Snow Party!

This month has been so snowy! I'm not kidding about the snow. Apparently, it is the most snowy month in history with I believe about 60 inches of snow. I'm not sure if this is a good or bad thing, but the snow started to melt on Sunday so (good) many people were able to come to the open house my parents threw for me. The bad thing was the roads were inches of ice on Monday. Yuck! I still managed to go shopping at my second home: Nordstom! I had gone to Nordstrom downtown on the 26th and to the Nordstrom Rack on the 29th. If anyone doesn't know my love of Nordies, they called to check up on me when I was gone this year and make sure I was okay since I hadn't been in! Who has a store call and check on their health? I bought almost all of my work clothes there and was in the stores a lot when I was working: watching and waiting for the sales because why pay full price when you can catch a sale? If sales shopping at Nordstrom was a sport, I'd be on the national team. Anyway, it was fun to be back to shopping for sport! Mom and I managed to find her a beautiful outfit for Angie's Wedding, my sister. They still had some summer looks at Nordstrom Rack, so I also managed to get some dressy light weight/summer clothes for going back into the hospitals in Dominica next semester.

Speaking of Dominica, I have for more months in Dominica. Then, I start 5th semester which is a transition semester. There are three locations for 5th semester: Dominica, Michigan or Miami. There are advantages and disadvantages to all locations and honestly, I don't know where I want to go. I'm leaning toward Miami or Michigan, but we will get more information next semester and then I will be able to make a more educated decision. After 5th semester, I will take a Step 1 prep course. The Step is one of the most important exams of one's medical career and I need to do my best of this exam. So, if I calculated correctly, I will be taking the Step sometime next fall (I believe I have until next November to take the exam). After passing the Step, I'll move to do my two years of clinical studies. Most likely I'll end up in New York City, Chicago or Washington D.C. There are other cities that rotations are available, but I want to stay in one city for the entire two years rather than moving about, so the East Coast it is!

Oh, this is my 100th post for the year, which is a good end to a great year. Happy 2009!

Merry Christmas!

I got an early Christmas present this year. Our grades came out on Monday ( which is early since they usually they take at least a week and this was only five days including the weekend). I had my best semester of medical school! I'm looking forward to doing even better next semester!

Yesterday was also an exciting day. I got to see my sister, Angie, and her fiancee, Jeremy, as well as some of my favorite people: Deanna and her girls. It was so nice to get to see and spend time with people that I love and have missed so much over the last year. We were going to go to midnight mass at St. Aloysius; however, given the three feet of snow and the non-stop addition of snow we decided just to stay home and enjoy each other last night. Mom made a honey ham last night and we watched all that snow fall next to the glow of the Christmas Tree.

Today has been pretty laid back, which is nice as it hasn't stopped snowing since I returned to the great Northwest! I am so lucky that my flight arrived on time--so very lucky. We are having the neighbors over for a nice Christmas dinner --Mom is making prime rib! Yum!! I hope that everyone has as great of a Christmas as I have. As Farley would say, "God Bless!"

I made it home!!

It took me six flights, four trips through customs, two cab rides, two days and one overnight stay in Ft. Lauderdale, but I made it home last Friday at 3:30 pm! It was a long trip and I am so lucky that I was only thirty minutes late and all of my luggage arrived with me. I read an amazing book on my way home: Water for Elephants by Sara Gruen. If you need an excellent, exciting book with a happy, uplifting ending, this is the book for you. Little did I knowthat when I got home, I was going to walk into a winter wonderland! I have a few pictures from a couple days ago, but I believe we have another six inches or more of snow.

Mom and I put up the Christmas Tree after I got home and I got busy on wrapping presents on Saturday and doing some baking. It was nice to sit by the fire and be with the family. On Sunday, we went to lunch with some of my favorite people in the world: Aunt Molly and Uncle Albert. I haven't been to the Davenport in such a long time, so it was nice to visit. Here are some pictures:

Here are some great pictures of some great parents:

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!

Rest In Peace, H.M.

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

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

Argentina is in the news again...

