Thanksgiving Weekend

Thanksgiving was so much fun this year. Mom and I did our baking on Wednesday afternoon and Thursday morning. We had to make an Oreo cheesecake for dinner at my aunt and uncle's house and we had to make pumpkin bars with cream cheese for the neighbors. I got up early and worked out so that I could enjoy every last morsel. First we headed to the neighbors to visit a bit before heading out to the relatives house for dinner. I haven't seen some of my cousins and their children since before I left for medical school. It was extremely exciting to see everyone. We had a great dinner and a wonderful time visiting with everyone. After dinner, we headed back to the neighbors to visit for a while before heading home to retire for the night.

Friday, we had a relatively quiet day. I was suppose to unpack and organize my room; however, I decided to go to the yarn store which turned into going to four yarn stores. I've been wanting to start knitting again for months, but obviously, I've been a little busy getting ready for the Step. I thought that it would be a quick trip to buy yarn, but we were out for four hours because we went to so many different stores. I just couldn't find the right yarn so we kept going to different shops. I ended up finding some beautiful yarn that is perfect for the blanket that I'm making at Sew EZ Too . Sew EZ Too is one of those shops for serious knitters/quilters/arts people. I wouldn't describe myself as a serious knitter and I think they quickly figured out that out too--they offered me knitting classes if I got into trouble with my project. The blanket that I'm making is a knitted version of a log cabin quilt. I made a baby blanket in a similar pattern about three years ago, so I think I can handle this giant queen sized blanket. I started knitting and the tension in my shoulders has melted away. Knitting is such a great way to release tension; in fact, believe it or not, I taught myself to knit the summer I studied for my MCAT (entrance exam for medical school). I am not an amazing knitter but knitting is like riding a bike...you just don't forget.

Saturday, I finally got down to business and cleaned my room and unpacked my bags. I managed to fill two bags worth of clothes that I rarely ware anymore. I'm notoriously bad about holding onto clothes that in case one day I might want to wear them again. Sunday, Mom and I made a second Thanksgiving so that we could have left overs. There is nothing like a home made turkey meal and having two in one week was amazing.

Moving from Miami

My time in Miami is coming to a close. After the exam, Farley and I didn't do too much on Friday. We, obviously, had to go to the gym, run errands and clean the apartment. We spent a good two or three hours cleaning the apartment. On Saturday, our land lord come by to make sure we hadn't ruined the apartment so we could get our safety deposit back. After that, we continued our exciting times in Miami by packing. On Sunday, we headed to see some of Farley's family and started to pack our suit cases. Monday, we had to run all over Miami. We had to drop off some internet equipment, go to goodwill, take boxes to the post office, and we made a stop to get Cuban food one last time before dropping off the car at the rental agency. We decided to go to a movie since we were finished with our work earlier than anticipated. We saw An Education which is a coming of age story about a young girl who is seduced by an older man. It was good movie but not horribly exciting. It was what Farley calls "a people story". After the movie, we headed to school to print our boarding passes and such. Then we went out to Dan Marino's for Farley's birthday dinner. It isn't my favorite restaurant but it was very good.

Tuesday, I woke up early and got in a work out before finishing up my last little odds and ends before leaving. Farley's flight was at 2:30 and mine was at 5:00 so we were at the airport at 12:30. I thought that the airport would be super busy but it wasn't. Farley and I were flying on different airlines but luckily we were both sent to the same security place. I sat with him until he left then headed to get a late lunch. Finally, it was time for me to board the plane. We were headed to Denver, which is a four hour flight. I was on the aisle seat and there was a couple next to me. I feel asleep right after take off, but I was woken up by the gentleman's earphones next to me. I presume he was hard of hearing because I didn't have on the headphones, but I could hear the whole in flight movie. I managed to put it behind me and get back to sleep then the person in front of me pushed her seat back. I assumed this was an older woman with poor joints so I didn't say anything. Well, a few hours later I saw her and she was probably 22 years old. Gosh, I can't imagine pushing my seat back that far back. It seems a bit rude to me, especially for such a young woman (who was probably 5 foot 6 and 130Lb). As if that wasn't enough, the guy next to me started yelling out the names of the characters in the Harry Potter move that was playing. Then after the movie ended a t.v. show came on and he yelled "choo choo" when a train was on the show. I was beginning to wonder if there was something funny going on with him, but I'm still not sure. His wife was in window seat and I think she was a college professor. She was grading papers and her mannerism and dress just screamed professor to me. When the drinks came around, she made me laugh because she ordered a blood mary then continued grading papers. I'm sure she wasn't drunk, but it didn't seem that professional to me. Then again, maybe the papers were so bad that she needed a drink. The flight from Denver to Spokane was much less eventful. I was so excited to get home and get to bed; however, Mom and Dad had other plans. They got me a subscription to the New England Journal of Medicine. How exciting! I'm a member of the American Medical Student Association and they were having a deal with the New England Journal of Medicine a few weeks ago. The pamphlet arrived at my parent's house. Mom asked if I needed it and I said not at this point in my career but it would be fun and the price is fabulous. It was such a fun surprise. By the time I headed to bed, it was hard to believe that I had woke up in Miami.

