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.

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.

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).

My last trip to Roseau and the Dominican hospital.

I had my second trip to the hospital last Tuesday and boy it was a heck of a day. As usual, the day started with a dose of dramamine for the long winding road to Roseau. Midway though the drive, I realized that this stretch of highway looks a bit like California Highway 1. The Dominican Road (which, I cannot find a name for other than, "the road to Roseau"), is so windy, barley two lanes and plunges into the mountains and then plunges out toward the ocean before taking a hair pen turn back into the safety of land. There is one strip of the two way lane is straight (about 1/4 of a mile) that looks shockingly similar to the picture below from Highway 1 in California--and I heard Tom Cochran's "Life Is A Highway" for the rest of the day. The main difference between California and Dominica is that Dominica has huge mountains just inland of sea and it is much greener. In fact, Dominica is so green that it is almost intoxicating.

But alas, we are no where near the United States, let alone California (or Washington!). There is a sign outside of the library that states we are 3,818.42 miles from California and that California is 34°26'N and 119°50'W. The funny thing is that the sign is facing Southwest rather than Northwest. I'm not exactly where you would be if you went 3,818.42 miles southwest of Dominica, but I think it is somewhere in the Atlantic ocean or on the Atlantic coast of Africa.

Now onto the hospital, I was assigned to the OB/GYN unit for the morning of shadowing a physician. The first three patients we saw where all hospitalized for intense morning sickness. They were all between 11-16 weeks and overall doing well. Honestly, it wasn't too exciting because there isn't anything to see and basically they just give these women antacids, anti-emetics and IV fluids. I don't want to say that any patient isn't exciting, but I guess since three of them had the same thing wrong it wasn't as interesting by the third time through.

Sometimes you don't always get what you wish for because my next patient was exciting, but I'd never wish anyone to be in so much pain: a young woman who had a primary outbreak of herpes. I won't describe the lesions in too much detail because I know that most people don't want to hear the details of infections. I feel so horrible for this young woman as you never can get rid of herpes simplex virus. For those that don't know, herpes is an extremely painful infection and my patent's infection was so extensive that she couldn't comfortably sit down as she was in so much pain. On the other hand, medical students don't usually get to see such extensive infections so early in their career so I'm grateful that I was able to see this infection--it looked like something from a pathology or microbiology book. I was also able to see the vagina and cervix, which I have not done yet in medical school (they only let us practice pelvic exams on mannequins at this point in our education).

After finishing up with that poor patient, we headed upstairs to the delivery floor. Our next patient was 44 weeks pregnant! 44 week!!! For those of you who don't know, 40 weeks is the general length of pregnancy and a baby is considered full term at 38 weeks. In the U.S. (and Dominica), babies are not allowed to hang out in utero for 44 weeks (babies get big and can get stuck during delivery amongst other problems). However, that involves the mother coming in for prenatal care! This Mom had come in once before and then came in because she thought it was time that she had the baby. Upon ultrasound and a good history (I'm not sure how they got a good history out of this lady), they determined that the baby was 44 weeks along. The most exciting thing about seeing his patient was that the doctor showed us how to feel for the position of the baby and we got to listen to the heartbeat. I even found the heartbeat all by myself! It was SO exciting!! Babies have quick heart beats (if I remember correctly a normal fetal heart beat is 120-140 bpm) and they sound a bit like a choo-choo train.

After that patient, we went out to lunch. Again, I have no idea why we needed a two hour lunch. We went to a different restaurant this time and it wasn't that good; but I didn't get food poisoning, which in a third world country means that that it was a GREAT restaurant.

After lunch, I was assigned to the pre-surgical unit. My patient had two gunshot wounds and his hallicus (big toe) on his left foot lost all movement. The working theory is that his sciatic nerve was injured either from the bullet (less likely based upon his history) or the due to the healing process (more likely based upon history). He was going to have an exploratory surgery at the end of last week, but I don't know what they found out. At least the interview was interesting.

The ride home was, as usual, rather tipsy turny--thank goodness that I had time to take my dramamine before we left Roseau for the 20 mile, 60 minute drive back to school. That was my probably last trip to Roseau ever. Speaking of things coming to an end, I've got to enjoy these Caribbean sunsets while I can because I have less than 30 days left in Dominica. But that also means I have less than 30 days of cold showers left too!!

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.

He's breathing...