I think anyone who has read my blog since August realizes that I fell in LOVE with Buenos Aires. In fact, during a five minute brain break last night I looked at pictures of Argentina on my P.C. and I could feel the brisk air, the coffee on my lips, the sales on handbags, shoes, just about anything and the love (the Argentine people are very affectionate!). Much to my excitement, I saw an article about Argentina on Slate today and obviously had to read it. Well, all of those sales in Buenos Aires are not just because the shops are locally owned (but that plays a big role), it is also because the economy crashed a few years ago and they don't have all of the wrinkles worked out. Which, as a tourist is why you can stay at amazing hotels, eat at great restaurants, and shop so reasonable (after the air fair that is). Apparently it has also played a role in the revival of the Argentine cinema, which is winning many awards. Anyway, the article is talking about their money and that people are hording the coins and smaller notes (Farley and I both ended up with a few coins and paper pesos). I sure didn't realize that we had such a hot commodity when we begrudgingly left that wonderful country. Here is a picture of a 100 peso note, courtesy of Farley:

I feel an excuse to post another picture or two of Argentina!!

Oh, I love Argentina...

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!!!

Rainbow

There are lots of rainbows in Dominica. I guess that is a perk of living in a rain forest: it rains and then it is sunny so you get a rainbow. However, this is the first rainbow that I've gotten a good picture of--taken from my balcony of course.


I found an old Irish lullaby on iTunes that my Grandmother sang to me when I was little. Then, when she was dying of cancer, I sang it to her. I even remember climbing in bed with her and singing it together. I was only six when she died but I vividly remember that day. I remember pretending to be sick so I wouldn't have to leave. I remember telling Mom, very frankly, that Grandma was dying so I needed to stay home. Mom and Dad made me go to school and when she picked me up I remember standing in front of St. Joseph's Parish informing her that I knew Grandma was dead. She asked me how I knew and I told her that I just knew Grandma would be dead before I came home from school (Mom told me laster that Grandma died about 45 minutes after I left for school). It was the day I knew I wanted to be a doctor. The pot at the end of this rainbow is completing my Doctorate in Medicine. Grandma will be so proud!

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) .

Thanksgiving 2008

Farley and I decided to have Thanksgiving down here in Dominica. We are a bit weary of the meat in general, so we didn't try to hunt down a turkey (literally). Besides, I have a propane oven/stove, which is extremely difficult to manage the temperature (my oven is on or off); thus, I don't think a turkey would have turned out anyway. So, we decided to get chicken breast from Nelson's Chicken (the best chicken on the island and the only place to get chicken breast--he has a monopoly). I have never made instant potatoes or stuffing before (always from scratch at home), but I didn't have an option here. We bought the chicken early in the day, so I heated it up in the pot then made the stuffing with the chicken still in the pot. Honestly, I was shocked that the chicken tasted completely different than it does when we have it for lunch. We had some instant "Idahoian" potatoes, fresh green beans (which were the only thing that took longer than 5 minutes to make), and cranberries. I like my cranberries hot because we always make our cranberry sauce from frozen cranberries; thus, it was in a pan. Mom had sent me down black olives, which was such a treat, especially since Farley hates them! We also bought a bottle of wine, which was shockingly good. I wish the pictures looked a bit more artistic, but heck, my kitchen fits into a closet, so I'm just lucky I managed to cook all of this and have it all ready at the same time!

Above: There is our instant Thanksgiving meal.

Below: a close up of the stuffing/chicken dish.

Farley and I decided to take the night off and relax. We talked to our families, had some no bake cheesecake, and watched t.v. We can't ever really take a night off medicine, so we watched a plastic surgery show on Discovery Health, Grey's anatomy and the show with everyone's favorite OB/GYN: The Cosby Show. At one point on The Cosby Show, little Rudy said that she was board and Dr. Huxitable responded lets read a book to which she said I don't want to read. That prompted him to reply that he has 3 million dollars worth of medical text books and she couldn't find one interesting??? That just made me chuckle as I have, literally, thousands of dollars worth of books and I'm only in my second year of medical school!

Well, unfortunately, our day wasn't just no-bake-cheese cake and The Cosby Show, we had classes from 8:00-12:00 then we had an exam in Behavioral science-a ten minute full interview of a patient. I think we both did very well. Farley and I spent hours interviewing each other. We came up with some pretty interesting cases: patient with malaria and a G6PD deficiency (which mean that they can't metabolism some of the malaria medications and will get even more ill with medication), a pregnant medical student, a manic-depressant patient (Farley's shinning moment of acting), and a womanizing-old-man with erectile dysfunction and benign prostate hyperplasia (my shinning moment of acting). Well, all that fun practice helped out as we both were given great feedback from our examiners, but we don't have the final grades yet.

A few things I'm thankful for:

• Family and Friends!


• The Internet so I can communicate with my friends and family--it keeps me sane down here.


