Things that make life in the Caribbean easier for me...

1. The Internet: I am able to keep up to date on current events at home and abroad as well as communicate with friends and family. Moreover, I get to keep a Blog, which surprisingly, reduces my stress. Farley always says that women have so many words per day that they need to say (basically women need to talk) and I guess my blog is a way for me to talk with family and friends even though I'm very far away. I can even talk over Google Talk or Skype, which is even better than typing to friends.


2. Coffee: Now, it isn't great coffee, but at least there is some coffee on this island. Being that Dominica just received it's independence from Great Britain 30 years ago (as well as many other islands), there is some yummy tea down here. I'm okay with substituting black tea for coffee for some variety.


3. My I-Pod: I LOVE that I can check my email from my I-Pod and it has even been helping me sleep better at night. The music has been so loud this semester that my parents bought me these rather strange looking earphone (see photo) that are designed to be warn while you are sleeping and listening to binaural beat technology. This binural beat technology is a way to help you relax and then it is suppose to drop you down into Delta sleep (deep sleep). I was skeptical at first because I like QUIET when I sleep, but to my surprise, these little sleep phones have worked when it is loud down here all but one night since I got them (but there isn't much anyone can do for you when you can hear the lyrics to songs that are playing in a bar 1.5 miles away).
4. Gregorian Chant and Classical Music: I didn't realize how much classical music I own until I looked at my I-Pod the other day. By far, the classical section is the biggest--by hundreds of songs. I go through phases when I'd rather listen to Scott Joplin, George Gershwin, J.S. Bach, or Gregorian chant to name a few. Currently, I'm on a chant kick--so relaxing. It just makes the pathology and microbiology that much more pleasant.


5. Discovery Health/TLC: When I take a study break, obviously I like to watch medical television. I especially like when I can diagnose patients on T.V. --it makes me feel so smart!


6. Nelson and Addison: Nelson has THE best chicken on the island--he has a monopoly on the chicken breasts and his employees are the best, gosh-darn grill men on the island. Yummy! Addison has a fruit juice stand and his fruit juice isn't the best on the island, I think it is the best anywhere in the world I've been. Amazing!


7. Dominican Sunsets: The sunsets are absolutely breathtaking at my apartment. The colors of the sunset just dance upon the ocean. Better than in St. Lucia or Barbados. Beautiful!


8. Balcony study spot: I have a little plastic table on my balcony that is a great study spot. I love being able to escape out there and feel like I'm not trapped in doors all day, while still getting things done.


9. Subway's expanded menu: It isn't as large as the U.S. menu, but we now have soup and pizzas in Dominica. There isn't a huge variety of choice on this island of things to eat, especially for me as I am allergic to seafood and shell fish. Being able to go to subway when I can't get to the "grocery store" is a life saver. Since we've gotten more items on the menu this semester, it's been easier just to go to subway as the default. Besides, everywhere but Subway and Nelson's fries things, which has made me gain weight since there are not enough hours in the day to work out as often as I should. I'm losing weight this semester by just eating subway more often when I don't have time to cook. I'm practically the new Jared.


10. Not being along: I've saved the most important thing on the list for last: Farley. Having Farley down here is such a blessing, even when we get on each other's nerves. It is so lonely down here and there isn't much time to make many friends as studying consumes so much time. It is nice to have Farley down here; I'm never really alone, even if I feel isolated at times since I'm so far from home. Farley is always just next door, which isn't far at all.
    

Reproductive Health

"Too many good docs are getting out of the business. Too many OB/GYNs aren't able to practice their love with women all across the country."—G.W. Bush, Poplar Bluff, Mo., Sept. 6, 2004

We started reproductive health in pathology, pharmacology, microbiology and clinical medicine this week. I've always been interested in reproductive health, so this by far has been my favorite set of lectures for the semester. I still think I'll end up in oncology and gynecological oncology is much more depressing than pediatric oncology, so I probably won't be a gynecological oncologist.

