Finished the semester...

The test on Monday, went VERY well. Much better than I anticipated, so I was extremely excited. In fact, it might have been one of my best of my medical school career. I didn't check the grades yesterday, but they did come out unexpectedly. Right after the final, I checked my exam from Monday and I was so excited. Farley and I are just relaxing and enjoying the beautiful, sunny day before heading to the frigid north (well, one of us is going to the frigid north). We still have to wait for the final exam grades and the overall final scores, but it is so nice to be able to relax because Farley and I are both in good shape going into the final.

Another test down, one to go this semester

The test today was so incredibly difficult. Farley commented that he thinks we might have more information for this single test than we did for the entire first semester. Well after I looked at my four-one-inch binders and the piles of papers that didn't fit into them (for just the last 1/3 of the semester), I realized that he is probably correct. See, I had four one inch binders for the entire first semester. The total binder space that I have filled this semester: 2 two inch binders and five or six one in binders. Speaking of all of that binder space, I have to review it all by Wednesday at 8:00 am when we take the final.

When I spoke to Mary this weekend she kindly pointed out that if medical school was easy, than everyone would be a doctor. She is so sweet and I find it a bit humorous. She is a PhD candidate in cell biology (I believe her PhD is in cell biology) and probably one of the smartest people I've ever met---including all of the professors and physicians that I know. Also, don't forget that I got to go to international research meetings on childhood cancer AND I'm including all of those renown brains while making this bold statement. It is a good thing that she is researching T.B. cause with a brain like that, she will save lives. PhD programs are not for the faint of heart either!

The dichotomy of time!

There are just hours left in this semester. Both too many hours and not enough: a dichotomy of time. I am so tired of studying. Having only about 16-19 days off per semester break sounds good in theory, but in reality isn't enough time to relax because you spend at least seven of those days waiting for the grades to come out. Why do we have tests worth about 50% of our grades in the last week or two of EVERY semester? It boggles my mind and stresses me out (poor Farley, I tend to cry a lot this time of the semester). Which makes waiting for grades even more stressful at the end of the semester because you can be passing everything and if you have a bad couple of weeks: BAMB there goes your GPA. Anyway, two more test to go (Monday and Wednesday) and luckily for me, they are worth 50% of my grade in two classes, 4o% of my grade in one class and only 20 or 30% (can't remember) of my Behavioral Science grade (as we had the shelf on Thursday, Behavioral Science is NOT on the final, but don't worry, they still did about 45% in five days). I think the stress at the end of this semester may be the worst so far (even though we had 10 days in 14 days last semester) because we've been almost going at medical school non-stop for a year. The stress just builds in Dominica, which is probably good mental training for when things will matter the most and be a million times more stressful: treating patients in life-threatening situations.

I think I'm done whining, for now. I don't enough time to take a longer mental break--there is SO much to study and review. Yet, I can't be done with this semester soon enough!. I can't wait to relax, actually get a good night's sleep and see family. Oh, the dichotomy of time on this little island!

Behavioral Science Shelf

We had our Behavioral Science Shelf today. A Shelf exam is from the National Board of Medical Examiners (NBME) and is a standardized exam in a subject that is given nationally. It is like a SAT or ACT for a subject, but worse. Shelves are good for students and schools because they are a measure of you (or your school) vs. everyone else in the US. The NBME is also the governing body who is responsible for the USMLE (United States Medical Licensing Examination). Anyway, a shelf exam is always a lot because they are information from more than one semester (this one covered things from every semester of medical school) and they involve a lot of reasoning. In fact, it seems (I could be wrong) that they might talk about an obscure disease (or something they expect that you don't know about) and based upon background knowledge, they expect that you can answer a question using reasoning about this topic that they didn't expect you to know about.