• The opportunity to be a doctor, despite my whining at times


• The semester coming to a close and getting to come home


• My health and the health of my friends and family, especially after learning about all the things that can go wrong. Heck, I'm surprised any of us are healthy there are so many things that can go wrong!


• Obviously, my Farley. Farley's picture is in the new Catalogue for Ross University School of Medicine that is sent out to all prospective student (see page 74). He looks so handsome and thoughtful in the picture. He is with Dr. "I LOVE ANATOMY", who perhaps, is the only person on campus who likes anatomy as much as Farley does (and when I say that I'm including all of the other faculty of anatomy. Farley and Dr. "I LOVE ANATOMY" are anatomy addicts).


• Which reminds me of another thing that I'm thankful for: I'm done with anatomy!

Doesn't Farley look like he is hanging on everything that Dr. "I LOVE ANATOMY" is saying. It's like Farley found a mentor who loves anatomy and teaching of anatomy as much as he does. Which is completely true, other professors are also great at teaching anatomy, but NO ONE is an enthusiastic as Dr. "I LOVE ANATOMY".

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.

World AIDS Day: December 1st

Amongst all of the happy celebrations that occur this time of year like Thanksgiving, St. Nicholas Day's, Christmas, Chanukah, and New Years, there is a more somber day: World AIDS Day. It is observed on December 1st each year and is a day to bring attention to the world AIDS epidemic. 2008 is the 20th anniversary of World AIDS day. Today we had a lecture on HIV and I thought it would be appropriate to give you some interesting facts we learned during our lecture. The information I've provided is directly from my lecture notes.

AIDS: Number Comparisons

• 40 million people infected worldwide; Population of Canada: 30 million
• Over 21 million people have died from AIDS so far; Population of New-York city 21 million
• Over 13 million children, mostly in Africa, have been orphaned because of AIDS; 15 million students are in primary and secondary school in the United States
• About 1/160 people is infected with AIDS worldwide; about 1/520 people has cancer worldwide
• 16,000 people are infected with HIV daily; 11,000 children are born each day in the United States.

In the United States, it is easy to forget about how horrific HIV/AIDS is since we have such amazing medications that are extending the lives of HIV patients (and giving horrific side effects). Nonetheless, AIDS is still a huge problem worldwide, check out these numbers from UNAIDS and the World Health Organization:

Citation for the Red AIDS ribbon image on this blog post.

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!

Hot water, HA, it' s been out for over a month!

That's right, living on a Caribbean Island may seem like sunsets, rum and lazy days, but my friends, it's not. I have not had hot water in a month--yup, I'm showering in ice cold water. I don't even think the bottled water on this island is as cold as my shower. It was luke-warm for about three days a month ago and before that it was another month. That's right it has really been more like two months since I've had a really good, hot shower. It is so bad that if either or Farley or I have not freezing water at we immediately calls the other to say "get in NOW, before the ice cubes start flowing again!" I'm not quite sure what we'd do without each other. We have a study buddy and a not-so-ice-water-shower-notifier. Yes, it is more than most can ask or even expect in a significant other! Farley spoke to the management yesterday and "told them what to do." Well, when I checked the shower water tonight, it is warm and even clear--not brown!!!! It's a good day!

As if the hot water situation isn't enough, our Internet has been out at our apartment for about a week. Yea--it stinks! But right now, we are back in business as I'm typing during a study break at my little apartment right this very moment. A great thing about the Internet being back is that I get these cravings for music and with the Internet I can buy whatever I want to hear. It is the only indulging I get on this little island, so I allow it. I missed my Dad today, so obviously, I downloaded his favorite Christmas tune, "You're a Mean One, Mr. Grinch." I think Dad thinks he IS the Grinch, but he isn't. Before the last exam, I decided that I needed to dance to "Thriller" and "Billy Jean." Yesterday, I decided I needed to hear "The Mission--Gabriel's Obeo." Anyone who attended a Jesuit School probably, like me, is very familiarly with this amazing work of music. I didn't love the movie (with Robert De Niro), but I LOVE (can't emphasize enough) the music.

Another great thing about the Internet being back is that I can talk to Mom and Dad again on Skype or Google Talk (or anyone else if you email me and we can exchange Skype names---how fun!). Now that Mom and Dad have high speed Internet, the world is their oyster! They can even look at my smiling, tan face and I can see them.

I haven't posted a Caribbean Sunset lately and since I've been complaining, I should put something positive up too:

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.

Dancin'

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

I only have a studio--no room for roommates, large lizard in my window!!

