Most people get caught between a rock and a hard place, not a crab and four cows!

The semester is over and I'm glad we get some time to relax! I sequestered myself in my room for about 10 days...I'm nervous enough as it is, I don't need to talk to other people and get more nervous! We had our third big exam on the 17th and our final on the 22nd. I don't know how the final went, but I did great on the third exam (the class averages were the worst so far for the third exam--it was by far my best exam). Apparently, my hiding in my room paid off--I hope it worked for the final as well. Oh and desperate times call for desperate measures, I took a pen and write all of the cutaneous nerves on my legs and hands. I took some pictures of my feet and hands as well as my view from my room.

Here is a picture from my balcony. Yup, I have a million dollar view. I would study at my table on my balcony during my self imposed sequestering.

Below is the view from my desk at dusk. You can see the white railing, which is the railing to my balcony.

Below is a picture from my apartment door down the hallway to the sea. You can see the tops of the coconut trees at the end of the hallway. Those trees are about 10 feet from the high tide. Thus, my apartment is about 50-60 feet from the ocean (and three stories up).

Here is a picture from the end of the hallway, at sunset of course:

Since the exam, Farley and I have been hitting the gym like crazy people. I'm so sore! I also found fit TV in my room and they have yoga on several times a day, so I've been doing yoga as well (and I did it during my self sequestering). We've also hit the beach. What is the point of living on a Caribbean Island if you can't go to your black sand beach and relax. The campus and island is getting quiet as many people have left for the semester break, but we are just relaxing and enjoying our time here.

Above, a picture of Farley's favorite tree which is right on the ocean and on our hotel (apartment) property.

Above is a picture of the dock near my apartment. Looks a bit rickety, Hun?

The pelicans are all over the place, which is MUCH better than seagulls. I hate/fear seagulls and the wonderful island of Dominica doesn't seem to have any! From my balcony, I can watch the pelicans dive into the ocean and pick out fish. They are fierce hunters.

The rain forest meets the sea...and there is a little river comes running down to the sea. There are several little rivers running into the sea, but what is interesting is that some of them are hot springs and others are cool mountain water. You never know.
Farley was in the midst of the rain forest little river and took a picture of me walking toward the sea with our beach bag. He thinks it is the best picture ever, so I posted it for him.

Here I am in my "old lady" bathing suit. I don't care what anyone thinks, I love it! Below is Farley, looking good. We couldn't find anyone to take our picture together, so sad. We had walked down about a mile from our apartment in the water; this picture is taken about a mile south of our apartment looking north (toward our apartment).

On Tuesday night, we went out to dinner. We were taking the trail through campus and saw a huge crab. After navigating past the crab, we saw a blockage on the road: FOUR LARGE COWS. Usually the cows don't really get in the way, but they looked as if they meant business that night, so we had a decision to make: take on the cows or retreat and take on the crab again. After a quick analysis of the situation, we decided to retreat and take on the crab again. He was still there, so we meekly skirted the crab's territory, which he defended like a warrior. I have a shaky picture of the mean crab, he was so scary, we were shaking in our flip flops.

We leave for St. Lucia on Sunday morning. We both get seasick, yet we are taking the ferry. We have our motion sickness and we are ready to go. It should be a great fun time. We get to stay at a little hotel for three nights in the capital city and five nights at an all inclusive resort...that's right all inclusive means drinks too!! It is going to be so much fun to have a Caribbean cocktail or a glass of wine and sit on the white sand beach. I'll take LOTS of pictures--my camera is charged and ready to go.

Medical School is a pain in the neck

Now, I mean this literally: medical school is a pain in the neck. My neck REALLY hurts. We have an exam tomorrow and a final on Tuesday (we had two exams last Thursday and one the week before). I don't mind having so many exams, I just wish we had a ton of exams throughout the semester rather than a handful of big exams (all within a couple weeks nonetheless!). The one good thing about medical school (okay there are many amazing things about medical school, I'm just tired and cranky now): I can now name the muscles in my neck and back that hurt. Medical school is the whole package, you get knots in your neck you didn't know were possible and you name the muscles that must be causing the pain. I guess a girl can't ask for much more. I better get back to reviewing the Embryology of the cardiovascular system (our Embryology professor is an angel sent from God to teach us this difficult, yet amazing and interesting subject--I'm surprised anyone is born without a birth defect).

Boneheads surround me....