Last semester, we had to take 5 shelves in less than two weeks. That was horrible. This semester we only had this one shelf and it was okay. There was enough time to actually STUDY the information, which was nice. With so many exams last semester, it was a matter of just doing the best I could with the time I had. Also, I don't think this was as conceptually difficult as some of the exams last semester, such as neuroscience or biochemistry. I think that a lot of the behavioral science exam was (1) keep patients safe (2) protect confidentiality (3) know when to break confidentiality (4) how to diagnose some psychiatric disease (5) what drugs do you give/or why do you give that drug and (6) how to talk to patients/interview patients/be nice! This was the first (and probably only) medical exam that I have finished about an hour early. I usually finish a bit early, nothing like today (Farley was done early too, but he is generally quicker at exams than I am). I found it interesting that at line in the bank people were saying that they couldn't finish the exam, they didn't study at all because "who can study behavioral science?" and they were so tired from all the reading (the "stems" or questions are long--sometimes several paragraphs). Farley and I didn't have these problems, but then again, we DID study for the exam and probably did at least 300 questions to prepare. It is hard to know how we did, but I expect that Farley and I will both be pleased. Taking exams is like being an athlete. You can't just go out and play in the Superbowl if your only practice is memorizing the plays on a white board: you have got to get out there and PLAY the game to be prepared. In the case of a medical student, you can't just read books and notes, you have GOT to practice questions.

Less than a week left. Oh gosh, I can't tell you how excited I am, even if that means I'm leaving 80 degree weather for a blizzard!! My mind needs a break and I need to see my loved ones (well, other than Farley)!

One test down, three to go.

We had our pathology lab final today and boy was it a dozy. I didn't know up from down after leaving that exam. I had heard it was bad last semester so I wasn't as shocked as some of my peers were. I really have no idea how things turned out on this exam. There were stretches of questions where I thought, "gosh darn Nicole, you are so good they could just give you a doctorate now" and other stretches of questions that I thought, "Did I forget to look at a lecture? I've never heard of this." The funny thing is that when I leave a test and have no idea how it went, it usually goes pretty well.

I wish I was done and could relax, but alas, I'm not. We went to the gym after the exam (guess whose idea that was) and I probably have to get back to studying. Just a couple weeks left.

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!

It's the MOST wonderful time of the year....

Despite having 50% of my grade on the line, in way, this is my favorite time of the semester.
Don't get me wrong, I do NOT like all of the pressure of the last two weeks; geeze, we've had 13 weeks of classes and they decide, every semester, to make the last 2 weeks worth at least half our grade. I have no idea how they schedule exams or grading at U.S. Medical Schools, so I can't complain too much and I'm getting used to it. Besides, I don't have time to whine, too much studying to do. Which brings me back to why this is the BEST time of the semester: NO CLASSES. We had our last classes on Tuesday (well most of us did, one of us was home sick all day feeling sorry for herself). That means that we have over two weeks to study for four exams. It is like an early Christmas present. Last semester we had 10 exams in 14 days, this time I've got 4 exams in about 17 days....much better. I GET to wake up every morning and study for hours and hours without the distraction of class. It is so nice. I am back to being a lean mean study machine (that might have had to do with sleeping for over 18 hours on Tuesday, but I'm not a doctor yet so I can't have an official opinion regarding health unless I run it past an attending). Anyway, I just hope the next couple weeks go well and then BAMB, I'll be home!!!

Then it will really be the most wonderful time of the year: Christmas. There is one fake Christmas tree down here and the lights sing "jingle bells" but it isn't the same as watching the snow falling while sitting around a fireplace and drinking hot chocolate in the Great Northwest with friends and family. Speaking of the Great Northwest, here are a few pictures from last year when Farley came to visit and we went to Walla Walla:

Oh, and this one is from outside of Clinks! I love Clinks almost as much as the Davenport!! I shouldn't get started or I'll start listing all of the resturants and places that I love at home.