USMLE Step 1: Check

Yesterday was the day: USMLE Step 1. I've been dreading this exam since before I was accepted to medical school. I always thought that if I could pass that exam, I can do anything. Well, I've at least finished it. I barely sleep the night before (or the night before the night before). I was up at 6:45, got ready, and headed out the door. We had to drive north on the Palmetto past Miami. Luckily, it went okay. We arrived at the center to take the exam a half hour before our slot. We checked in and headed to the back. They take your picture, fingerprints, review your ID and your paperwork. After all of that, you are assigned to a computer and are allowed to start your exam. You are given a tutorial about the software, then you start the seven blocks (one hour each) and 45 minutes of breaks. If you finish a block early, than that extra time goes to your break time. Break time also includes the time it takes to check out and recheck in (check ID, check finger prints, and sign in and out). I'm really glad that I had done four full length practice exams because this day was just something else. I've never been so tired. It is shocking how tiring it can be to think all day and obviously the questions were very difficult and there is a lot on the line with this exam. Anyway, I think it went okay. I'm really glad to have it behind me and I'm really glad to sleep and relax.

Geez Louise

Yesterday we decided to our testing permits for USMLE Step 1. First we went to the Internet cafe in our condo, but the computers were down. On a side note, it really isn't a cafe--it is a room with computers and free wireless Internet for the tenets to use along with a printer and fax. There are some tables and couches and the room has a view of one of the courtyard gardens. It is a nice area but no one has ever offered me a Café con leche so I don't think it qualifies as a cafe. In addition to it not really being a cafe, I don't really think the computers are down. There is new management at the condo and I think that the new management just doesn't know the passwords as the computers and wireless Internet looked to be working, but the computers needed someone to log onto them.

Anyway, after finding out we couldn't print out our testing permits at the condo we decided to make the two block walk to school. We grabbed our IDs and waited until after 5:00pm (because you have to be dressed up to go to school during working hours). Neither Farley nor I had a print card, so first thing we went to the print card vending machine. Luckily for us, you had to had a one dollar bill to buy the card then you could add money to the card. Neither of us had a one dollar bill and the machine was not accepting credit cards. We went upstairs to the main offices (which frankly can be a scary place) and our favorite office worker, Mrs. Kind was still at work. She didn't have change for a $5.00 and refused to let us pay her a $5.00 for the $1.00 dollar bill that we so desperately needed. I think she is probably one of the most helpful and genuinely caring people that our Caribbean Medical School has to offer. She is like a surrogate mom to any student in need, while maintaining her professional boundaries of course.

After obtaining the elicit dollar bill, we bought the card and then put $5.00 on it to purchase copies. We headed right to the computer lab and logged onto our respective computers. Farley hopped right on and had his permit printed quickly. I, on the other hand, ran into some troubles. I logged onto the website a few weeks ago to check the permit and make sure it was correct--it must match your ID exactly or you are not allowed to take the exam and if there is a problem you must correct it a few weeks before your exam. Obviously, I knew my password three weeks ago, but I could not get logged on yesterday. I tried retyping my password several times. I tried a different password. I tried everything I could think of. Nothing was working so I decided to click the "I forgot my password" link and have them send me a temporary password. We waited and after five or ten minutes, I thought that maybe I didn't fill out the "I forgot my password" information correctly so I did it again. About three minutes late, the temporary password arrived: It didn't work. We thought maybe another email would be coming since I did the "I forgot my password" thing twice. We waited for about a hour and kept trying to use the temporary password to no avail so we headed home.