Remember Leo the Lizard?? I posed about him last August in Miami? Well, today, Farley had to save me from his great, great, grandfather! I was minding my own business at my little desk and I had the erie feeling that someone was looking at me. I looked at my window seal and there was about a 5.5 inch lizard. I thought he might be dead--then he blinked. I calmly stood up and marched to Farley's house. Farley, in his manly way, staggered over, took one looked at the lizard and declared him "a grandfather lizard." We both though he looked sick, that was, until Farley poked him with a pen. This time I didn't manage to walk slowly out of the room, I ran. Farley kindly pointed out that running, screaming, from the lizard doesn't help the situation. If Farley knows one thing, it is how to keep his cool---maybe he will be a trauma surgeon (I like to joke that his future career path changes each time we learn something new because he likes most of it so much).

At this point in operation lizard removal, I called maintenance; however, they were all on vacation (remember the five day weekend??) They were going to send up the gal at the desk or the housekeeper (who is probably 65). Well, my manly Farley wasn't going to stand for that! He sent me to his house to get some gloves then promptly stood on the desk and negotiated the lizard into the corner. Then he grabbed the little guy and took him outside. I took a picture of him. Farley wanted me to zoom more in on the little guy, but he tried to bite Farley. Well, lets just say our little lizard when on a little trip to the grass below my apartment complex. Don't worry about the little guy, he landed in the grass. Besides, remember when I told you about the giant lizard that fell off the landing and landed on the cement---he was fine.

Well this lizard got into my apartment via a screen that had been broken (and reported to maintence) three weeks earlier. I was a little too busy studying to be a doctor to follow up and well, I paied the price. Good thing my hero was around to keep me safe!!

I'm not alone!

I couldn't keep my eyes open any longer last night, yet I couldn't fall asleep because I wasn't sure I studied enough yesterday; thus, I was reviewing as I lay in bed until I drifted off to sleep. This morning, I skimmed the NY Times and an article caught my eye. It is written by a physician reflecting on medical school and in retrospect, how miserable she was. I'm not miserable (tired, but not miserable), but it was sure nice to see a successful woman physician talk openly (in print in a major newspaper) about how medical school isn't all that fun. I've talked with physicians from home about this which is always nice, but the timing of this article was great--just a few days before an exam.

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!

I'm Finally Coming HOME!!!

Thanks to my super travel agent, Mom, we worked out a plan so that Farley and I can get home on the 19th of December and be able to stay at home until the 9th of January! It is so exciting, as the flights appeared to be all booked and we thought we were not going to get home until Christmas Eve (and LATE at that) and we were going to have to leave home on the 3rd of January to get back to the island. The only way we could get a flight so late in January was if we fly ouy of Miami on January 10th for Barbados, stay overnight then go onto Dominica on the 11th. Farley and I will have to keep a stiff upper lip during our 23 hour stay in Barbados. We start classes on the 12th so we will make it back just in time.

Besides being unable to get flights off the island easily (we started working on this in JUNE) the most astounding thing is that the flights are so expensive. For example, Farley and I could have gone to Paris or Rome for two weeks (air and hotel but excluding food) for cheaper than it cost me to get home. That is crazy! It is a good thing we didn't look into that before we booked our flights home because ....well, that is how we ended up in Argentina. I'm so excited to get to see everyone, but I will sure miss my Farley. Farley and I haven't been apart for more than 8-12 hours since last December; it is going to be strange not to see him for three weeks!

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)!

Dominica: The Original Maverick Country

Dominica decided to get mavericky yesterday: we had a storm and they closed the entire country. That's right, Dominica such a maverick country that they declared at 9:50 am that the country will close down at 10:00am---where else do you hear about closing down an entire country due to one storm in ten minutes or less? I should probably start at the beginning....

Wednesday night, Farley was hanging out in the anatomy lab helping prepare his students for the anatomy lab test on Friday. He came over to my apartment, smelling like formaldehyde and declared, "Are you ready for the hurricane?" I had been locked in my room reading pathology and was shocked to hear THAT! I started questioning him like he was a criminal caught red handed who had been taken to the police precinct without a way to escape. He calmly declared, that our apartment management had placed fliers in the hall and that the school hadn't said anything that he knew of. I promptly moved my cute leather shoes off the floor in hopes of protecting them if a flood managed to climb to the third story of my solid concrete building then I went to bed. Unfortunately, I didn't sleep much as the ocean was ripping and the sounds of waves awoke me throughout the night, despite my ear plugs and my fan and air conditioner being on. Sometime around sunrise on Thursday morning, I heard a noise I've grown very familiar with since moving to Dominica: the rain falling so fiercely that it sounds like someone is pointing a garden hose on full blast onto a concrete driveway. Alas, the storm had arrived. I always attend class, but was wishing that I didn't have to go and could Mediasite (watch lectures on the Internet from on campus or at home), but I get SO bored mediasiting so I got dressed. Looking at the muddy trail, I was proactive and decided to wear scrub pants (rolled up so they didn't get too muddy toward the ankles), my keen sandals and a tank top. Farley came over and coffee in hand we braved the muddy trail.