But in Dominica, it is still sunny and 88 degrees with a 30% chance of showers--everyday. Yup, it is lovely. I fully intend on going either to the beach or the pool (or both) after my exams are completed. Here is a recent picture of the Caribbean Sea with a palm tree frame:

Christmas isn't quite Christmas unless it is cold. See you soon!!!

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) .

And I thought MY exam was funny....

After speaking to my peers, I realized that as humorous my examination of the physical exam was, other people had more humorous situations. How about the student with the heavy accent who repeated her patent's name as "Pepsi" rather than "Patsy," the patient who started to fall asleep during the exam (excuse me miss, could you please say "99" each time my stethoscope touches your back....zzzzzzzz), or the patient who refused to follow directions (sorry Farley, that was your patient). My favorite was from Farley's exam. When conducting a general survey, the medical practitioner must comment on weight and BMI. Apparently the student in Farley's group made a comment that the patient was obese and she went from dazing off into space to glaring at him for the rest of the exam. Farley also said that she was VERY obese. I think it isn't the most kind thing to point out someone's weight in front of a group of white-coat-wearing-students, but we have to do it. The thought of this woman glaring at the student, like it was his fault, just makes me chuckle.

An exam of how I perform a physical exam....

Let me introduce you to my dear friend, Bates' Guide to the Physical Exam and History Taking. Our syllabus for Introduction to Clinical Medicine (affectionately known as ICM) states that, "Bate's Guide to the Physical Exam and History Taking" is the prescribed book for ICM curriculum. Now there are other suggested books, but this is THE book. Our exam in ICM today consisted of performing part of a physical exam and let me tell you Bate's was a lifesaver. If there was anything that I wasn't sure about or couldn't remember, Dr. Bickley discussed it in her edition of "Bates" and she also had a DVD so I could watch a master in action. There are videos of our professors performing the same exams, but they were done during class so you had to skim though an hour of stuff to find what you need; whereas, these videos by Dr. Bickley were five minutes or less (which is how long we had to perform the exam).

This exam is probably one of the most important things that we've learned how to do thus far in our training; however, the exam today was only worth 2.5% of our Behavioral Science grade. It is a bit of a bummer because it took so much time to master all of the exams (they are not hard, but there is a very specific order in which you are required to do them and according to the nurses and PAs in my class they are much more detailed than what is required of other professionals). Farley and I practiced the 14 physical exams at least 4 times each over the weekend, plus we did the exams that we were less confident about an additional two or three times; in other words, Farley did 56 exams on me plus the extra practice exams that he wasn't as confident about (and I did the same to him). I think we can safely say that our measurements of our JVPs are within normal limits, our carotid pulses are monophasic with a brisk upstroke, all lung fields are negative for bronchophony, negative for egophony and negative for whispered pectoriloquy, and finally the apical impulse is focal, in the mid-clavicular line of the 5th intercoastal space, it is tapping, full and lasting less than 2/3 the length of systole. Yes, Farley and I are healthy. Well, we are healthy as far as I can tell based upon the exams that I know how to perform at this time.

Speaking of the exam, it was rather amusing. So ten of us walked into the room, washed our hands and took our seats. A rather robust early 30s local woman was our patient. We had one professor grading us and one student a semester ahead of us as a second grader. Then the fun begin. There were 14 cards lying upside down on the table and as each of us volunteered to go, we had to pick a card then the timer started. You have six minutes to complete the tasks at hand, report your findings and answer questions regarding your findings. The problem with this set up is that some of the exams have 15-20 tasks necessary to complete them, such as "examination of the respiratory system excluding auscultation" or "perform a general abdominal examination" whereas other tasks have only four or five things that you need to so, such as perform an "examination for the presence of Ascites." I didn't want to go first, because I had never seen this professor before and I wanted to see how she was during the exam. To my pleasant surprise, she tried to help us by asking us the questions that should be at the end during the middle of the exam if someone got stuck and forgot to do something (for example if you forgot to check for edema during the "general survey" she might ask you what would cause edema to (1) get the question asked during the six minutes so you get the points and (2) try to remind you to check for edema). I think people were too nervous to notice that she was doing this. We were not only graded on how we completed our task, but if we were kind to the patient, if we explained the procedure to the patient and obtained consent correctly, if we dressed like a professional (or as I say, "dress like a pro so I can make them think I'm are already pro"), and if we answered our questions correctly.