I was worried about this password thing all night. I knew that I would be able to contact the medical board people and figure out my password in the morning, but it was weighing on me. I kept thinking to myself, thank goodness you decided to print this out two days in advance rather than one day or you would be in trouble.

This morning at 9:00 EST, I got online and tried one more time with the temporary password. It worked. After all of that, it worked just fine. I logged in changed my password, copied the permit into an email in case I had any other problems then headed back to school.

School was a ghost town. It is Wednesday so all of the third year students were enjoying a great day of lectures in Downtown Miami. I was alone in the computer lab, so alone I even turned on the lights. I tried to log onto the computer and it wouldn't let me. I was contemplating trying to find one of the IT guys, but on the fourth try, I got onto the system. Besides, the IT guys are also in Downtown Miami for the all day lectures, lucky them. So, once I was on the computer system, I logged onto my email to get my account number so I could then log onto the medical board web site and print out my testing permit. Failure. I could not get onto the medical board website. I tried to print out the testing permit from the email, but the formatting was completely different so I didn't think it would work. Security for these exams is extensive--they finger print you every time you take a break and leave the test room in addition to taking your picture and probably your first born child. But, it is a good thing security is so tight as these are medical boards and it is essential that medical students meet the minimum marks before moving forward with more extensive patient care.

Anyway, I ended up calling the medical board. I spoke with a very helpful lady. After telling her my life story to prove that I am who I claim to be, I she gave me the password that I had typed into my computer less than an hour before. In my rush, I neglected to read that passwords should be 6-9 characters and mine was much longer. So yes, I typed it in correctly that morning but the computer only picked up the first 9 characters and when I typed in my full length password which was longer, the computer caught it as an error. I felt so stupid. But, I now have three copies of my test permit just in case I lose one before tomorrow morning!

It's that time of year again: Elf Yourself!

Send your own ElfYourself eCards

I know that it isn't even Thanksgiving yet, but the Christmas decorations are arriving in the stores. Let me tell you it is strange when it is 86 degrees in Miami and there are plastic snow flakes on the windows at Target. I know I'm a little early for Christmas, but I just LOVE this elf yourself website.

Happy Birthday!

It is a special person's birthday today: Farley! Unfortunately, Farley and I have both had big tests near our birthdays this year. I had the comprehensive exam the day before my birthday and obviously we are taking the USMLE step 1 next week. Thus, we don't get to go out to dinner or do anything fun today for Farley's birthday.

Since his birthday is so close to the exam, I bought his present a month ago. Regrettably, it was delivered while we were eating dinner and he signed for it. He didn't know what it was, but he got to shake the box. I intended on hiding it in my room until this week, but the day it arrived I put it on my bed and went back into the kitchen. I heard a strange noise and looked out into the living room where he was shaking and listening to the box. A little while later, I joked that I should put it under the banana tree and we could call it the birthday tree. (The banana tree is a holder to keep the bananas from getting those yucky black marks on them). Later, I went to open the box to make sure that his present arrived in one piece, and it was missing. I was a little panicked until I looked under the banana tree--Farley moved it while I wasn't looking. I grabbed the and opened the box, wrapped up his presents, put them back in the box, wrapped the box and put it back under the banana tree where it sat until his birthday. I was going to get a picture, but Farley wanted to open it a little earlier than I thought he would. It has been sitting there for a month so he opened his present a few hours early (before I had time to bake the brownies and sing "Happy Birthday"... perhaps it was the thought of my singing that made him want to open the present early). Since he loves reading, I got him a couple of novels for after the exam.

Happy Birthday Farley!!

More motivation

"Some give up their designs when they have almost reached a goal; while others, on the contrary, obtain victory by exerting, at the last moment more vigorous efforts than before"--Herodotus

At this point in my preparation for USMLE step 1, I'm needed to exert more vigorous efforts than before. I'm trying really hard, but sometimes I need a little extra motivation to keep me going. Since I'm part Italian and a full time jazz lover, I've found just the motivation that I need: the Jazzed up Rocky Theme. Yes, you read correctly. Not only is it an amazing version of the Rocky Theme, the orchestra is wearing the most fantastic 1970s suits ever. If you ever need a pick me up, just listen to this and you too will be ready to take on the world.