We made it to class relatively easily, as a break in the rain occurred as we were leaving our apartments. On Thursday, all second year medical students are required to attend CPC, which is a case presentation and review of a certain condition (this week steroids given to pregnant women that are likely to delivery babies prematurely and problems babies have when they are born prematurely). After CPC, we headed to our normal classroom and got ready for another great Behavioral Science lecture. About 9:50, one of the assistant deans politely interrupted the class and said that the dean, after direction from the Prime Minister, is closing the campus as of 10:00am. In fact, the Prime Minister declared that EVERYONE in the whole country should go home unless it isn't safe to go home (then I guess you have to go to a friend's home). Farley and I usually filter water at home, but the water has been too dirty to filter lately so we brought containers to school to fill up, which we did quickly before campus closed. At approximately 10:00 (when we were all to be heading home), the rain started and BOY did it start.

Farley thought it would be a good idea to walk along the street (it is one of the few paved streets in the country) rather than the muddy trail, which was a good idea, but it did mean we had to walk a little further. I'm not sure if any of you have seen this commercial, but I remember an insurance commercial (I believe All State) that had a guy walking with an umbrella against the wind in a storm. That was us. We managed to walk the approximately two blocks and both looked like we had just hopped out of the shower. My rolled up scrub pants were unrolled by the weight of the rain and my cotton clothes stuck to me skin like spandex. We were in the home front when we had to walk down a set of stairs. There was muddy water that was more than ankle deep. I'm lucky a fish didn't swim up and crawl in my pants! After climbing to the third story and safely into our apartments, we decided to take a few pictures.

View of the storm from my apartment at about 10:15am. Note, the storm was so dense at this point, we couldn't see the Cabrits.

View from the top of the apartment complex. Usually the Caribbean Sea near our apartment is as calm as a lake, almost like bath water. However, as you can see, it wasn't calm at all today. I know there are places where the waves get very large on a daily basis, but considering how calm it usually is, this was big. At this point, the storm wasn't as bad; you can now see the Cabrits again.

Here is our sturdy dock. Now, the end has already been destroyed in a previous storm (before we arrived in Dominica), but there was an entire section that broke away (the missing section that is closest to the shore). I watched it floating in the sea about 300 feet down the beach from the dock.

There is a little stream that is by the apartment usually. It is just runoff, but is very small, but not yesterday.

Here is the grassy garden between our apartment and the restaurant. I suspect the overflowing "stream" above caused some of the flooding.

I'm not sure if you can see this well, but there were multiple colors in the sea. The brown color toward the shore, a teal color, then a dark blue, then teal again and finally dark blue again. I think the teal and blue is due to the depth of the water, but I'm not sure. I do know it was really strange looking because it was so clear yesterday and it usually isn't this defined.

After taking pictures, I decided to take a nap since I didn't sleep well Wednesday. Again, it was so loud that I didn't really get to sleep much but it was nice to get to rest. After the rain stopped, Farley decided it would be nice to read on the balcony so we went outside and read novels for fun. I made a late lunch/early dinner (we had pasta with zucchini and "doctored up tomato sauce"). It was so lovely: we had an anti-mosquito candle lit and enjoyed our lunch on the balcony. That's right a candle lit lunch! After that we both buckled down and studied for about five or six hours, but even that wasn't too bad because we were already caught up and got to do extra review and prepare for today's lectures.

Unfortunately, the waves were still very loud last night and I didn't sleep too great. Fortunately, closer to day break the waves seemed to be quieting down, but then it was time to wake up for school. I suppose I can catch up my beauty sleep this weekend. As usual, when there is a lot of rain, the water is brown (similar to the water seen above in the little flood). Apparently, these are the worst waves they have had in Dominica since a big hurricane in the 1980s, so they didn't want people on the beach or even out and about. However, I'm still not sure why they shut down the school and country during the worst part of the storm and had 1,600 students walking home; but heck that's what mavericks do. Mavericks don't follow convention....they wouldn't be mavericky if they did!