I, unfortunately, had to take the blood pressure. Obviously, I can take a blood pressure, but I didn't want to have to fiddle with equipment during an exam. I was doing okay, but I had a heck of a time finding the brachial pulse on this very robust woman and I got flustered. I was so flustered, that I was shakin' in my stilettos! However, I was able to get back on track within about 10-15 seconds and I finished with time to spare. I'm sure I missed a point or two, but I'm pleased with how I did overall. If I was nervous, boy, some of my colleagues were scared to death. Everyone's hands were shaking, some of the gentleman's voices were cracking, one girl was shaking so hard that she could barely take a measurement, and one guy was so nervous that he didn't finish the exam because he had to stop and gather himself twice (he was about 30 seconds from finishing when the buzzer went off). But the worst, had to be the guy that was stating things that were not true. I think he was so used to practicing on his healthy friends that he just said the exam as if the patient was normal and she had a couple abnormalities; moreover, he stated that she had dullness in her stomach upon percussion and she didn't. The big problem with that was that when you percuss (you lay one finger over the patient and tap that finger with another finger) the whole room can hear what is going on; thus, the professor knew that he didn't know the difference between dullness in the abdomen and tympanic sounds (which are normal and what the patient had). Oh, it was a mess! On top of all of that, every time someone started his/her exam the student had to ask the patent's name and everyone of us said her name differently. It was all I could do not to start laughing. I'm still not sure what her name was, but I am sure she had high blood pressure and needed to go see a real doctor--not a medical student.

I think this exam was so nerve wracking because we have never done this type of exam before and we had to do it in front of our peers(no one wants to look like a dope), but next semester if we don't pass the exam of the physical exam we will fail the semester (we will have an entire class on ICM rather than having ICM part of our Behavioral Science class). I'm pretty sure it works that way from here on out. Moreover, as part of STEP 2 (the second set of boards that a physician must pass to practice in the US, which is taken after completion of four years of medical school) there is a physical exam. I'm not sure how it works, but I think you have to interview and perform a full physical. I believe that you are even graded on your "bed side manner" (as we were today). I'm not sure about the amount of time or anything specific, but I do know if you fail it, you cannot practice medicine in the U.S. until you pass it.

Farley and I took pictures last January once we got down to the Island. I called these our "Grey's Anatomy" pictures. Good lookin' but not really doctors. Well, I'm happy to say that we feel like we are in over our heads in medicine right now, but in reality being in our second year of medical school we are probably about knee deep. Nonetheless, we are really starting to think like physicians and we are well on our way to becoming excellent physicians!

You can't believe everything you see on T.V., but you can believe this!

Yesterday in microbiology we were had lectures on "strategies of laboratory diagnosis" and "antibiotics and resistance." During these lectures, our professor mentioned a procedure known as a fecal transplant. It is used for Clostridium difficile (see picture above), which is a bacteria that causes diarrhea. C. diff can be found in the normal flora (normal bacteria) of the gut, but if you are immunosuppressed (cancer patients for example) it can overgrow and run amuck. I suspect that the fecal transplant is used in other bacteria. I am not 100% sure all of the bacteria that are treated with this procedure because when I searched for academic papers, most of them discussing "fecal transplant" were so recently published that I couldn't see the full article online--just the abstracts. I did find news report published by the Canadian Broadcast Cooperation that discusses this medical procedure.