Relief

One of our professors, Dr. GoodAdvice, advised us to take a practice exam from the NBME (National Board of Medical Examiners, the people who write the boards), which will estimate your USMLE step 1 score, ten days before you plan on taking the Step. Dr. GoodAdvice told us that if you want to go into an extremely competitive speciality like dermatology, you need to get a score of X ten days before the exam. If you want to go into something less competitive with more residency programs, like internal medicine or pediatrics, you need to get a score of Y. Dr. GoodAdvice also told us that if do not meet a score of Z ten days before the exam, postpone your examination. The USMLE step one exams is extremely important in residency applications and if you pass the exam, you cannot retake it to increase your score. Basically, this is a one shot deal.

It is ten days before I plan on taking USMLE step one. I've always had a bit of test anxiety, but since starting medical school I've noticed a pattern of my test anxiety. I usually get really, really nervous two to five days before an exam. Then by the time I take the exam, I'm still nervous at the start, but I'm okay once I get going. Well, today was completely different. I've been dreading taking the USMLE practice exam all week. I was really afraid that I wouldn't be ready. However, I knew I had to take the practice exam because if I wasn't ready, I needed to know 7-10 days before the exam so that I could move the exam. I think I've talked about the scheduling of the exam, but is is a process. Moving the exam is doable but you need at least a week to do it. When you apply for the exam, you are given a three month window to take the exam. If you move the exam, you must move test date within your three month window. If you need to move out of that three month window, I think you might have to start the whole process from scratch, but I'm not certain.

Anyway, there was a lot riding on this practice exam and I think it is the most nervous I've been taking an exam. This exam was four blocks of fifty questions and each block lasts sixty-two minutes. After you complete a block, you cannot go back and change any questions. This is the format of the USMLE step one, except that the USMLE step one is seven blocks rather than four. I started my first block yesterday and I wasn't sure of the first question. No big deal. After being unsure about the first five or six questions, I started to get more nervous and was planning for the worst case scenario. Then the next fifteen to twenty questions I felt much more confident about. It is amazing how every question you are not sure about stands out and is easily remembered, but all of the questions that one feels confident about just fade into the background. I kept checking my pulse during the exam (since there is a clock at the top of the screen to let you know exactly how many seconds you have left). I usually have a resting heart rate of about 60 beats per minute. During this exam, my pulse ranged from 120-150 beats per minute, but my mind remained clear. I felt like I still could reason my way through things fairly well especially when I took 10-20 seconds to just stop and breathe/relax. Nonetheless, by the time I clicked the button to see how I did on the exam, my hands were shaking. Then relief: I did okay. I met the marks that Dr. GoodAdvice gave us. I didn't do as well as I hope to do next week, but I put so much pressure on myself for this practice exam that doing well on it is a huge confidence boost. This probably sound strange, but I'm grateful I was so nervous today. This practice exam gave me a chance to practice stopping to take a few breaths, centering and then concentrating on my task at hand, despite being nervous. I am really lucky that I had a chance to practice and gain confidence in myself. Those four hours today, hopefully, will pay dividends next week and later in my career. There will always be times that I get nervous (everyone does), but having the ability to calm myself, focus and be successful are necessary skills that I've proven to myself I possess.

Now, I've got ten days to practice taking more exams and review errors I've made so that I can reach my goal USMLE score!

Sprinters train by sprinting. Medical students train with multiple choice questions.

I finished watching the 160 hours of Kaplan lectures at the center yesterday. Today I'm finishing the USMLE world question bank. Between the questions in my Kaplan course and the questions in the USMLE world question bank, I've done at least 4,000 questions since September. Since everyone I've spoken with that has recently taken USMLE step 1 says that the USMLE world questions are very representative of the types of questions that are on the actual step, I am planning on taking a few full day practice exams using the USMLE world question bank next week (hopefully, I'll be able to go though the whole question bank at least twice). I know academically that it is a good idea, but the thought of spending 7 hours doing question every day for the next week or so doesn't sound like fun. There is an analogy between sports and training for standardized exams. An Olympic sprinter does not just run around the tract and lift weights to prepare for the 100 meter dash, she practices the 100 meter dash. USMLE step one will not ask if I can read and understand the text book as well as the next medical student; they want to know that I can answer multiple choice questions, so I will practice as many multiple choice questions as I can from now until test day. I hope I'm ready!