Apparently, there are a group of boneheads in my class. There was some cheating on the first anatomy practical exam and we all paid the price: sequestration. It was like my own personal hell. It was so loud and people were getting nervous and passing the nervous around. I had in ear plugs and could still hear conversations all around me. It was horrible. If I was someone who got migraines, I would have had one. As if that wasn't a bad enough, we had a histology practical in the morning (when they said, the practical was only accumulative in regards to the new things we had learned--such as recognizing the skeletal muscle in the true vocal cords, well they misspoke and many of us didn't review as much as we would have if they would have said that it was actually cumulative in all respects). Anyway, Thursday was yucky!!!

One good thing about Thursday was that I found a yoga program on Fit T.V when I came home, so I did yoga, then walked on the beach at sunset. Farley came over after he took his anatomy exam, and uncharacteristically, was complaining about being sequestered (can't say I blame him as I'm complaining now). We ordered dinner in and watched T.V.

I thought I'd be back in the study game by Friday, no such luck. I thought I'd be back on Saturday...Well, I was by Saturday afternoon. Sometimes despite wanting to study, your mind says, "NO WAY." Anyway, I'm glad to have my focus back. Speaking of focus, I better get back to the books. I can't wait for the exams and studying to be over for a few weeks and to be on my way to St. Lucia. However, I found a cool chapter in my medical genetics book, so I might be taking my medical genetics book to St. Lucia---I guess that is why I'm going to medical school. If you don't LOVE medicine 365 days a year, becoming a doctor isn't the right profession.

Exams and St. Lucia

I don't get to go home for the semester break. I miss home, family, good food and wine, my comfy bed, and of course consistent hot water. It is so expensive to get from the beautiful island; thus, I don't get to go home. In fact, it is so expensive that I can go to St. Lucia for a week at an all inclusive resort for hundreds cheaper than it cost to fly back to Miami; so, goodbye Dominica, hello St. Lucia! I'm pretty excited about this trip. Farley and I both get sea sick, but that isn't going to hold us back. We are planning on taking the ferry. We will GET to stop in Martinique ( I think in the little Paris), then on to St. Lucia. We might stay the night in Martinique and have wonderful French pastries, wine and I'm sure wonderful coffee. We would go to Martinique for the whole vacation, but it is on the Euro, which is makes it very expensive (they are French). Anyway, I'm excited for our vacation. I can't wait to sit on a white sand beach and having a nice Caribbean drink while reading a book (that isn't titled, "Human Anatomy" or "Pulmonary Physiology: The Essentials"). This trip is giving me the energy to keep studying hard, even when I'm tired.

Since we can't go to St. Lucia for the whole three week vacation, I intend on spending my time on my local black sand beach. You know, the one that is about 50 feet from my apartment (see the above picture from the west side of my building that puts me right on the beach). I think I'll go hiking on the Carbrits (the two "mountains" in many of my pictures). I might even see if I can talk Farley into taking a boat ride up the Indian River to see the amazing parrots of Dominica. There are also islands tours at the beginning of the semester, which we can participate in. It will be great!

But before, I get to enjoy the wonders of the Caribbean, I have to attack the upcoming exams. I've been having trouble concentrating the last few days. Farley and I decided to take a nice walk in the ocean (see below picture--I can't seem to post to my blog without including a sunset picture), went to dinner at Subway then headed to the anatomy lab. I think the mental break (I did get some work done, just not as much as usual), is exactly what I needed as I feel like myself again. I'm ready to attack pulmonary physiology.

Before, I can attack pulmonary physiology, I have my last anatomy lab of the semester: posterior mediastinum. I just love the mediastinum: it is where the magic happens. The mediastinum is the space between your lungs and there are SO many things located in this little space: your heart, great vessels, thymus, lymph nodes, and many other exciting visceral structures. It is just jam packed with important structures. I'm ready to be done with anatomy lab for the semester, but I'm excited about the information we've been covering in anatomy. Learning the muscles organ, insertion, blood supply, nerve innervation and function is just a lot of memorization and isn't the most interesting thing to me. However, looking at the heart, lungs and other important structures is so much more interesting. Our semester is finally starting to intertwine, for example, pulmonary in physiology, anatomy, doctor patient and society and histology. SO much better!

I never post pictures of the mountains, so here is one. I've never lived anywhere as green (literally, this place is a giant rain forest).

