Happy Belated National Coffee Day!

During one of my study breaks yesterday, I came to the happy discovery that today is National Coffee Day!!  Who knew there was such a thing.  To celebrate my new favorite day in September, I drank the last of my hazelnut flavored coffee from CTB. Mhmmmm it smelled absolutely delicious.  I actually brought some of this to the clinic this past Wednesday and everyone was SOOOO jealous of my amazing smelling coffee.

In order for you to fully understand my addiction to coffee, here is is a picture of my current coffee horde.  When I came down to visit Dominica in June, the first thing I scoped out was the coffee situation and found it to be horrific.  Hence me shipping coffee in my barrel and having my Dad bring down some more Starbucks when he visits.  These all resulted in my accumulation of a glorious amount of my liquid crack!  (It should last me the whole semester....)

I <3 coffee

Now back in the States, many places give out free coffee. I wish, wish, wish they had that traditional here in Dominica. Instead I had to satisfy my desire for free coffee by reading about coffee traditions....here is a neat article I cam across (Coffee around the world ).

My Typical Day

I figured I would write a post about my typical day so that everyone can get a feel for what a "day in the life of a med student" is like.  Be forewarned.....if you did not like the movie  Groundhog Day, you might not like this post.  My life strongly resembles this movie...take the below schedule and apply it to Monday, Tuesday, Wednesday, Thursday and Friday with slight variations on Saturday/Sunday (aka no class on those days).

Here we go....

6am:  Wake up (sometimes I will snooze until 6:30/6:45 which means I don't have time to shower.  I know Megan and Claire used to absolutely love my habit of snoozing for an inordinate amount of time).

7am: Make my coffee, find something to eat for breakfast.  I strongly dislike breakfast so it is always  chore to find something to eat.  If I don't have anything, I am absolutely starving by the time I get done with classes for the day.

7:30am:  Trudge to class (generally it is already 80 degrees).  Sometimes I am lucky and the shuttle drivers take pity on me and pick me up.  One positive of the walk is that I have a gorgeous view of the rain forest covered mountains.

8am-Noon: Class.  Sometimes we get lucky and start at 9 or 10 but sometimes we go from 8am to 2pm.

Noon to 1:  Lunch/Nap in my hammock

On Tuesdays and Thursdays I have either anatomy lab or just a lab demo.  If I have the actual lab, I can be in the lab until 5 or 6pm.

Once I am done with all my required parts of the day, its time to review the lectures and make a study product.  We are supposed to take between an hour and two hours to make the study product per each hour of lecture.  After making the product, you have to review material from past lectures and preview the next day's lectures.  So basically I am doing something academic almost every waking hour.  I don't let myself go to bed until I finish all the lecture material from that day (This hasn't caused any major problems.  I have been able to go to bed around midnight each night which is decent).

The weekends I have a little more free time because I am not getting any new information.  (This why I always video chat everyone on Saturday or Sunday!!)

So now you know my typical day.  I know you are all probably EXTREMELY jealous of my exciting life lol.  I just tell myself I am always chugging along to the goal of becoming an MD and that eventually I will accomplish my life-long goal.

Diabetes Clinic

After 4 straight weeks of extremely intense classes without any breaks, I was starting to lose my mind with the overwhelming amount of material.  So when the chance came to volunteer at a diabetes clinic right in Portsmouth, I jumped on it. I desperately needed to have patient contact to remind me why I am here.  

Diabetes is a major problem here on the island due to the increased super-processed "Westernized" food-(i.e. doritios, chicken nuggets, etc) and because the lifestyle is starting to become more sedentary. This clinic provides invaluable routine care to the known diabetics on this portion of the island.  It checks their blood sugars, checks for edema, and most importantly checks for any ulcers or lesions on their feet.  This allows for early detection of foot problems which hopefully will reduce the need for amputations later in life.