Fall Back

The fall back weekend couldn't have come at a better time for me. I've been getting up at about 7:30 every day, but the day of the Step I'm going to have to be out the door by 7:30. It is so light and bright in my room that despite my sleeping eye mask, I am up and alert by 6:30-6:40. Falling back has made moving my get up time, so much easier. This is one of those times I can thank Uncle Sam! Just a couple more weeks then I will kick some USMLE butt (or so I hope!).

Pet Peeve: Student Doctor

I'm not sure it if is just me, but I hate when medical students refer to themselves as "student doctors." Part of that might be because we had a professor who told us that student doctor isn't an appropriate term and that if we were overheard calling ourselves that, we'd have to deal with him . I haven't met a student yet that has anything good to say about this professor so I think the threat of having to talk to him is enough to whip people into shape. When medical students call themselves a student doctor, it implies that they are a doctor. The vast majority of medical students do not start medical school with a PhD or other doctorate and thus are not doctors. If anything, resident and fellowship level physicians are the closest thing to student doctors, as they have earned their MD but they are completing their training and specializing before they are considered independent, attending physicians.

When I'm working with a patient, I try to go out of my way to let them know that I'm only a third year medical student. I'll even explain how much schooling I have and how much I have left to complete. I don't want to mislead someone into thinking I'm a physician; I think that is dishonest and unprofessional. I know a lot of medical information, but I am not a physician yet. At this point, I do not deserve the title "Doctor" and I'm not ready for all of the responsibilities that accompany that title. When I am a physician, if I hear a medical student call himself a "student doctor," he will get an earful from me or I'll just send him to go see that mean professor from my medical school. The threat of going to talk with that mean professor will keep anyone from misbehaving.

Lentil Soup and Beef Stew

On Mondays, I try to do most of my cooking for the week since Mondays are our day off while we are studying for Step 1. Farley is fairly easy to cook for because when he decides he likes something, he will eat it every day. I, on the other hand, like some variety. Recently, he has decided that he wants lentil soup and beef stew. The beef stew I can understand because he loves meat, but I was a bit surprised about the lentil soup. I asked him why he wanted lentils so much this fall and I thought his response would be something like, "My mom made it when I was a kid." I was wrong. One of our Kaplan video lecturers said that fiber inhibits the uptake of cholesterol from the gastrointestinal tract, which is basically how drugs known as bile acid sequestrates work. Farley decided that we should eat more fiber and lentils are extremely high in fiber. I wanted to do something different this week but he really wants to make sure that our cholesterol is kept in check, so we are having lentil soup again. He was so excited to get more lentil soup and beef stew that he chopped veggies, beef and helped me cook for an hour. I took a few pictures, but I don't know if the pictures look as good as it tastes.



Above: Double batch of Beef Stew
Below: Lentil Soup (many lentils were at the bottom of the Tupperware)

Bagger!

Farley and I take turns buying groceries and today it was my turn. We loaded up everything onto the conveyor belt and said hello to the Cashier and to the Bagger. As we said hello, the Bagger replied, "Well this should be interesting, who is going to pay?" I got out my wallet and the Bagger then looked Farley in the eye and declared that "men should pay for food." I told him it was my turn. Then the Bagger told me that, "Men should pay for food and women should stay home and cook." I don't think there is anything wrong with women staying at home, but obviously, that isn't for me. I looked at him and informed him that was I halfway though medical school and I wouldn't be staying at home anytime soon to cook all day, besides I owe so much in student loans I couldn't quit now even if I wanted too (which I don't). Then Bagger looks at me and said something like, "Well what does he (Farley) do all day?" When I replied that he is halfway through medical school too, I don't think the Bagger knew what to say next. At that point, I needed to finish paying and Farley had to deal with him. After we left the store, Farley and I discussed Bagger a little more. I think Bagger probably had a low IQ making him slightly mentally retarded (I'm not typing that to be politically incorrect, but it still says mentally retarded in medical text books not special needs). Also, I'm not just saying that because he thinkgs women shouldn't work; I really think using the medical knowledge that I have obtained since starting medical school that Bagger has a low IQ (and Farley agreed). If Farley and I are correct, I'm very happy that Bagger found a job and that he is able to be somewhat independent. If not, well, I wish he would stop irritating people in line and the nice cashier lady.