At any rate, on "Grey's Anatomy" last night, they discussed a patient who needed and received a fecal transplant. I am here to tell you that yes, in fact, this procedure is done. From what I know, this is reserved for patients who have had severe diarrhea for a long period of time (so perhaps the case wasn't severe enough to warrant a transplant). Nonetheless, it works when other things don't. I spoke with my professor (a PhD in microbiology) today about the actual procedure and she thought that it was done as an enema, but the next presenter (an MD) said that it would be administered via an NG tube (a tube in the nose, often used to feed patients who cannot eat). Yup, that is correct. Grey's got it right. Fecal transplants do, in medical practice, actually occur.

Scopes and Folks

"'Faith' is a fine invention when gentlemen can see---but microscopes are prudent in an emergency" --Emily Dickinson c. 1860

I really like Pathology; in fact, it is one of my better classes. Of the "hard sciences" this is the subject that just makes sense to me. Don't get me wrong, I still have to work my tail off, but the study of disease is just more fun than some of our other subjects. Moreover, I feel like I retain the information well after I study, which is always nice. No one wants to spend hours reviewing then not be able to recall the information the next day, which unfortunately, happens to the best of us occasionally. Currently, we are studying pediatric pathology--the professor is one of my favorites (and he is--without a doubt--Farley's favorite professor). Maybe I like pathology so much this semester because intellectually, I love pediatrics, hematology/oncology, and reproductive health (Obstetrics/Gynecology). We've covered three of the four in the last month, but I don't think that is why I like pathology so much. I think I like it because is feels like we are really learning something important, something that could, perhaps, save someone's life. I do know one thing, I don't want to actually be a pathologist. I like the subject, especially the human aspect of the disease and conditions, but I do not like the microscope enough to spend my life devoted to pathology. And no, even the pretty, shiny and pink Hello Kitty microscope isn't enough to make me change my mind--I want to spend my days a physician with folks not scopes!

The end is near

Farley and I are about four or five weeks away from being done for the semester. Boy, am I ready!!! I am so tired. I just want to rest, but I can't. We have a billion (okay not a billion) exams left in the semester and I must be battle ready to take on the professors and their questions. We just finished up a review by one of the professors about our oral exam in behavioral science and we are having another on our oral exam for clinical medicine. I am doing excellent in Behavioral Science and am not too worried about the oral exam; however,I do need to focus and do well on these exams. Back to it!

It's okay

I stopped trying to guess how an exam goes. It is just too difficult. However, when I left on Monday, I thought I probably did absolutely horrible in Microbiology. I was bracing myself for the worst---it didn't happen. Going into the exam, I thought I was extremely prepared, but the questions were very strange (by strange, I mean difficult to interpret what is being asked) and the questions didn't reflect what was stressed in class (I hate it when they ask a minute detail mentioned in passing, considering that we get 1.5 questions per hour of class. To give you an idea of how much information is taught in an hour of class, it isn't unusual to have 80 pages of a medical text book covered in one hour and those textbooks are thick.) Anyway, I wasn't 100% please with how I did on the exam (but I doubt any of my classmates are either). Actually, I did pretty amazing in Behavior Science and Pathology and Microbiology and Pharmacology were okay. The great thing about medicine is the repetition. By the time I'm responsible for any of this information and a patient at the same time, I will probably see it at least one if not two more times (oh and there will be an attending and probably a senior resident to double check me). The medical profession knows that there is a mountain of information to learn and not enough hours in day--so we repeat, repeat and repeat.

Don't wink, don't think, don't even blink!

Monday night, I took a break from studying and watched part of Boston Legal. At one point, William Shatner's character said something like, "Don't wink, don't think, don't even blink." It made me chuckle, as this show always does; however, I was a bit shocked that midway through my exam I heard him saying that to me. There were several questions, as there always are, that I think to myself, "I'm pretty sure the answer is C, but I have no idea why." Now, if I stop to think about it I almost always talk myself into another answer and miss the questions. So Tuesday at the appropriate times I didn't wink, I didn't think nor did I blink---I bubbled! I have no idea how this exam went, but as Farley and I discussed, I'm usually wrong if I get a strong feeling one way or another---I guess there is no point in speculating!