The Diabetes Clinic was definitely an eye-opening experience and really showed me 3rd World medicine.  I will never take the US healthcare system for granted.  When we pulled up the hospital, the first thing I saw was a large open double-door into the main hospital ward.  There were no rooms or beds, just cots with signs overhead saying "Female 1, Male 13, etc).  Walking into the hospital proved to be more of a shock.  The only waiting room consisted of long wooden benches that resembled church pews.  There were already 30 or so people already there at 8am.  We walked to the room we were going to do interviews and I was even MORE surprised!  The room was the hospital's old X-ray room which was approximately 5ft by 7ft, still had the old Xray equipment in it, and had lots of shipping boxes.  There were no patient records kept at the hospital and there certainly weren't any fancy-smanschy electronic records like we are used to. Instead, the patients keep their own records in the marbled composition notebooks that they bring each time they come to see the doctor. (All the patients clutch these notebooks for dear life because they know how important they are. The patients also seemed to be proud of their notebooks.)  We also did not have running water in our exam room because the only running water in the hospital was in the restroom and the doctor's room.

The set-up of the clinic worked so 3 of us students were in the old X-ray room doing the initial interview and blood glucose level, while the other 3 students were in with the Doctor, listening to her patient assessments. It was exciting to work one-on-one with the patients and have them call you Doctor.  I am extremely grateful for all of my EMS experience because not only was I comfortable with the patients but I could do blood pressures, blood glucose levels, and could take a basic history.  After today, I feel rejuvenated and excited again.  So all-in-all, it was a great experience!

Channeling my inner John Nash? (aka the crazy things med school makes you do)

Do you remember the scene in A Beautiful Mind, where John Nash is writing out his theories on his window?    I guess eccentrically smart (we will go with that label for this analogy) people use their walls, bathrooms, windows,etc to write out problems and search for the potential solutions.

Well tonight, after perhaps one too many cups of coffee coupled with too little sleep, I decided to try to write on my refrigerator (after all it feels basically the same as my whiteboard). After testing a small section and realizing that it easily erases, my life was forever changed!  Now I have a huge whiteboard that will help remind me of the key ideas I am supposed to be learning!  Granted if anyone walked into my apartment, I am sure they would be quite concerned about my mental sanity.  I wish I could be fly on the wall when my maid sees it on Wednesday! I am sure there will be some gasps and head-shaking.

John Nash writing on the windows

My refrigerator

You know you are a med student when...

1. Your friday and saturday nights are spent coloring anatomy pictures

2. You get excited for the weekend not because of the fun plans you have, but because you aren't getting any new material for two days.

3.  Your YouTube experience consists of looking up songs about glycolysis and the brachial plexus rather than music videos

4. Your kitchen/living room is filled with flashcards and notebooks

5.  You don't have coffee books on your table, you have biochemisty and anatomy textboks

6.  You wake up at 6am every day and consider sleeping in until 9am a luxury

7.  Your main drink of choice is coffee (well for me this is not a new development)

8.  Your "social life" consists of group study sessions

9.  Everything has a mneumonic associated with it (and generally, the dirtier the mneumonic, the easier it is to remember)

10. You get frustrated with medical shows because all you can focus on is all the inaccuracies

11. You're really frightened by the thought of some of your classmates becoming doctors.

12. You use extremely long words in your normal, every day conversations

13.  You "treat" yourself by going to sleep at 10pm instead of midnight or 1am.

Hypothetical Situation 1: What to do if you are chased by a bull

Today in my biochemistry class, my professor was entertaining us with a story from his nine years of living on Dominica. This is kind of how the story went....

"This one time I was walking home from campus on the lizard trail, when I came face-to-face with a giant bull.  And I made the mistake of making eye contact with the bull.  This set the bull off and it started chasing me.  My only option was to climb a tree, so I climbed a tree and waited until the bull ran off."

This had the entire class in absolute hysterics and I am sure many of us were thinking that this would never actually happen to in our lives.  But then, as I was leaving the Annex (where 1st semester students take their classes), I heard a giant MOOOOOO!!  I kept walking thinking that someone was just fooling around and being an idiot.  Then I heard it again....MOOOOO!!  I walk farther along the sidewalk and bam, there is a giant bull standing on the other side of a rain forest outcropping.  This bull had giant horns and thankfully was tied up.