Many times Farley and I have been out and people asked what we do. We usually try to respond that we are in school and inevitably we are asked about what we are studying. When we say that we are third year medical students, there have been several people (in Miami) who have actually said, "That is wonderful.. He is going to be a doctor and you will be a nurse!" Nurses are great and it is a wonderful profession, but I didn't go all the way to a Caribbean medical school to be a nurse. It really irks me that people assume because I'm a woman I can't/won't be a physician. Living in Miami is like living in a different world sometimes.

Pimples that Kill.

There is an area of the face known as the dangerous area of the face. This area is can be found by drawing a triangle with one tip between your eyebrows and have the base of the triangle at your upper lip. Here is a picture. The venous drainage of this area of the face also drains parts of the brain. This area is called the dangerous area of the face because there are documented cases of large pimples managing to infect systemically and cause death. I don't think that has happened much since the advent of antibiotics, but the dangerous area of the face received it's name in the 1850s not the 1950s. I'm really not kidding about this. A paper was published in 1852 that documented six cases of patients who had pimples in the dangerous area of the face and died (I couldn't get a copy of the original paper, so I have referenced a paper from 1932 that discusses the 1852 paper). Really it's true. So anyway, the first patient was a 20 year old otherwise healthy male who had a pimple near his upper lip. He scratched off the head of the pimple six days before his admission to the hospital and died 36 hours later. See there was a reason your mother told you not to pop your zits--it has killed people!

I'm giving you all of this background information so that I can tell you a funny story. I really should have blogged about this story last spring when it occurred, but I guess I didn't find it as funny at the time. Anyway, at the end of my second year of medical school, I had a clinical medicine lab every Thursday morning. There were eight students, one professional patient and one professor. I loved my professor. Let's just call him Dr. MD/JD. Dr. MD/JD was in his 70s. He was from the Caribbean and did his residency at the University of Edinburgh in surgery (and is board certified in surgery in the U.K.). He came back to the Caribbean and worked as a surgeon for a number of years and then at some point decided to move to the United States. If you are a physician from another country you must pass all of the U.S. medical boards and then repeat your residency to practice medicine in the U.S. Thus, Dr. MD/JD decided to do his U.S. residency in Family Medicine and is still board certified to practice here. While he was in the U.S., he got into a debate with a law professor about the difficulty of law school and the law professor challenged Dr. MD/JD to go to law school at night if he thought law school was really that easy. Well, apparently law school was that easy for Dr. MD/JD because he not only earned his Juris Doctorate he passed the bar and is still a partner of a law firm in the U.S. Not only did Dr. MD/JD have an extremely broad range of knowledge, he was really funny and I think he honestly cared about his students. Dr. MD/JD even picked up prescriptions for one of my friends because the only pharmacy in the country that carried the medicine my friend needed was in the capital (over an hour drive from school).

One lab session, Dr. MD/JD walks into class and jets right toward one of the girls in the class, who we will call Blemish. Blemish had a pimple the size of Mt. Everest in the dangerous area of the face. Dr. MD/JD asked if Blemish knew she had a pimple. Blemish was quickly turning as red as her pimple as she informed Dr. MD/JD that she had noticed it. In fact, it was pretty obvious that she tried to cover up Mt. Everest, but Mt. Everest was so large that no amount of make up could cover it up. Dr. MD/JD then started asking her when it first arrived, what she was doing to treat it, and warned her not to pop it or she could get a systemic infection. Then he told her if it wasn't gone soon, she need to have it drained by a physician. Blemish was thrilled when Dr. MD/JD decided it was time to start the lab; however, he did take this opportunity to review infections, antibiotics and why the dangerous area of the face is so darn dangerous.

The next week, Blemish walked into class just as we were starting. As Blemish walked into class, Dr. MD/JD said he was so happy she made it because he was getting worried that the pimple had gotten out of control. The he went right over to her to check on Mt. Everest, which was almost gone. He said that he had been worried about her all last week. That pimple that could kill.