During lunch, the Introducing to Clinical Medicine support staff were helping our professor (we'll call him Dr. Interesting because he NEVER gives a boring lecture) set up STAN. STAN is a relatively new took in medical training--1996. STAN is a simulator that breathes/respires, blinks, and I think he can even talk. He codes but since he is only a simulator, if a medical student make an error and gives the wrong medication, no one really dies. Yes, I said "gives the wrong medication". Students get to start IVs, give injections, perform CPR and even perform endotracheal intubation. You may have seen him on t.v. as he makes appearances on Grey's Anatomy and other medical shows. I'm not sure if our professors can talk back to us as STAN which is what happened on Gray's Anatomy, but I think they probably can. I do not know when students at United States Medical Schools get to start using the STAN machines, but I think it generally is later in their career (but this may have changed as there are more places with STANS). I have heard 3-4th years or even during residency, but I'm not sure and I couldn't find anything online. I do my first session (with 6 other students) next Thursday, so I'll report on if we can keep STAN alive or not.

Dr. Interesting's lecture was on respiratory failure. Because he is Dr. Interesting, he didn't just want to show pictures or videos of a patient, which is why he brought in STAN. Dr. Interesting showed us each method of increasing oxygen (such as a nasal cannulus, incubating and bagging the patient and putting a patient on a respirator). STAN's vital signs were on monitors all over the room (by monitors, I really mean large plasma t.v.s and a HUGE screen in the front. The huge screen isn't a projector, but it isn't a plasma t.v. either...it is probably 15 feet by 15 feet, which is also roughly the size t.v. that Farley wants in his bedroom). So Dr. Interesting kept things interesting by letting a student give the medicines to sedate and paralyze STAN and then Dr. Interesting incubated STAN. Let's just say, it was more fun than looking at a picture in a book. STAN got sleepy, closed his eyes, and once Dr. Interesting had incubated him, we could see the change s in STAN's breathing. Yes, Dr. Interesting got his nickname for a reason. Class was so much fun today.

Photo taken from an interesting article on simulators in medical training from The Guardian.

Doctors Orders: Two cups of coffee in the morning

Today we were discussing drugs used to treat respiratory disorders, such as asthma and chronic obstructive pulmonary disease (COPD). One class of older drugs methylxanthines, which includes the Theophylline, Aminoophylline and Caffeine, isn't used frequently and are not drugs of choice--nonetheless, we need to review them. These drugs work by inhibiting phosphodiesterase enzymes and blockade of adenosine receptors. Basically this means that they cause bronchodilation (but not as well as beta-2 agonists, such as abulterol), they increase the ventilatory response, increase mucociliary clearance (which is important in asthmatics because the pathology of asthma results in an increase in mucus), and improved diaphragmatic performance, which is unique to this class of drugs. Bottom line, these drugs makes it easier to breathe. I'm sure your wondering why I'm telling you all of this as you probably don't care about mechanisms of action and classes of drugs--if you did care you would be a pharmacists or a physician--I have a story about coffee.

Our lecturer today started teaching medical students in 1956 and is an MD and a PhD. I think he might be the smartest person I've ever met. He is an excellent professor and I think he could teach just about any topic in medicine school at any moment without much preparation. He is amazing in that he is so intelligent, never embarasses students, is extremely helpful and very modest (but he writes extremely difficult exam questions). After discussing the respiratory effects of Methylxanthines, we discussed effects in other systems such as the gastrointestinal tract, genital urinary tract, cardiac system and central nervous system. Obviously caffeine acts on the CNS, which is the point of this blog post. He made a point that moderate doses of caffeine has the following effects on the central nervous system:

• Cortical arousal with increased alertness and deferral of fatigue


• Decreased reaction time, more rapid and clear flow of though, and increased learning capability for simple tasks

Then he bluntly said in a thick Italian accent, "If you need to stay awake to study for your exams, please just have two cups of coffee. It will work better because you will be more alert and is safer than abusing other drugs." Through out the world, people abuse substances, such as Adderall which is an amphetamine, to keep them awake for school or work. I, personally, don't know of anyone who is abusing drugs to stay awake and study, but I do know that it is habitually done in medical schools and I'm sure some of my peers are doing so. It surprised me that he stopped to talk about drug abuse and reasons it is so horrible. Not only is he an amazing professor, I think he truly cares about his students (and he looks like a cute Italian grandpa). Now back to caffeine, there are obviously side effects if you take too high a dose of caffeine including insomnia, headache tremors, and headache (which he also warned us about). Nonetheless, the moral of the story is if you need help staying alert, Doctor's orders: two cups of coffee.