Picture me as the guy in the tree.  Picture the tree a Palm tree.  Then you will have a picture of me running with the bulls in Dominica.  

However it got me thinking, what would I do if I got chased by a bull? First off I am going to avoid eye contact by all means possible. Second if a bull starts chasing me, I am going to run like hell to either a sturdy tree or to a nearby building and take shelter. Because in all honesty, there is no way I am going to use my "quick catlike reflexes" to jump aboard the bull and ride it like a professional bull rider would (even though this crossed my mind for a brief second). So in this hopefully hypothetical-only situation, I am going to find the nearest tree (ideally not a palm tree but instead one with lots of limbs and a thick trunk) and climb it!

If for some reason this happens, I can cross off one of the 1000 Things You Should Do Before You Die because I think running with the bulls is one of them.  While I know it is supposed to be in Italy, I figured running with the bulls in Dominica would be more than sufficient.   

 

"Open Chest"

Yesterday we had our first patient interaction!  We had a video conference with a patient who was in Roseau and had the opportunity to ask the patient questions regarding chief complaint.  During the course of the interview, the patient stated that she had suffered an episode of "open chest" when she was a child.  Now you say this to a room of brand-new med students and you couple it with a chief complaint of chest pain, you should expect the entire room to gasp and automatically draw the conclusion that the patient had an open chest surgery.  Nope!  Not at all! When my fellow students started asking the patient questions about the surgery and what exactly happened with it, the patient was utterly confused!

It turns out that "open chest" is a saying here in Dominica that means chest tightness/pain and is generally given to symptoms that are diagnosed as Costochondritis (which is basically a painful inflammation of the cartilage that connects your ribs to your sternum). Needless to say this condition does not have quite the same severity that open heart surgery has.  Once our teacher explained that "open chest" was not in fact open heart surgery but rather the painful inflammation, we were mildly embarrassed.  I think that this experience taught me that whenever my patient's say a phrase that I am not familiar with, I will ask them to elaborate.  This way I will understand exactly what they are trying to tell me and that I will not include faulty information their history.  I am definitely learning a lot about how culture factors into medical practice.

First Med School Test Done!!!

Survived my first med school exam and I have to say it was not nearly as bad as I expected.  It was nice to take a test where your studying actually pays off!  While I studied my butt off, it was worth it.  I had a general idea on what the questions were asking and there weren't any moments of total confusion (unlike my experience with Orgo...).   I don't think I got a perfect score on the test but I am confident that I passed with a room to spare.  Of course during the test, it starts monsooning. Horizontal rain and thunder so intense that it shook the building.  Thankfully I love thunderstorms so this didn't faze me, but some people were definitely distracted by the weather. 

After the exam I went on a hunt to find frozen chicken breasts with my friend Lisa.  It is a rarity to have boneless, frozen chicken breasts, so when you find them you need to stock up!  The IGA for example won't have a new shipment of frozen foods until the beginning of October.  The rain made our adventure to find frozen chicken breasts particularly exciting (Amelia, you will be happy to know I didn't get swept away even though I did get absolutely soaked).  We got the chicken breasts and then headed up to campus to the coffee shop.  I have decided that this coffee shop will be my new guilty pleasure on the island.  I had such a good chai latte!  Almost CTB quality :) So overall it was a good day.  I survived my first exam, found frozen chicken breasts, and found a fantastic coffee shop.  

How much can you handle?

This past Sunday/Monday were my two worst days on the island so far.  I was fighting a very bad sinus infection that not only gave me a 100 degree fever, but also resulted in such bad sinus pressure that my eyes and teeth were hurting too.  Since I had been spending time during the week studying and doing various other activities, I was out of groceries and was almost out of electricity.  This was a very bad combination.  I went to the IGA and realized they didn't have any normal food (only pigs feet, smoked fish, various canned goods, etc) and they had somehow ran out of electricity.  So Sunday night needless to say I was not in a very good mood (thank goodness I had my roomies to video chat with or I would have been even more stressed out).