Chased by a cow...

Things like this only happen to me. I was minding my own business walking from my apartment to the study space. Now this study space is about 30 degrees Fahrenheit so I needed to go get a parka to maintain a healthy body temperature. I safely made it to my apartment and saw a few cows, there are always cows.....returning to the study place, I was coming around a blind corner and I heard a noise. You must always be paying very close attention down here in the tropics as you never know when a giant crab, lizard or cow is just around the corner. Thus, I peered around the corner; low and behold, there is Betsy, the cow, scratching her hind legs in a bush with her two calves munching on grass. Right as I came around the corner, a security officer tried to scare her off and she starting running toward me! So there I am, with my red Gonzaga University sweat shirt in my hand, in the way of the 1,000 pound bovine! I tried to act brave, I managed not to run, but I did power walk away from Betsy...to which the security officer said to me, "you have to let the cows know who is boss and not move out of their way. If you move they know you are afraid." Well, I had to state the obvious, but when a 1,000 pound cow with HORNS is running toward me, I am a little afraid!!! Then the security guard started yelling at the cow. Betsy and I looked at each other and I think we were both a little afraid. Needless to say, I've been studying at home as to limit my exposures to the cows.

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.

Finally, I'll finish my Argentine tale.....

On Sunday, Farley and I decided to go to Argentina's National Museum of Art. It wasn't as amazing as the National Gallery of Art in D.C., but it was still large and fun. There were Picasso, Monet, and even Rodin (a very famous scalper). We even saw Rodin's the kiss which was so much larger than I would have guessed. The lovers int he sculpture were life sized. WOW. We had a great time at the museum and saw some beautiful art, but couldn't take pictures in the museum. However, I have some pictures of the museum:
Here is handsome Farley on the roof of the museum:
Oh and one thing that I found very strange was the soap in the bathrooms. They had a bar of soap on this metal arm rather than liquid soap. When I first walked into the bathroom, I had no idea what it was. Farley said that the soap in the men's room was blue.

The museum is in the same area as the flower that we saw on the city tour. We went to that park and took a few more pictures of the flowers.
Tango is everywhere, here is an advertisement on the walk way into the park with the flower. The art museum is actually just across the street.

To get to the park from the art museum, you cross over this big walking only bridge. Here is a picture from the bridge looking toward the downtown area.

Going the opposite direction from the museum, there was another park with a weekend farmer's market and crafts fair. It was fun to go to these parks on a Sunday because there were so many locals out and about. It was a very busy day, in part because there had been a road race earlier in the morning. Here is a picture from the other area and some of the beautiful architecture:

After returning to the area around the hotel, we wandered around and ended up at another mall. I have no idea where it was but there was a beautiful ceiling with mirrors all around. Here is a great picture that Farley took:

Later Sunday night, we went to see "The Dark Night." I didn't really like it too much because it was too violent for my taste, but Farley loved it. I did enjoy the movie theater. It was tall and steep--Farley said it was like the theaters in NYC. We bought the tickets for the movie on one block then had to go down two blocks to get to the theater. They had four or five screens at three different locations down the block. I thought it had been two or three different theaters before we went to the movie. After the movie, we went to dinner and it was okay. It wasn't our best of the trip but it was still good.

On Monday, we decided to take it easy and enjoy the neighborhood. We both decided to do some Christmas shopping and I had to buy a purse....I just couldn't leave the great country of Argentina without buying a leather purse! We had such a great day. I don't have too many pictures of the day, but here are some pictures from dinner:

Here is handsome Farley in his new Argentine tie. I got to help him pick it out

Here I am:

This was Farley's favorite restaurant and part of the reason we returned was because we LOVED the wine we had there. In case you run into any Argentine wines, look out for this one. It was fantastic:

One last picture of the outside of the restaurant. The decor alone was one of the reasons we had to go to this place in the first place, but the food and wine made us come back:

We left about noon on Tuesday morning, despite wanting to say for another few weeks. We landed in San Juan late Tuesday night then did some shopping and shipped supplies back to the Dominica. We did NOT have a good experience in San Juan and couldn't wait to leave the island. I never been anywhere that the locals, as a group, have been so rude and mean. I'm sure that not everyone on this beautiful island was being accurately represented by the cohort we met, but geeze, I sure don't want to go on vacation there.