At any rate, this stuff is amazing. Every lecture has me at the edge of my seat. There are so many strange things that can arise from the reproductive system from a pathological perspective. At this point, we have just covered the female reproductive system, but part of the reason why it is so interesting is because there are germ cells, which retain their ability to differentiate into multiple cell lines or in plain English, they can become different types of cells like hair cells, teeth, skin, parts of the gut, etc. When these germ cells go wild, all heck breaks loose and some extremely disturbing masses can emerge. Obviously when talking about mix histology, the first thing that comes to mind is a teratoma. Teratomas can occur in adults or children and there are differences in these tumors. Generally teratomas are benign, but they can rarely have some malignant tissues within the neoplasm. These things are horrible looking, but thankfully, they do not act horribly (meaning that they are NOT likely to kill people). I didn't want to put anything to disgusting looking (and some of these teratomas are quite disturbing looking), but the following is an X-ray of a woman's pelvis with teeth in it. Those teeth are growing from a teratoma and I believe our professor said that this ended up being a benign neoplasm.

Sexually transmitted infections have been covered in microbiology. It never ceases to amaze me what these little bugs can do. In case you didn't know the the "in thing" is to call sexually transmitted bugs STIs (sexually transmitted infections) rather than STDs (sexually transmitted diseases) because some bugs will not cause symptoms of disease so a carrier does not have a "disease" per say, but he or she does have an infection and can keep spreading this infections around. I didn't realize before starting medical school that there are parasites that are sexually transmitted, Trichomonas vaginalis. In fact, these are the most common, curable STI in the WORLD. I'd have guessed something like chlamydia, a common bacteria. This is one subject that is best to study in books rather than get first hand knowledge and experience with! Here is a picture of that parasite, Trichomonas vaginalis, taken from my microbiology lecture.

Then the pharmacology: hormones. So interesting and so complex. For example, the differences in the types of birth control by both the dosing and the types of hormones--lots to keep straight. The steroids that athletes illegally use to bulk up--I can practically study by watching ESPN because there is so much steroid abuse in the athletic news. Manipulating hormones to treat prostrate and breast cancers. Pharmacology is not as intuitive for me, but still at least this is interesting.

As I already said, at this point in my education, I still want to go into pediatrics and hopefully I will get a fellowship in Hematology/Oncology. However, I've always had an interest in reproductive health but one of the reasons I doubt I'll actually go into OB is the malpractice insurance. I hate to agree with our former president GW Bush, but too many good doctors don't are not practicing obstetrics because of the malpractice. It is a really big consideration when thinking about going into something as stressful as OB/GYN.

Decisions, Decisions.....

We had a talk about the transition semester this week. I'm more confused now than I've ever been about where is the best place for me to go. If I go to Michigan, I do not need to bring my car; however, the majority (if not all) of the clinical work will be nursing homes and there will be more required papers (which could be good because each paper is worth less of the overall grade). If I go to Miami, they have a board review course, but I would need to get my car to Florida because I will be sent all over the Miami-Dade county for clinical rotations. If I stay in Dominica, I will be in a third world country for another three months, but you don't need a car. Since the laws are different than in the U.S.A., medical students are able to PRACTICE some clinical skills that physicians are responsible for rather than than just clinical skills that are generally performed by nurses or phlebotomists or just observing--assuming that I don't faint daily in Dominica.

Another consideration, on May 18th, about three weeks after finishing this semester, we have to take the National Board of Medical Examiner's (NBME) compressive exam on the first two years of medical school. I'm not sure of the exact statistics, but a LARGE number of students fail the NBME's comprehensive exam on the first try. We have three attempts then we are expelled from Ross. It is extremely rare for someone to be expelled, but if I stay in Dominica, I will be able to take a three or four day break then have the entire three weeks between semesters to study for the exam as I won't be moving back to the States and having to move my car across the country. If I stay here, I might move down to Roseau (the capital where the BIG hospital is located) or else I have to take the hour drive every day.

I really don't' know what to do, but I have a feeling I'll be staying here. You should vote to my exciting voting pole or leave me a comment or email about where you think I should go and why. I do know, that Farley and I will likely be doing a review course for the USMLE Step 1, another exam from the NBME, in August. I think we are going to take the Kaplin course rather than the Falcon course. If we take the Kaplin course we will be in Chicago for 7-weeks and if we take the Falcon course we will be in Dallas for 7-weeks. The USMLE Step 1 (the first set of boards) is arguably one of the most important (if not the most important) exam of my career. These decisions in the next couple months are very important, but the most important thing is doing well on that exam next fall.