They break you down to build you up...again and again.

I don't know it if is a good thing or a bad thing that we have 50% of our grade on the line in the last three weeks of school (really mostly in the last two weeks). We had our practical in Doctor, Patient and Society last Monday, we have two practicals on Thursday (anatomy and histology), our third written exam is the 17th and our final is the 22nd. I am a worrier and I've been so good, but everyone has their limits! I'm trying to stay calm and focused, but it is getting stressful.

I've never been in the military (nor do I want to be), but I hear that during boot camp (or basic training or whatever they call it) the recruits are broken down then rebuilt. Well, I can tell you without a doubt, medical training is the same way. As you talk to students further in training become more calm and confident. They talk about the first few semester like it was a battle they barely survived; however, once they get toward the end of the second year they are more confident. This is good since you take your first boards in your 5th semester: the USMLE step 1 (DUN DUN DUN). This test has a huge impact on what residency you will get. Bottom line, you MUST pass. If you want to be a plastic surgeon or a dermatologist, you gosh darn better get in the upper echelon. However, medical training isn't done breaking you down after you pass Step 1--now you go into the hospital and realize that you really don't know much of anything. Okay, that isn't fair, you know a LOT of stuff, but you probably don't know how to use your knowledge yet. So, the next two years of clinical rotations will break you down and build you up again. Then you get to take the USMLE Step 2 (not as important). After you pass that, your feeling great--Your name is now Doctor! But the medical community isn't done breaking you down and building you up, because now you are an intern (your first year of residency). Yup, the bottom of the barrel again with TONS to learn and another set of boards-USMLE Step 3 (I don't think it is as bad by this point, but then again, I don't know yet). You will finish your residency and be back on top, then you will either start a fellowship or join a practice as an attending---bottom of the barrel again. I guess you get the idea.

I suppose it isn't any different than another profession: the young and less experienced have a lot to learn and they will be put in their place by the more experienced and wiser teachers. However, in medicine as in the military, lives are on the line--it is just a little more intense.

Speaking of intense, I've got an intense study regimen and by break is over. I just love sea side sunsets and I take tons of pictures. Today, toward the south there was a storm brewing and looking south was beautiful. Hope you enjoy:

The above picture, was looking toward the Cabrits (the two mountains) toward the north part of Dominica.

Looking south (the pier is coming from the restaurant at the hotel (I live in a hotel)). A storm came in about an hour after I took this picture; but it just rained out to sea.

"I need a hero"

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

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

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

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

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

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

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

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

A taste of practical medicine

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

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

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

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

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

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

Here is another picture of beautiful Dominica:

Pay Back STINKS!

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

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

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

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

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

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

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

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

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

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

Blackout!

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

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

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

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

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

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

The Views of Dominica that I have MOST of the time.

I thought you'd all like to see a picture of my books. Not too bad for this semester. Now, some of them are review books, like First Aid, but most of them are my test books. I'm sure you are jealous. However, my book store sized collection of text books shouldn't be what makes you jealous, it is my white erase board and my book stand.

As you maybe able to tell, these two tables are right next to one another. Some of my most important tools are one this table: my dry erase board, book stand, and COFFEE MAKER. Note the coffee maker is within reach at all times. I suspect that you are wondering what I've written on my white erase board. Luckily for you, during my study break, I was camera happy.

That's right. These are the clotting factors. Did you ever wonder how the amazing connective tissue, better known as blood, makes a clot and how it degrades the clot. You could study my color coordinated white erase board then you can listen to my super notes.

If you look closely in the background of the previous two pictures (I know it is difficult to pry your eyes away from my ever so interesting books), but my balcony is behind the wooden slate windows. Yes, having a studio apartment makes things easier (yet, I still manage to scare myself at night on occasion despite Farley is next door, I live on the 3rd floor AND there is 24 hour security--sometimes I sleep with my maglight....). Anyway, there is a beautiful view, but you can't see it when your nose is buried in a book.

