PRN: take as needed

Just one of those days

2009-10-28T13:21:00.002-08:00

I have recently started a new elective rotation in Geriatrics. This particular rotation is only 3 weeks. I consider this a short period of time to learn everything I can from the doctor, hopefully impress him in the process, and consider a future in Geriatric Medicine. Since this is such a short period of time, it is understandable that I would want to start off on the right foot and really be on top of my game from day 1. That was the plan anyway. Instead, I had a terribly "off" day starting with showing up late to the hospital. I absolutely HATE that, and I can think of no worse anxiety provoking situation than sitting in traffic watching the minutes tick by and not being able to do anything about it. I'm surprised I didn't have a heart attack in the car. Even better than being late, the doctor had instructed us to meet him in the hospital lobby because he thought we "would never find his office otherwise." GREAT! So, I get there, and of course they are all already gone. So now I have to figure out how to find him in this great big hospital. I enlist the help of the information desk who feels its best to overhead page the doctor before I can stop him. So, not only am I late, my lateness is broadcast to the whole hospital. "Dr. BLAHBLAH, please come to the information desk, you have a lost medical student." The rest of the day pretty much went the same. In my haste rushing into the hospital, I apparently dropped the parking ticket so when the doctor asked for it to get validated, I had to empty all my pockets and my purse to finally declare that I lost it. I found it under the car 20 minutes later. After lunch, we were all supposed to meet at his other office. Since I was not going to be even a second late, I rushed to be early and realized after parking and walking to his office that I had forgotten my stethoscope in the car. I apologized profusely and ran back to the car to spend 15 minutes searching for it, which then of course made me late again. As I walked back to the office, upset that I had lost a borrowed stethoscope, and freezing cold from the wind, I shoved my hands into my white coat pockets to keep them warm and discovered the stethoscope, which had not been left in the car in the first place. Perfect! I guess it was just one of those days.

Im Back!

2009-09-10T20:31:00.002-07:00

OK, so I am obviously not on the island of Dominica anymore and, therefore, can no longer be called Dr. Dominica. I am taking suggestions for new names, please email or comment. I am currently in my 3rd year of medical school attending Ross University. After passing the USMLE Step 1 (the first in a long line of medical licensing exams), I am doing rotations in Chicago. Rotations are the clinical part of medschool where you actually get to learn the practical aspect of medicine and work with patients. I have already completed Psychiatry (and received an A, thankyouverymuch) and an elective in Infectious Diseases. I am currently doing Family Medicine in the Uptown area of Chicago. More to come...

What am I supposed to be doing?

2008-12-03T15:31:00.004-08:00

I am currently not studying for my final tomorrow (obviously, because I am writing this blog instead). I am not sufficiently prepared, nor am I extremely anxious about it. I am strangely calm. My theory is that I am so overwhelmed by the volume of information I need to have in my head by tomorrow morning that I do not even know where to start. If I were to start to think about it, I would have a panic attack like no other panic attack I have ever had before, my heart would stop and I would die. My body is obviously aware of this and therefore, as a defense mechanism, is diverting my mind from thinking about the test. Instead maybe I will start writing my 20 page paper that is due on Friday and that I haven't started. No, that sounds pretty stressful too. Im just going to continue with my little brain vacation for now.

Have you ever seen a heart before?

2008-11-09T13:05:00.003-08:00

Holy crap! I absolutely love my new rotation with a Thoracic and Cardiovascular surgeon. He is harsh and mean and kills my self esteem but he is teaching me so much I can't really hold it against him. The first day we walked in, he asked if we had ever seen an open heart before and before we could answer, swung open the operating room doors to reveal an open heart surgery in action. I was totally not prepared for that. In the last week I have seen a beating heart 2 feet in front of my face, a lobectomy, an endoarterectomy and I even got to assist in surgery by changing a pacemaker battery!! I love using that cauterizer thingy. I should probably figure out what its called before I go back on Tuesday. Im so excited!

5th semester failure...so far

2008-10-25T10:26:00.004-07:00

I feel totally unprepared to be a doctor. In 5th semester so far, the theme of lectures seems to be "you learned this wrong on the island and you look like an idiot doing it." Things have not been going that well with tests and papers either. I did pass the COMP exam on the first try (by like 1 point) but I am starting to think that is a disadvantage. Pretty much everyone I know failed it the first time, but you can take it 3 times and it does not count in your grade for 5th. The problem is that you have exactly 6 months from the day you passed the COMP to take the Step 1 exam. Therefore, passing it right away means I also have to take the Step right away and I am definitely not ready for that. For our first paper on a patient, I received an "unsatisfactory" which is basically an F. Granted, I do not know a single person who passed the paper and it was probably the worst paper I have ever written in my life, but that just shows again what we learned wrong on the island and have to relearn here. Thank God I passed the ACLS class easily, however if I actually had to run a code I think I would have a heart attack myself. This poor track record for 5th so far is not very encouraging and I have a midterm this coming Monday. Great. Lets hope for a change in the tides this Monday. Wish me luck!!

