Holy Pathology Batman!

The pathology shelf was one heck of an exam. I don't think that there were just tertiary questions; I think there were quaternary questions! It was extremely difficult and I just hope it went okay. The next challenge is Friday at 1:00: Pharmacology Shelf. It is nice to have almost 48 hours between exams. I even had enough time to take a much needed nap this afternoon. I'm excited to finish up this semester, but then we have to take the comprehensive exam, then the shelf (1st set of boards). The hard work is just beginning.

I put on picture of a pterygium on this post because it links bats and pathology. Ptergiums earned their name from a Greek root meaning, Greek, “like a wing.” I, for one, can definitely see the a similarity between the pteryguium and the fruit bat wing (Yes, there are fruit bats in Dominica and yes, they are ugly).

For anyone who wants to learn more, a pteryguium is a benign growth of conjunctiva on the nasal side of the sclera and it is an elastotic degeneration of collagen and fibrovascular proliferation. They are often found in people with sun exposure (no sunglasses) and unlike other similar eye problems, such as a pinguecula, pteryguiums often progressive and may involve the cornea if left unchecked.

I'm up to my neck with things to study....

I am in the midst of three major exams in forty-eight hours: Microbiology/Immunology shelf, Pathology Laboratory final and Pathology shelf! After that we get to take a shelf in Pharmacology on Friday, another shelf in clinical medicine on Monday and finally we get to take the third local exam on the 23rd (covering the last 1/3 of the semester in all classes).

We just completed the Immunology and Microbiology this morning. It was a doozie! Shelves are administered by the National Board of Medical Examiners (NBME), which is the organization also responsible for the medical boards for licensing. The shelves are a review of everything in a specific subject. This means that the shelves always cover at least two semesters---there was genetic information on the exam that I haven't look at since my first semester in medical school! I hear (but I don't know) that most U.S. medical schools do not make their students take shelves in ever subject at the end of the school year like we do (in less than a week, no less). On top of all of that, we also have to prepare for the pathology lab final and the exam covering the last 1/3 of the semester! No one said medical school would be easy, and I think it is only going to get more challenging once I'm doing clinical medicine full time.

We have less than two weeks on the island left and I'm sure I'll miss it, but right now I'm ready to get home. There is a large Catholic population on the island and boy have they had a party for Easter! I don't remember ever having as much fun on Easter as they do. The music was thumping all day yesterday and since today, Easter Monday, is a national holiday they are partying today too. It always amazes me how loud one little island can be!

As the sun is setting on my time in Dominica, I know for sure one thing I'll miss: The most beautiful sunsets in the world.

Just a sip from that fire hydrant...

This week, I've set unrealistic expectations for the amount of studying that I'd complete. Shockingly, I've almost met these expectations the last few days days; but unfortunately, today hasn't been so great. I've still accomplished things, but not nearly as much as I'd hoped. People compare medical school to taking a sip of water from a fire hydrant or that it is both a spring and marathon at the same time. I guess I've been drinking from the fire hydrant and sprinting too much this week because my mind is numb today. I'm sure I'll be back on point tomorrow, achieving more than even I think I can.

Introduction To Clinical Medicine exam--Done; Another lizard

I had my exam this morning. I barely slept last night because I was afraid that I was going to sleep through my alarm or that I set my alarm for 6:50 PM rather than AM. Thus, I double checked my FIVE alarms probably five times and work up every half hour the last three hours I was in bed. Fairly typical for an 8:00am exam, especially since Farley wasn't assigned to take his exam at the same time I was.

When I left the exam, I knew I made at least one mistake in each of the four rooms. I felt really great about the exam when I got home, but when Farley was practicing this afternoon for his exam tomorrow, I kept thinking of more and more things that I should have said and done. Now, I'm not sure how the exam when! This happens every test I take, so I guess I'm right on track. One of the Introduction to Clinical Medicine exam, said that the students who leave the exam worried that they did horrible because they forgot so many things generally do extremely well. I'm hoping that I'm one of those students who do very well after worrying about my performance!!

I went out onto my balcony today and saw another 5-6 inch lizard HANGING UPSIDE DOWN on the ceiling of the balcony! Obviously, I immediately left and grabbed my camera. Here is a picture of the little guy, next to my light outside. I took the picture between my wooden slate windows through the mosquito netting so it is a little blurry.

After getting evidence of this lizard, I headed over to Farley's house. He thought that I needed to get this lizard out of my balcony. We headed back to my house to see if the lizard was still in place. Farley was brave enough to head outside to take a better picture of this lizard. Here is his picture, from a different angle:

Farley tried to encourage him to scurry off by poking him with a broom pole. At this time, the tail fell off again, but this time it didn't flop and the lizard didn't move. He was dead on arrival. Farley managed to knock the carcase onto the lawn then he pushed the lizard onto the lawn.

Let the games begin...