Without struggle, there is no reward

"Nothing in the world is worth having or worth doing unless it means effort, pain, difficulty... I have never in my life envied a human being who led an easy life. I have envied a great many people who led difficult lives and led them well." -- Theodore Roosevelt

I'm not claiming that my life has been difficult, for there are many people who have lived far more difficult lives than I; but, I am willing to claim that medical school is just the start of the difficulties that I face. I don't think I chose medicine, I think it chose me--I can't imagine my life in any other way. However, I didn't think I'd get to my end goal via an International Medical School. Nonetheless, I glad that I came down here. I knew becoming a physician meant that I would miss out on parts of my personal life and it would also mean that I would be an integral part of a relative strangers' personal lives in both the best of worst of times. It is just part of the package. Since coming to medical school, I haven't been too involved in stranger's lives yet (although I was in my position as clinical researcher). But I have already started to miss out on parts of my own life. Since starting school, I missed my grandmother's death and funeral, my cousin's wedding in the Puget Sound, multiple family BBQs, extended family trips to the Seattle area, birthdays, holidays, and tonight I'm missing my half-sister's wedding. I don't think it is any particular event that I'm sad about missing, but I do feel a bit like an outsider since I'm so far away. It might sound a bit selfish but in the end, I don't regret missing these events. In just a couple years, I will have the high honor of being a physician--even if I'm a little lonely and homesick from time to time. Nothing worth doing, comes without struggle.

Yes, You DO have the right book!

Yesterday, Farley and I bought the review book of all review books: "Rapid Interpretation of EKGs" by Dr. Dublin. The book just cracks me up. The back of the book doesn't describe how the book is set up just why is it such a great book. It talks about the imitators and how other review books have replaced "EKG" with "ECG" etc. I was laughing when I read the back of the book. The first point that made me laugh, "Yes! You do have the right book." and later when it says (highlighted in yellow) "There are books you buy for a course...This is a reference you keep for life." Please note, I had a hard time taking pictures for you to see this great reference, so I apologize that they are not my best pictures.



Obviously, I had to rip off the plastic and read this book immediately. I was not disappointed. For example, the yellow box under the Table of Contents: "Since this book will be your lifetime reference, you should place an identifying tab on the first page of each chapter." Then it highlights which pages start the chapter in the table of contents.


Finally, I started reading the first chapter. This books is beautiful. Every page is glossy, colored and the pages are thick, but not quite card stock. Each page starts with a drawing, graph or table. Readers are to first read the caption then try to understand the content of the drawing, graph or table. Next, it has a few sentences about the drawing, graph or table and expanding on the topic at hand. These sentences, however, lack a key word which is in the margin and you are expected to fill it in as you read (and obviously you can check if you are not sure). For example, it might say, "Living in Dominica, Nicole has many sunny days but also many ____ days because Dominica is not only near the equator but also a rain forest." Now in the margin it would say "rainy." It was actually fun to read the book. Luckily for me, there was yet another comment after the first page of chapter one, which made me chuckle: "*Get yourself a warm cup of coffee, relax and enjoy...the rest of the book is just as easy and entertaining."

I've never seen such a cocky text book, but if all the things I've read about it are true I guess it can afford to be cocky. From what I've seen so far, it is fun and easy--I just hope it stays that way. It has been published for over 30 years, is in it's 6th edition and the 60th publication...seems like reason to be cocky.

Start of the semester

I'm a bit surprised that I'm excited to be in class this morning--the semester break just didn't seem long enough. Both pharmacology and microbiology/immunology are worth 3 credits each this semester, pathology is worth 4 credits and Introduction to Clinical Medicine is worth 5 credits. This most exciting part of this semester is that we are starting to get more heavy on clinical medicine rather than just the books. We will be doing hospital days more frequently than last semester, which is both good and bad. It is good because I want to be a doctor (in large part) to work with people not just to think about theory in a philosophical manner. It is bad though, because the drive to the hospital is an hour and the road climbs uphill and downhill as well as bending tighter than a hair pen. YUCK! Thank goodness for Dramamine (dimenhydrinate) because without it, I'd be sick enough to be a patient by the time I get to the hospital. With the two hours of driving and the eight hours of clinic time, we will have fewer hours to study (which is always a bad thing). We will also be required to write multiple history and physicals, which is a great thing for me because writing up patient histories is probably one of my strongest skills as a medical student. You might be surprised that writing a history and physical is extremely important and not nearly as easy as it sounds it would be.

One funny thing was said today in class. We were told that if we are too sick to attend a clinic that we must call in (obviously, you have to call in when you have a job so it makes sense you have to call in as a student). The funny thing was that our professor said, "if you are too sick to be in clinic [as a student] than we will send a transfer to pick you up so we can see you [as a patient] to check you out." That is one great thing about medical school: there are plenty of people to make sure we are healthy and wise!