Tuesday was such an exciting night. We went down to the election party at our beach side bar and restaurant. It was fun to hear people yelling and dancing as the election returns came in. The funny thing was that at least half of the people there were not even Americans, but they were as loud as the Americans!! There were students from Canada, Africa and the Caribbean as well as professors from all over Europe, the Caribbean, Canada, Africa, and the Middle East (I didn't see our Chinese Histology professor, but her children are very little, otherwise I'm sure she'd have been there too--she is too fun to miss a party). Anyway, Farley and I returned home to watch the end of the returns and the speeches. Wasn't it amazing? We lived a moment in history! In 50 years, we will tell people where we were when President Obama was elected!!! I was also pleasantly surprised with Senator McCain's gracious speech. Overall it was an amazing night. Wednesday when we were at Nelson's Chicken (best chicken on the island) getting our yummy lunches, Nelson told Farley and I that he heard people in the streets at 2:00am and thought it was the students celebrating. However, it wasn't. It was the locals. It would have been unbelievable to be in Chicago or D.C.; however, to be outside of the U.S. on this monumental night and to see the people of the world cheering was, well breathtaking.

Here is my favorite political cartoon posted on Slate Magazine today (it is probably my favorite online magazine). You should check out all of the cartoons--I don't think I've ever seen so many uplifting and positive political cartoons. They will make you smile.

Medical School is so cool

We had the coolest lecture ever today: a real-time-live abdominal ultrasound with a Radiologist performing and analysing the ultrasound. So amazing!!! When our patient was breathing (and therefore moving the diaphragm) we could see the apex of our patient's heart and watch it beat---what a beautiful heart!! In my opinion, seeing ultrasounds of babies is the most amazing, which I've been lucky enough to see before, but I can read the scan now. So COOL!!

Come Tuesday, it's time for exams, elections and events!

We have our second exam on Tuesday. Yupee. I just wish we could stop having classes so that I could go study. I think that this is one of the worst test information sets we have had for several reasons. (1) Disorganized: we were taught how to treat malaria before we were taught what exactly malaria is.---pharmacology professor thought we had already had the microbiology lecture on malaria and was NOT happy that no one answered her questions about the disease during class. (2) Poor Weather and Illnesses: We have had classes several classes moved to do weather and professors being ill. and (3) Segmented: All of the lectures are well done, but even before the schedule changes, we were scheduled for a lecture on viruses, then one on bacteria, then one on fungi--just really hit and miss --topic to topic. It makes things much harder for the poor student to keep things straight. Nonetheless, it is my job to make sense of it and I will.

Obviously, the election is on Tuesday as well. Every time I turn on CNN it says something like"6 days, 5 hours, 12.6 minute until the close of the polls" and that sure weirds me out. It's like a giant banner reminding me of my upcoming exam. As if I need reminding: I had 30 anticancer drugs to learn (than goodness I worked on oncology) and that is just 2 hours worth of lectures! I don't need to be reminded that I need to study. On another note, if you haven't voted yet, you should. I found time to read my voter's pamphlet, vote and mail in my ballot last week so I know everyone else can find time. I often don't even have time to go to the grocery store or gym on a regular basis because I have to study and review so much (Don't worry Mom, I have a stockpile of Costco products....no one is going hungry).