PS - I cut and dyed my hair and got another tattoo, just to keep you all updated.

Wedding pics!

2008-10-12T12:59:00.003-07:00

I am very excited and distracted right now. I got back my wedding photos and I am looking at them instead of studying. Check them out CLICK HERE! OK, back to work!

Hola From Miami

2008-09-21T14:42:00.003-07:00

I know you probably all thought I was dead, but no. I have just been really busy. Actually, that is a huge understatement. I have been ridiculously, terribly, extremely busy! Lets see. In the last few weeks I have passed 4th semester, moved from Dominica back home to San Diego, gotten married, moved to Miami, started 5th semester, and taken the COMP exam. Crap, I am tired just typing all of that. It is pretty exciting though because I actually feel like I may become a real doctor someday. I have my first clinical experience in the United States on Tuesday! When I take a history, I wont have to ask what kind of bush medicine my patient is taking or figure out why he swallowed 3 slugs to treat his ulcer! Actually, now that I am in Miami, I probably wont be able to understand a word my patient is saying since everyone here speaks Spanish and I can only count to 10 and ask where the bathroom is. Hopefully there will be a translator! Haha! OK, I have to go relearn the entire physical exam so I don't look like an idiot on Tuesday. Wish me luck.

Goljan is my God

2008-08-12T08:49:00.002-07:00

Everyone here has their own way of studying for shelf exams. By far, the most popular way amongst students to study for Pathology is to listen to audio files from Goljan. He is magic. He talks and you suddenly understand everything. In the first 30 seconds of listening to him he says "not everything that ends in '-oma' is benign." Oh my god! That would have been nice to know about 6 months ago. I vote for Ross to pay him a million dollars and just come teach us Path. For now I am just going to have to settle for the bootleg copy audio files.

Senioritis

2008-08-07T17:09:00.003-07:00

Holy moly I have 347.5 tests in the next two weeks. Ok, maybe only 6, but it feels like a million. I normally thrive on stress, it gives me motivation. But this is crazy, this is system overload. All I want to do is go climb in bed and curl up to some mindless television. It is taking everything in me to sit in front of this computer and study. What is worse, is that when I am done with these tests I am leaving the island for good. FOR GOOD! So my mind keeps drifting to thoughts of America and I find myself shopping online for clothes and cars and toys. As a future doctor, I am going to have to diagnose myself with senioritis...do they make a pill for that?

Don't Drink the Water

2008-06-24T12:15:00.005-07:00

It has been raining a lot here lately. When that happens, the water in the apartment buildings turns brown. We have all learned to cope with this and head over to campus with empty water bottles to fill up from the triple filtered water fountains. That is exactly what happened yesterday and as usual you could see everyone stocking up on campus water to take home and use. Unfortunately, this afternoon we all received an email with the following title in bright red:

Drinking Campus Water Advisory Warning!

Basically it said the water on campus has not been safe to drink, cook with, bathe in, etc for the last 24 hours. Great! This would have been nice to know 24 hours ago. So now I probably have giardia lamblia or something. I guess I am going to be spending some quality time with the toilet tonight. There is a picture of him above, isn't he cute. Too bad he causes diarrhea.

Nothing is Free

2008-05-29T08:17:00.002-07:00

I am a big fan of free. I think being a poor medical student has something to do with it. But, I also happen to think that free food tastes better. I'm also constantly on a diet and for some reason it's easier to justify eating cake if it is offered at some meeting, or having a hershey's kiss if its in a bowl on someones desk. During the beginning of the semester here at Ross, all the clubs have their orientation meetings and there is free food everywhere. I find myself attending meetings for everything from Physicians for Human Rights to the Vietnamese students association (they have great spring rolls!). However, this semester I have been caught and now realize that nothing is for free. One of the last meetings I snuck into was the Neuroscience Society. Dr. Odutola was the guest speaker and went over taking a neurological history. At the end of the meeting, I asked him a quick question and happened to mention that I was a neuroscience major at UCLA for undergrad. Oops! He corners me and before I know what happened, I am the new Historian for the Neuroscience in the News Newsletter. As if I didn't have enough to do this semester! So what I thought was free pizza ended up being one of the most expensive meal I have had here. Oh well, at least I actually like neuroscience!

Semester 3 - check!