I finally gave in and started the antibiotics (which I definitely should have started early. I was just being stubborn).  So after a really bad night of constantly waking up (I was worried that my electricity had shut off in the middle of the night and therefore my alarm was not going to go off), I head to class.  This is when the infamous centipede-crawling on me episode occurred.  Clearly this made me even more happy (please note the sarcasm).  I finally went to the store after class, get restocked on electricity and bought some groceries.  Also the antibiotics started doing their job so I could finally breathe again.  At one point during this awful series of events, I was about ready to throw in the towel.  Thankfully I took some deep breaths, realized that this was just life in Dominica, and settled back into studying.

What I realized from this instance was that if you just keep trudging along, you can get through pretty much anything.  If I can survive being really sick, having disgusting bugs crawling on me, and scrounging for groceries, all the while studying, then I can survive pretty much anything!  The saying "What doesn't kill you makes you stronger" definitely applied to the beginning of my week.   But now, here I am, on Friday night, feeling much better and now have a wonderful, entertaining story to tell everyone.  So I learned I can handle a whole lot and still get through it. 

Where is Dominica?

When I started telling people that I was going to school in Dominica, many said "O, isn't that by Haiti?" Nope that would be the Dominican Republic.  If you look at the picture below, Dominica is circled in Red.

 We are actually closer to South America than North America but we are still in the same time zone as all of you people on the east coast (thank goodness because it makes video-chatting that much easier).  One main difference is that in Dominica, there is no daylight savings time.  

We have daylight from about 6am to 6:30pm every day and the weather is pretty much 93 degrees (of course with humidity it generally feels over 100 degrees).  When it rains, it REALLY rains!  The other night it sounded like there was a waterfall outside my room because the rain was so intense.  

I hate centipedes/millipedes

I hate, hate, hate, hate, hate these vile centipedes/millipede things that are all over the place.  Not only do they freak me out on my way to class (I keep thinking that one is going to come and bite me because I am only wearing flip flops) but one was crawling on me in class today!!!  BLECCHH.  Of course I was sitting in the front row so I couldn't get up and shriek because I didn't want to make a major scene. ( Inside I was screaming like it was the end of the world!)  So my class on gene expression got that much better because I was stuck envisioning all sorts of creepy crawlies on my back for the rest of class. After flicking it off my neck (yes the nasty creature had some how crawled all the way up my back onto my neck without someone telling me there was a bug on me....whatever happened to good Samaritans!!)  I then trapped it beneath my water bottle on the floor where it stayed until the break which is when I smushed it with the Nalgene.  Needless to say, I am becoming quite adept at killing bugs/not screaming whenever I see them.

I found this on the internet and I think it sums up my experiences today fairly well...Ross Insect Repellent.  While I haven't gotten to the point of throwing knives, my Nalgene seems to make a wonderful club to go "all caveman style" on the bugs.

First week of classes

Survived the first week of classes!  And man was it a lot of material.  During orientation they had given us a pancake analogy (each day we are expected to eat three pancakes and all the pancakes have to be eaten before the mini.  If you don't eat all your pancakes for that day, they roll over to the next and eventually you will be stuck eating twenty pancakes...aka stay on your studying so you don't have to learn 10 lectures before the mini).  I have been following my study schedule and it has been extremely useful keeping me on track.  I have finished each lecture material the day that I get it and I am getting six hours of sleep each night. Getting sleep is really important for me because I turn into a grumpy person when I don't have sleep/coffee.

Right now the material is kind of a review from the stuff that I learned at Cornell but it has more clinical correlations.  I am in LOVE with the clinical correlations.  Generally they provide the little extra oomph that I need to get the lightbulb moment. Since I am able to spend so much time studying, (no distractions...everyone will be so proud of me!), I can actually get a solid grasp on the subject matter the first time I review it.

