inmates in the Philippines. Farley would also say that tomorrow we gotta, "Showin' (professors) How Funky Strong Is Your Fight" but I wish , "It Doesn't Matter Who's Wrong Or Right." Well on that note, I've got to get back to memorizing drugs and bugs, which is clearly not as much fun as dancing or using Jackson's lyrics to describe my "battle" tomorrw, but much more important!