I usually have my meals on my balcony looking at the BEAUTIFUL ocean. However, the cows sometimes get in the way. I don't live on Moo Cow Lane but sometimes, there are cows outside my apartment. That's right, I live in a village, without even a stop sign nor street names...Moo Cow Land and Banana Tail...NO STREET NAMES. At any rate, the cows eye ball you when you walk by them, they are loud, and they run shockingly fast. Oh, and never ever say to a cow when walking by, "Good morning Betsy, how are you?" They tend to turn around (in a 180 degree turn) faster than you can blink an eye, move toward the street and look around. I think she wanted to say hello back to me, but the people behind me on the sidewalk, were not so amused (they looked pretty scared...cows are BIG animals). I haven't gotten a good picture of the cows from my apartment since they aren't around THAT much, but they were in the field that is in front of my favorite study area. Here is a pictures of my favorite bovine from my apartment (in front of my favorite study area).

I realize that it is still cold up north, so I decided to throw in another picture of the sea from the Sea side deck at school. I know, most schools don't have sea side decks (it is the upper deck, we have a lower deck too).

RUSM...Is it Ross University School or Medicine or Rumor University???

Well, as previously posed, the exam was a disaster all around (please see my 2/21/08 post). There were numbers floating around that approximately 54% of the class failed biochemistry. Well, the chair of the biochemistry department gave us a little talk today and it was even worse than the rumors: Over 60% FAILED biochemistry. If anything, I thought the numbers that were floating around would be worse than the actual numbers, but they were actually better. He also confirmed that if 25% of the class or less got an answer correct, the question is automatically dropped. Unfortunately, when he reviewed some of these questions, I got some of them correct (this means that having the questions dropped actually HURT my grade). Why couldn't my peers miss the questions I missed (or why couldn't I miss the questions my peers missed)? All I know is that it was a BAD exam all around.



We haven't gone out for a fun evening since school started, so Farley and I decided to go to dinner on Saturday night at Tomatoes, which an American type restaurant run by Canadians (from Vancouver, BC....they must be good people; they are from my neck of the woods). It was nice to have a real red wine (from France). I don't know that I deserved a nice evening, but it sure was great to get out for a couple hours.


If you look, I even have a tan! I think I am losing weight as well. Apparently the stress, chocolate and coffee diet works well! But that might also be why doctors have a shorter life expectancy than the rest of the population.

Finally, I'm posting!

WOW, it's been a busy few weeks and I haven't seen much of Dominican in a while. We had our first couple exams of the semester. During the anatomy practical, there were 40 questions. We were in a line, each person had 40 seconds per station where there was one body (or radiograph) tagged. You had to walk from the stations, review the question and answer the question in the 40 seconds before the bell went off telling you to go to the next station. You could NOT go back and double check any answer after the bell rang. I did very well on it and was pleased with myself (after spending much of the preceding weeks up to my elbows in a cadaver).

On Monday we had the written exam. It is very much like taking a standardized exam. All of our subjects are on one exam, which is 120 questions (you have 2.5 hours to complete it). It was horrible. After taking tests at Ross University last semester, I was shocked by this exam. Unlike last semester, it didn't closely reflect what was taught nor was the information applied clinically. However, we had more MDs teaching last semester and this semester there are more PhDs, which would change how they write questions. Not all doctorates are equal. There are different purposes of an MD, OD, or PhD and it reflects in their training and the way they teach , explain concepts and write exams. Obviously it makes the most sense to have a PhD in biochemistry teach a biochemistry course; however, if an MD taught the course it would be taught very differently as an MD would probably teach what they use daily rather than strict bench science.

I did okay on this written exam, but not as well as I expect myself to do. However, things could have been SO much worse. Rumor has it that approximately 50% of the class failed the entire exam. FAILED THE EXAM-- in every subject. There is also talk that someone got a 14% on the entire exam. That means that this person got about 16 questions correct out of the 120 questions. I think this is a person who really tried and just got really confused, because statistically they should have got at least 20-25% just by chance (given that we had 4 or 5 answer choices). Nonetheless, this was a bad exam. I don't think the grades are even finalized yet since it was so bad. There is an appeals process in which our class representatives argue that unclear questions are either thrown out of the exam or that two answers are correct (double bubble). I believe that if 75% of the class misses a question it is removed or if the top 15% of the performers on a particular exam miss a question it is also removed. THEN to complicate the situation even more, there is a 10 point range that is the mean passing score(MPS) can fall into, which is based upon how the class performs on the exam. The MPS; however, is not a curve. Generally with a curve, a certain percentage of the class must fail, but with the MPS system , no one has to fail the exam. Basically, you need a doctorate to understand the grading system--then again not all doctorates are created equally.

