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!!!