I didn't know it was possible to be that hot....

Last Thursday, we had our first Stan session. I hate to say it, but we killed him. I think it was much harder than working with a real patient, but I also thought it was fun. Medical students are not allowed to do too much hands-on work and we can practice hands on skills on the Stan machines. I think part of our problem was that we were so worried about not killing Stan that we thought too much and didn't act enough. Another part of our problem might have been that the air conditioner was turned off in the Stan room and we couldn't turn on a fan--it was probably 90-100 degrees in there with no moving air!

Yesterday, we had our first "Mini" exam of the semester. Don't even get me started on the "minis!" Each mini consists of 1/3 of the information from the semester from each class on one BIG (not mini) exam, which we are given 2.5 hours to complete. It is a mini examination compared to the USMLE Step 1, but these Mini exams, my friends, are anything but mini. When I left, I felt like I did horrible, but then after I talked to some friends, I think I did okay.

Today, I had to go to PMH (the BIG hospital on the island). I got up, got dressed, had a small breakfast and a Dramamine then I hit the road at 8:00. We took the 23 mile (>60 minute) drive to Roseau, the capital. It was a bumpy ride and I'm glad that I took my Dramamine, but I was extremely sleepy from the medicine until about 10:00-10:30. We were broken down into multiple groups and randomly assigned to physicians. If I had my choice, I would have rounded with the hematologist/oncologist since that is what I'm interested in, but I got the post-surgical rounds, which was fine too. The professors that we showed are Cuban and the first one (about 50-60 years old) had an extremely heavy accent. He was a great teacher, but I really had to listen carefully to understand him--part of that was that I was still drowsy from the Dramamine. I did manage to say a few thoughtful things, so I at least looked like a medical student with somewhat of a brain. Next, we went to orthopedics with the second, younger Cuban professor. I made huge brownie points with the second professor because I knew that osteoporosis caused micro-fractures often in the spine (fractures that are so small that they cannot be seen by X-ray). He asked how I knew this exciting information and I had to reply that I either saw it on Discovery Health or on a commercial for an osteoporosis medicine...not exactly doctorly, but I did know the answer.

Next, well, it was the embarrassing part of the day. Six of us followed the first doctor to the woman's ward to palpate a cyst in a lovely lady's axilla (arm pit). She had an ultrasound and they said that it was an abscess (infection) probably because she is diabetic and they are more susceptible to infections. All six of the medical students palpated to mass, then the doctor got down to business. At PMH, they have open wards so we had the curtains pull around so she could have some privacy. Six medical students, two physicians, and two nurses surrounded her bed (all within 2 feet of the bed because of the curtains). The hospital has no air conditioning, there were no fans nearby, windows were opened but there was no breeze, and worst of all it was probably 80-85 degrees before we all slammed around the bed like sardines. Next, the physician injected the woman in the axilla with lidocaine (a local anesthetic). I was cringing just thinking about a needle going into this poor woman's arm pit--her face confirmed the horrific pain she was experiencing. We don't cover anesthetic until March so I'm not sure how long it takes for lidocaine to numb the area, but I don't think it was as quickly as this physician moved. Probably less than 30 seconds after injecting the lidocaine, he injected his needle to try and aspirate the abscess. Our patient was quite, but her face was screaming. I asked her if she wanted to hold my hand and she said yes, so I tried to comfort her best I could, but I don't think it did much. This went on with little success for probably five minutes, then I got really hot. I don't mean a little hot, I mean really hot. I noticed I was getting hot then 30-60 seconds later, I thought I better move toward the "hallway" (the area in the big-open-room ward that is in between the beds and curtains). I tried to find a chair, but I couldn't so I leaned against the wall. Then I remember shaking and being so, so hot. I knocked over two empty water bottles and I remember falling into one of my group member's arms. I didn't think I fainted because I remembered all of it, but the two gentleman who were holding me said that I was holding myself up for all but about 30-60 seconds--I guess I did pass out. I was assigned to my own bed. One of the doctors come over and checked up on me, but it was obvious that I was just overheated. Apparently, 1-3 students pass out per day because it is so hot. I was so embarrassed, but they are used it. I don't think anyone else passed out when we were there, but nine other people told me they thought they were going to pass out, but they found somewhere to sit down, which I could not. In fact, the guy that caught me left the oven (I mean the patient's bed) a minute or two before me because he was sweating so much and almost passed out. I'm lucky we both didn't pass out. Everyone was so nice, but I felt so stupid. I usually drink about 2 liters of water a day and I didn't do that today. I will make sure to drink more water before my next hospital day.