Anyway, I've decided that these PhDs are not going to get the best of me. In addition to my beautiful notes (Farley and I might just have to copyright them*), I'm taping myself reading these amazing notes and listening to them pretty much when I'm not in class (I'm even listening to them right now....Hemophilia A is a deficiency in Factor VIII and it is an X linked disease). They are even on my iPod. I know you are jealous: if you want to listen to my saintly voice reading biochemistry/histology/anatomy/medical ethics/or physiology notes, you can let me know and I'll try to email (sell?) them to you. Oh, but one great thing is that we started hematology this week and we have been doing LOTS of medical ethics in our Doctor, Patient and Society class. At least they are playing to my strengths.

* The professors give us "learning objectives" for each lectures. Every class, Farley and I type as fast as our fingers will go and try to answer all of these objectives during class. After class, we combine our notes to make super notes. Our beautiful notes didn't miss anything on the last exam; but the professors decided to test on things that they didn't stress or mentioned in passing. (In fact, a couple questions were on things we hadn't covered yet. ) I guess I'll just memorize every single word this time.

The Great Indoors

I just realized that I spend more time with dead people, than I do with just about anyone else. It is amazing to me that I'll be digging around some poor soul's axillary regions and two hours will pass. I don't even like anatomy that much, but I guess the old adage is true: time flies when you’re having fun (even when fun is being up to your elbows in a cadaver).

Some of you may be thinking that I actually get to enjoy the Caribbean...not true. Since classes started, I spend most of my time enjoying the great indoors: unless you count the bathrooms. See, here in Dominica, there are no bathrooms that have entries from inside. You have to go outside the building, walk around, and then enter in from the outside. I've seen a couple exceptions to the 'walk outside for the bathroom rule,' but in those cases the walls were shorter than the ceiling so you have a stream of light coming in from the outside. Pretty nice, hun? The only exception to both of these rules is my apartment, which has beautiful concrete walls, which are as tall as the ceiling. The only good thing about these Dominican bathrooms is that they are all clean. I do fell a bit like I’m going to the bathroom in a city park and once I saw a mosquito sitting on the toilet paper trying to outsmart me, but that is another story. At any rate, at least the bathrooms have toilet paper, soap and running water.

Speaking of bathrooms, when we were on the island tour I had to find a bathroom. To my dismay, they closed the bathroom near the tourist site we were seeing so I had to go into the little town and use one of these outdoor/indoor bathrooms that belonged to a bar. It was the strangest thing. Obviously with my fair skin, I stand out. As I was trying to find this bathroom, I was met with high-fives, handshakes and "hey, pretty lady you must need the bathroom" cat calls. Finally, I made it to the promised land: the outdoor/indoor bathroom. This one was a standalone building with teal paint. Sometimes at these tourist places, they make you pay $1.00 EC to use the rest room. I'm shocked that I managed to keep my $1.00 EC away from the high-fivers and handshakers (didn't need it for this bathroom). The bathrooms were not LABELED. I saw a gentleman near one entance, so I assumed that I needed to go to the other. Well, another guy came running and calling out to me, "wrong one, lady. The lady's room is the other one." It was nice of him to warn me and I'm sure the nearby locals were laughing at me.

I finally found my correct bathroom. Unlike every other bathroom in Dominica, this one wasn't as clean or well equipped. However, it wasn't the worst bathroom I've ever seen. As I was heading back to the bus, I had the strangest experience. All of the highfivers and handshakers wanted to know what I thought about the bathroom: "How was our bathroom, pretty lady?" What does a girl say to that? All I know is that this was more excitement than I ever wanted out of a trip to find the bathroom. But apparently I wasn't the only one who thought finding this bathroom was too much work: some of the local gentleman made their own bathroom... on the grass. I guess I should stop drinking so much water.

I dare you to find the bathroom here at the Carabantic....good luck and watch out for high-fives. They don't call it the "Nature Island" for nothing!

VIruses remind me of the cold war..

One could take me literally noting that the common cold is primarly caused by rhinovirus and that every year we fight a war against colds. However, I'm not speaking of an actual cold when I say that viruses remind me of the cold war. No, I'm talking about the military percision, spy vs spy, sinking battleships, or intense capture the flag. There are sneaky viruses that quietly enter the cell, replicate and lyse (or POP) the cell to get out (murders--killing their host). Others are worse: they hang out using the cell to replicate under the radar of the cell. They are like the neighbors who steal your cable. You don't even know they are there. However, if the virus recieves a single that things are not so good in this cell anymore they, they jump ship. They rapidly reproduce until there are too many for the cell to hold and BAMB---they lyse the cell (killing the cell). I think it is so interesting--I guess I just like little things: viruses, bacteria, genetics, cancer, embrology and children.