We have 21 days left on this little island and we are now beginning the exams. Tomorrow I will be taking my Introduction to Clinical Medicine Examination of the Physical Exam. There are four rooms and we have six minutes per room:

1. "Harvey", which is a heart sound simulator that I must exam and diagnose
2. Situation room, not the one with Wolff Blitzer, but a room with a patient who has one of 16 problems ( such as headache, blurry vision, numb feet). I have to do a general exam, one specific exam (in detail) and try to finish another specific exam for the problem.
3. The other two rooms are task rooms where we are given a specific task, such as examine the Cerebellum or perform a pelvic exam.

After this fun exam, I have a week before I get to take another exam. Then we have three in three days--nothing like fun in the Caribbean! I probably should review for another hour or two before bed for the exam tomorrow. I think I've done probably 60 or 70 six minute exams on Farley in the last two days! We started reviewing for this exam months ago, so I'm sure it will go well. Unlike last semester, we are in the room with two professors (we also had 10 peers in the room last time). I'm not sure if that will be better or worse for my nerves, but I think the worst part of this exam is the nervousness of performing for people.

Just ten minutes...

Before starting medical school, I was pretty good about working out 3-5 times per week. Since starting medical school, I have not been so good. I know that working out releases endorphins, decreases stress, and has a multitude of health benefits, but I still don't work out as much as I should. When I was home at Christmas, I decided to bring a few workout DVDs back to the island from the 10 Minute Solutions workout series. I really like the Quick Tummy Toners and the Fat Blasting Dance Mix, despite my inability to dance. I don't like the Hot Body Boot Camp as much because I can't keep up with her--I'm not cut out for hot body boot camp or military boot camp! I know, especially as someone training to be a physician, that I should work out more but with our schedule it can't always happen. On the other hand, I can find time to work out for 10-20 minutes in my apartment at least 3-5 times per week.

Speaking of just needing ten minutes per day, I found a free podcast from the Jesuits in the U.K. I LOVE the Jesuits so it should be no surprise that I love their podcast, which is titled, "Pray As You Go." They are ten minute little prayer and meditation sessions with music in the background, scripture and questions to reflect upon. The Jesuits started this project for Lent in 2006 so that people could pray during their long commutes, but they had such a great response that they have continued it--there have been over 5 million prayer sessions downloaded! Each prayer session is only 10-15 minutes long.

For those of you who do not know about the Jesuits they are formally known as The Society of Jesus. The Society of Jesus is a religious order of the Roman Catholic Church, founded by St. Ignatius of Loyola. The Jesuits are the largest male religious order in the world, with approximately 20,000 members serving in 112 countries. The contemporary mission of the Society of Jesus is the service of faith and promotion in society of that justice of the Gospel that is the embodiment of God's love and saving mercy. Different groups of Jesuits, in different regions of the world focus on different apostolic priorities within their region. They are especially involved in Education and Social Justice. Here is an example of some of these apostolic priorities from The Chicago Province of the Society of Jesus:

• Evangelization: Evangelize contemporary culture with special emphasis on the needs and aspirations of young adults.
• Collaborative Ministry: Strengthen partnership with lay colleagues, especially in leadership roles.
• Ignatian Character of Our Schools: Assure the Ignatian heritage, Catholic identity, and Jesuit mission of our high schools and universities.
• Intellectual Apostolate: Contribute to the intellectual mission of the Church, especially by scholarship, research, and writing.
• Solidarity with the Poor: Choose to be with the poor in lifestyle and for the poor in mission, locally and globally.
• Spiritual Exercises: Make widely available the opportunity to experience the Spiritual Exercises of St. Ignatius Loyola.

Basically, the Jesuits given their devotion to Education, especially higher education, are very current with events and technology. Thus, it really isn't a surprise that the Jesuits have this super cool podcast. They don't just stop there. You can download the Stations of the Cross, review Ignatian Spirituality online, or you can even look at their web page with links of to helpful ways to pray. From my experience, Jesuits love youth and educating youth, which is probably why they even have a my space page devoted to prayer. Talk about changing your mission as society changes!

I think it is fitting for me to end this blog post with a common Jesuit saying: A.M.D.G.

*AMDG is the abbreviation of the Latin phrase: “Ad maiorem Dei gloriam.” In English this translates to “For the greater glory of God.”

How To Determine Your Medical Speciality? Flow Chart!

Medical students LOVE flow charts. We use them to learn and understand different feedback loops in physiology and endocrinology, compare and contrast similar diseases and analyze a multitude of other things. How is the body affected if ADH is raised? Flow chart! How to you narrow a differential diagnosis based upon exams? Flow chart! How do you determine what speciality to specialize in? Flow chart! One of our professors had this useful flow chart in his lecture today. I think it might be fairly accurate, except for those gray areas like pediatric surgeons because every pediatric surgeon I've met has been VERY nice (but feisty enough to handle the other surgeons).