After the fun fainting on the wards, we all picked up a taxi and headed to lunch. The people I was with wanted to go to KFC, why, I don't know. So, KFC it was. Around the corner there is a little, cute, cozy coffee shop, so we got iced coffee. After our two hour lunch (why did we need two hours, I don't know), we headed back to the hospital. We were again divided into groups and I again had to go to the second level to the woman’s ward (I like to think of it as one large sauna with smaller, hotter pockets that are like ovens). We were supposed to have three students to one patient, but the second patient was discharged so we had six students to one patient. I was rather relived that upon returning to the oven to interview our patient, the other five people in my group performing the interview all had to leave to cool down. I really can’t believe how hot the woman’s ward was. I didn’t know I could be that hot without being sunbathing in the Sahara desert. Anyway, our patient was great and made our lives much easier by being so nice and easy to work with. If I didn't know our patient was a seamstress, I'd guess she was a teacher because she was so patient and caring. Then again, perhaps she was patient and caring because she is a Mom. I think that our interview and patient exam went very smoothly. Our attending professor was an amazing woman. She had been a practicing physician for 40 years! It always excites me to see women in non-traditional roles. Now, about 50% of medical students are women, but there is a lot of variety once physicians specialize (traditionally, women are more often pediatricians and obstetricians and less often surgeons). Forty years ago a woman in medical school was amazing feat, let alone a minority woman in medical school. I wish I could have spent more time learning from her: she is great.

We all loaded up on the bus to head back to school, but a group talked the bus driver into going to KFC (I don't know why they all love KFC so much). I really wanted to get back, but I didn't mind that we had this 40-60 minute delay as it takes that long for Dramamine to kick in. It is a good thing that I had the Dramamine for the ride back to school because I was stuck in the back, the ride was extra bumpy and the driver was going fast. I felt like I was on Mr. Toad's Wild Ride, but a Dominican version that could actually kill me!

Overall, it has been a exciting week. I am sad we killed Stan the stimulator, but I'm proud that we were good with our real, live patients. I hope the exam went well, as I studied and studied even after my head felt like it was going to fall off my shoulders. I'm starting to finally feel like I am on my way to becoming a physician; but most exciting of all, I think I'll make a great physician some day.

Laundry

Unlike in other parts of the world, there are no laundry mats and apartments do not have a laundry room in Dominica. No, I don't walk around smelling like the anatomy lab, nor do I wash my clothes in the rivers (like some of the locals). I use a laundry service. Now this sounds like a great luxury; however, it is not. There are several different services throughout the area. Generally they pick up your laundry about 7:00am and are suppose to drop it off between 6:00-7:00pm. Last year, Farley and I waited until our friends had done laundry and asked about the different companies before we had our laundry done. Waiting to do our laundry was one of the smartest things we've done. There have been people who didn't get laundry returned for a week, people who have had their laundry smell worse when it returned than before being washed and missing things. The laundry service that we use is overall pretty good. I've lost one wash cloth, our laundry was a day late once (when there was a big rainstorm and the water was brown) and a couple times we've had to call because we either were missing something or had something extra (but other than the wash cloth, we have gotten everything back). Our laundry is NEVER returned between 6:00-7:00pm, but excluding the one extremely rainy day, our laundry is always returned by 9:00pm. Another good thing about our laundry service is that it always smells like it has been washed; however, things often change colors. Light blue is often turned to an off blue white, black turns into dingy grey, other colors are dimmed, but whites are bright! The laundry is always hot, hot, hot! I never wash my clothes in hot water and I air dry a lot of my things (or I put them on low heat in the dryer). These hot clothes result in not only changing colors, but size and shape changes too. So, yes, it is nice not to do laundry (and the laundry lady folds things beautifully); but, I'd rather do my own laundry any day.