Most exciting, the EVENTS. Dominica is having their 30th anniversary of Independence (from Britain). These Dominicans KNOW how to party. They basically shut down the island from Friday until next Wednesday. Yea, you read correctly: FRIDAY (10/31) UNTIL WEDNESDAY (11/4)! They do NOT mess around when it is time to party it up and "jump up". I'm a bit bummed out that we can't go to the World Creole Festival (Sean Paul is the headliner) in Roseau, which is about 20 miles from us (and an hour drive). I'm also bummed out that they are going to be partying when we need to sleep, eat and study all weekend. The bars/clubs in the next town over (1.5 miles away) have the music so loud on normal days (I think it also amplifies across the bay) that it keeps me from falling asleep with my windows closed, air conditioner on and ear plugs in! However, I'm excited that we get an extra day to study for the exam (our exams are always on Monday, but the actual independence day is Nov. 3rd so school is closed). After we finish our super, fun exam, we Americans will get our own little party. The US Embassy/Ross University School of Medicine is throwing an election party for the students. I know you are jealous. We get to sit at our local beach side bar and grill (literally one step to black sands and the Caribbean Sea) and watch the election results come in.

Exams, elections and events....a very busy week!

No More Walks on the beach for a while....

We were discussing parasites today in microbiology and I don't' think there will be any walks on the beach anytime soon. The thought of a hook worm larvae climbing into my IN TACT skin and crawling into the blood stream right into my gastrointestinal tract is enough to make me want to take some Mebendazole (an anthelmintic drug---an anti worm drug) and run! The tropics have their disadvantages: worms, mosquito vector infections, dirt in the water; however, I'm not sure it is safer up north as you are at a MUCH higher risk for Multiple Sclerosis if you live at a certain latitude north of the equator (I'm not sure if this is also true if you are the same distance latitude south of the equator). But, we also can't go too far south or we will be under the spot that isn't protected by the O zone. GEEEZE, there isn't anywhere safe. Pick your poison, we can't win!

I Learn Something New Every Day....

One of the most influential immunologist (a WOMAN) developed the "danger model" of immunology and has recently published some additional research regarding the danger model. She led a very interesting life before becoming a world famous immunologist, such as being a cocktail waitress, jazz singer, and playboy bunny. It's amazing that you can't really find an article about her with a comment about her Playboy days. Apparently, she overheard some professors talking about immunology while she was a bunny waitress and which sparked an interest in immunology. Now she is a world famous immunologist---I guess Playboy was good for her (and us)!

Yea! I'm a second year medical student!!

Let me update you on the last month. I successfully made it out of the first year of medical school and I'm not looking back! Don't get me wrong, I liked the first year of medical school but it was hard and not as interesting as what we are doing now. The first year was all important but it important because it is the foundation for understanding the exciting stuff: diseases, pathology, diagnosis and treatment! We are just starting this stuff and I LOVE it. The pathology, so far, just seems to make sense. I have been enjoying pharmacology more than I thought I would and I've always liked microbiology and immunology. We are also taking Behavioral Science, which is interesting but there are a lot of grey areas which makes taking multiple choice tests in Behavioral Science very challenging. However, that is how the boards will test Behavioral Sciences so that is how we will be tested now. I do wish we could write an essay or something other than multiple choice. As part of our Behavioral Science grade, we are taking Introduction to Clinical Medicine (ICM). ICM is where we learn how to do a physical exam, write up a history and physical, etc. ICM is very fun and we even get to go to a local hospital. I went last week and it looked like a t.v. show. There were 23 patients in four rooms (men, women, OB, and pediatrics). There were no screens on the windows, only fans--no air conditioning. My patient was a 39 year old male with an abscess (infection) on his hip, who was in the middle of a sickle cell anemia crisis (extremely painful) and was also paralyzed from the waist down. Needless to say, it was interesting. The attending physician was VERY nice to us, but still pushed us to answer questions and think like a physician. Of everything we saw at the hospital, I was most surprised about the very tightly regulated visiting hours. There were four or five hours a day that visitors could be in the hospital. From 6:00 to 8:00; 12:00-1:00 and 6:00-8:00 in the evening. Anyway, I think the patients were happy to have the medical students around because at least they had someone to talk to, even if it isn't there loved ones.

I REALLY feel like I'm starting to think like a physician. I've wanted to be an oncologist since I was six years old and grandma died, so I can't express how exciting this is for me. I can really see myself as a physician....it's not just a dream anymore, it's becoming reality.