This week has made me realize that being in med school means that I am not going to have a life whatsoever. Last night I stayed up until 1:30, not because I was partying and getting schwasty, but because I was studying the superficial and deep back muscles (now that's a good time if I ever knew one lol). Any "extra" time that I have is either spent sleeping or it is spent talking to people back in the states.  I can say that all my amazing friends/family and their video chats have been the shining moments in the bleak hours of studying.

My study area...yay colored pencils making everything better :)

White Coat Ceremony

Now it finally feels real.  As soon as I got the white coat, I truly felt like I was in medical school and that eventually, if I put in enough hard work, I would make it.  It used to seem like I was endlessly trudging towards an unobtainable goal.  Now I know it will happen!

The white coat ceremony was a very nice affair.  We had the Prime Minster, the President as well as some of the other Ministers of Dominica as well as high-up representatives from the school.  My favorite part of the ceremony (besides getting the actual coat) was when the honor guard came marching in to pick up the flags without any sort of warning.  We were all sitting there and then BAM, six military personnel came walking in with guns.  It kinda freaked me out at first until I realized what they were doing.  I also really enjoyed hearing Dominica's national anthem being sung.

Getting my white coat!

My Dad made it down for the White Coat which I really appreciated.  Since it was such a major day, I loved the fact that he was there supporting me.  He ended up staying for a week and bought me some much needed supplies (aka a bookshelf, a printer that has a scanner attached, and more colored pencils!).

  

Dad and I at the White Coat Ceremony  

During the ceremony they had us all read the physician's prayer which was pretty moving (even for me who is not particularly religious)...

"O God, Let my mind be ever clear and enlightened. 

BY the bedside of the patient, let no alien thought deflect it

Let everything that experience and scholarship have taught it

be present in it, and hinder it not in its tranquil work.  

For great and noble are those scientific judgments 

that serve the purpose of preserving 

the health and lives of Thy creatures.

Keep far from me, the delusion that I can accomplish all things.

Give me the strength, the will, and the opportunity

To amplify my knowledge, which yesterday

I would not have dreamt of,

For the Art is great, but the human mind presses untiringly.

In the patient, let me ever see only the man.

Thou all-Bountiful One, has chosen me 

to watch over the life and death of Thy Creatures.

I prepare myself now for my calling. 

Stand Thou by me in this great task, so that it may prosper.

For without Thine aid, man prospers not even in the smallest things."

Cocoa Tea

Holy cow!  I am never drinking regular hot chocolate again!  When I went to the market, I saw these strange sticks that kind of looked like weird cigars.  I asked the lady what they were and she told me they were Cocoa Sticks and that Dominicans use it to make Cocoa Tea (pronounced "kako").

I made this tonight and it was so amazing.  Probably the best hot chocolate I have ever had.  You make this
tea" with condensed milk, coconut milk, almond extract, vanilla extract, cinnamon, and of course the cocoa stick.  While it took awhile to boil (you need to make sure the cocoa stick melts all the way), it was worth it. My apartment smelled like heaven.  The mixture of coconut, vanilla, and chocolate was delightful.  

Cocoa Stick

The ingredients (I didn't use any set quantities,
just kind of made it to taste)

Add the cocoa stick to the pot of condensed milk,coconut milk, vanilla essence and almond essence.
 I then boiled it for about 30 minutes until I made sure the cocoa dissolved.  You are supposed to
add cinnamon but I currently don't have in my apartment. I am definitely going to have to get s
ome and try making this again.  

Wooo me and the cocoa tea! Clearly the humidity makes my hair
go super frizzy (french braids are my best friend)

Final product! 

I am going to bring some cocoa sticks back during Christmas time and make this for everyone back in the states. Let me know if you want me to bring this back for you.

 Here is a link for a native Dominican's thoughts on cocoa tea http://www.jennifervalerie.com/2009/07/recipe-for-hot-cocoa-dominican-style.html