I've been meaning to write to my blog, but I haven't been very exciting in the last week. It was Carnival last weekend. Pretty much the whole island shuts down to "jump up" and "party, mon." I was going to go to Portsmouth (it is the next town over--about a mile), but I decided to study. However, I could hear them. Since my apartment is on the water, I could hear the party. The noise was amplified accross the bay. I could hear the lyrics to the songs, the cheering, and drums. The funny thing is that, they don't REALLY start to party until about 2:00am. It was almost comical. I woke up the next day, and they were still going. I don't think they stopped all night. Actually,I know that they didn't. Carnival was one of the things that I was most excited to experience; however, I'm here to become a doctor--not a super partier. Thus, I had a lot of fun getting in an extra day of studies. Honestly, I did have fun because I REALLY love embrology. I've thought about becoming a fertility specialists and these lecture are peaking my interest.

This is my current favorite picture of the island. It is from our Island Tour a few weeks ago.

I can't wait until I'm dead to sleep...

I heard that there has been over 17 new inches of snow in the last couple days at home (and it's still snowing), so I thought that all of you would need to see a Caribbean sun set. I know, you don't feel too badly that I have a million and one mosquito bites. I was told that the mosquitoes get bored with you after a few months, but the mosquitoes are not sick of me.

I haven't been sleeping well the last week or two. I'm not sure what it is but I've been waking up, not able to fall back asleep, and overall cranky. Last night, I actually slept through the night. IT WAS GREAT! I'm so excited that I could sleep. I feel that one of my down falls as a future physician, is that I function MUCH better on 7-9 hours of sleep. I can do 4 or 6 hours, but only for a day or two before I really feel the effects. I've been getting about 4 to 6 hours of INTERRUPTED sleep for the last two weeks or so, thus, my 7 hours of uninterrupted sleep last night was amazing. Attempting to achieve 7 hours of sleep a night in medical school, takes a lot of time management. There are a million things to do and you only have so many hours to do them. You do need time to rest. In fact, there are parts of the sleep cycle that help your memory retain the information that you've been studying. If you don't get enough sleep, your body can't process the information as well and you won't remember as well. The way I see it, this is a win, win: I am MUCH happier with sleep, it helps me focus while studying and retain the information. I guess I'm not as tough as the people who say, "I can sleep when I'm dead. "

Genetics...Are you a mouse or a man?

I'm reviewing my genetics lectures from last week. I REALLY like genetics. It is incredibly interesting and it makes sense to me. It isn't like enzyme kinetics...who really cares if it is non-competitive or an uncompetitive inhibitor (well other than me because I have to pass the exams). Moreover, who came up with the stupid inhibitor names: competitive, uncompetitive, non-competitive, mixed and suicide (which really is a kamikaze inhibitor because the enzyme doesn't commit suicide...it's killed). Don't get me wrong, I realize that I need to understand enzymes and that they play a big role in pharmacology, but they still aren't that interesting.

Since genetics is the coolest ever, I thought I'd write a little note to my blog. Did you know that mice and humans have approximately the same amount of genes in our genome, which is about 30,000 genes. Does it make you wonder how we can be so different? Well, humans are able to make MANY proteins from gene where as mice are only able to make a few proteins. In fact, humans get about 1,000,000 proteins form the 30,000 genes. That's right, we get about ONE MILLION proteins from THIRTY THOUSAND genes. Are you wondering how we do this? Well, humans have many means of post-translational modifications (modifications to the RNA before it is transcribed into proteins).

I think that is enough of a very simplified introduction to the wonderful world of the human genome. I know that you are jealous: I get to keep studying this the rest of the afternoon and your tutorial is done. If you can't keep your excitement to yourself, let me know and I will give you references so you can start your own adventure in genetics!

Death Becomes Her....

We had the first of many cadaver labs this week. My class of about 500 is separated into three groups, within those groups there are four pods, and twenty bodies. Therefore, about 5-6 people are dissecting the body at a time. There are two dissections per week, but only one group disects at a time (although everyone is responsible for all of the information from all the dissections). This works out to each group disecting once every week and a half.

I thought that I would dread the lab, but so far, I have to admit, I like it. It is really interesting to feel muscles and ligaments, to see nerves, to hold the spinal chord, to compare arteries and veins (if you squeeze an artery it keeps it's shape; but if you squeeze a vein it will flatten out). I am the only female in my lab group. I want to show that I know just as much, if not more than they do. I think I was successful this week. There were a couple of pushy people in my group (as always) and I knew my information as well or better than they did, so I was able to hold my ground. In fact, I was able to field questions from the professors that they were not able to do. I feel like it's me against them, which I know isn't true. I guess if it motivates me, than it is okay.

Actually, one of the best things about Ross University is that students are REALLY helpful. There is a camaraderie amongst us. We are so isolated on this little island, which I think has helped cultivate this culture of help. Many medical schools are notorious for being a dog eat dog, tell someone the wrong answer so you score higher on the curve, steal your neighbor's notes kind of place that it is nice to be here where everyone wants everyone else to succeed. Upper class man even ask what semester you are so that they can give you old, electronic notes and study guides. That is almost unheard of other places. For example, I was in the anatomy lab and saw student A looking for a structure. Student B, in the semester ahead of student A, stopped her own review to help the student A. It is amazing.

Back to the cadaver lab. It is an interesting experience. Apparently, it costs $15,000 per cadaver to prepare them and bring them to the Commonwealth of Dominica. After that, the University has to pay to keep a staff to keep them in prime condition in addition to the facilities (which are top notch). Many medical schools are going away from the cadaver lab: they are expensive and bodies are hard to come by. It should be noted that a disadvantage of the cadaver lab is that the structures have a bit of a different texture due to the embalming process (I'm sure there are many other disadvantages that I don't know about). Nonetheless, nothing can replace actually getting your hands on a body and both seeing and feeling it. Things make so much more sense when you can actually see the structures and how they relate to each other. Even the best text, can't replace the experience (computer models are in the works, but I don't think they are available yet).

My gentleman is a 58 year old, African American man who died of pancreatic cancer. He has BEAUTIFUL back muscles. I think it is because he is SO young and usually pancreatic cancer is a quick death. I was surprised to see him when I opened the bag. When I think of someone who donates a cadaver, I think of a VERY elderly person that died of old age with kyphosis (often referred to as a "humpback" appearance, which is caused by the exaggeration posture curvature of the spine, usually in the thoracic region). This probably sounds very strange, but my cadaver looks like a real, LIVE person. He doesn't have muscle atrophy, his hands are in a natural position, and his skin is still shockingly soft (many of the cadavers dry out and get very hard). Sometimes I look down and have to remind myself, he is dead (but it hasn't stopped me from talking to him when no one is within ear shot). They say that your cadaver is your first patient, they aren't kidding.

The cadaver lab is really an amazing gift. I suspect that most of these people wanted to be organ donors but, for whatever reason, could not. If you can't donate your organs, I guess the next best thing is to train physicians. Think of all the patients that will be positively effected, maybe even saved, by the altruistic gift of those who gave their bodies.

On a lighter note, Farley and I got our barrels on Tuesday night. We sure packed a lot of stuff in there. When we were packing them in Miami, I fell into the barrel. Luckily, I managed to get myself out before Farley noticed. I told him about it later and he was so sad he missed it. After weeks of pleading, I gave him a re-enactment. Please see the picture for a good laugh. Note that I'm not even half way down the barrel. They are VERY big (75 gallons).

Today, we went to the market at 600 (who gets to sleep in on the weekends anyway). Unfortunately, it wasn't my day. I lost my sunglasses. I LOVED them and I'm very sad. They were Serengeti sunglasses, which are AMAZING. Luckily, I have recruited Dad into finding me a new pair and shipping them down here. I will buy a cheap pair down here to get me by, which will increase my appreciation for my brown lens sunglasses. Next, my mag light fell out of my bag. Now those things are made to be both a flashlight and a nightstick so they are tough, but the light bulb isn't so tough. It broke. I think I can pick up a replacement bulb down here. Then, I went to make breakfast and it was down right horrible. I'm a good cook, but I think today just isn't my day. I've decided to stay out of the cadaver lab today, as I don't want to loose anything in the cadaver!! (I had a professor who lost her glasses in the abdomen of a cadaver...I think that is when it is time to go shopping).