2008-04-28T08:42:00.007-07:00

Yay! It's finally here. I get to go home for break. I thought this day would never come. I am physically sitting in the departure lobby at the Dominica airport. I can almost smell America. No wait, thats airplane exhaust. This semester was particularly difficult, even with Phil here to support me. I am still waiting for my final grades, so I don't want to jinx it, but I am pretty sure I am a fourth semester when I get back to the island. It will be my last semester here in Dominica and I am thrilled beyond words. This journey has been very trying for me, more emotionally than academically but it was still a big struggle. I think the promise of getting off the island for good is going to give me renewed energy to get through the next semester. There is NO WAY I am repeating 4th!!
As usual, getting to the airport this morning was like Disneyland's Jungle Cruise on wheels. There were exotic animals jumping out at us and palm leaves slapping our faces through the open windows. I kept expecting someone to get on the loud speaker with "...and to our left are natives bathing in the river." Our car's name was "Shadow Warrior" and our driver seemed like he could have driven the hour and a half trip blindfolded. He checked his phone messages more than he checked the road. In true Dominica fashion, we had to stop twice so passengers could throw up. Thankfully, I am here safe and tomorrow I will be home! If I miss Dominica, I'll go to Disneyland, but I'll get churros and mickey mouse soft pretzels instead of chicken and ground provisions.

California Dreaming

2008-04-06T07:57:00.003-07:00

My body was not meant to live here. When students get to the island for first semester they invariably sweat buckets, get sunburned, and need to drink 4 times their body weight in water to stay hydrated. We are told that our bodies will adjust and we will not be this uncomfortable forever. Well, guess what!? My body isn't adjusting. I have been here for 3 semesters and I still sweat like a pig and practically pass out from dehydration everyday. I really do not think I can survive much longer in this type of weather. Where I am from, rain equals cold. When you see that it is raining, it is normal to cover up to prevent getting wet. Here, if you put on a rain coat, you will create a steam room under your clothes. I cannot wait to get out of here and back to normal weather that I can handle. I miss California.

Fat Doctor

2008-03-31T14:27:00.005-08:00

As the semester starts to come to a close, our professors begin to realize that their chances to torture us with exams are running out. As a result, many tests get crammed in to the last couple weeks and we all go crazy. My reaction to stress is to eat, and I am good at it. I like to say that I eat my feelings...and they taste like chocolate chip cookies. The problem here (besides the obvious of getting fat and unhealthy) is that my normal comfort foods are hard to come by. I can't exactly hop in the car and drive to 7-11 or McDonalds. The only solution is the campus bookstore, which closes at 9PM. Additionally, its not exactly cheap since everything has to be shipped here. If you decide to spend the 5 dollars for a can of chef boyarde, you better buy the entire stock, because it is not gonna be there tomorrow, or ever again for that matter. I had one test this morning and I have another on Thursday, so you can imagine how stressed I was this weekend. Lets put it this way; last night I ran to the bookstore at 8:50PM and bought a bag of sugary cereal for 10 dollars. That cereal is now gone. Oh well, at least I passed my test. Looks like I am going to be a very fat doctor.

Medschool Life Cycle

2008-03-08T17:25:00.004-08:00

We are learning about various parasites and how they cause disease. This includes a study of their life cycles in various hosts. As I am trying to memorize the life cycle of malaria, I realize that my medical school life cycle is also worth studying. Im not going to make a nifty diagram like the one above for malaria, but it goes something like this...

1) starts enthusiastic, ready to absorb essential medical knowledge
2) 10-14 day incubation period of intense studying, Marisa can usually be found in the library during this time frame.
3) increased frustration/disappointment due to poor required hours to available hours ratio
4) 3 weeks into cycle, defeatist attitude is upregulated to counteract any remaining enthusiasm, Marisa can usually be found in bed watching Law & Order reruns.
5) 1 week prior to exam positive feedback stress cycle begins.
6) stress threshold level reached, resulting in emotional & mental breakdown. WARNING, this is an exergonic reaction and can be highly contagious, remain at a safe distance.
7) once homeostasis is restored, Marisa reaches maximum motivation and learning is increased 100-fold
8) exam is taken, passed, and cycle starts again.

Everyone has their own way of studying and making it work. I guess I just wish mine wasn't so exhausting.

The Man in the Arena

2008-03-02T13:15:00.005-08:00

"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, and comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows the great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who know neither victory nor defeat." -Theodore Roosevelt, 1910

Can you hear me now?

2008-02-24T18:17:00.005-08:00

I have committed to getting married on Aug. 31, 2008 in California with the help of my family instead of a wedding planner. Was this a huge mistake? I am in Dominica until Aug. 23 with no plans of going home for break. Whats even better is that the internet in my apartment has been so bad, internet phone conversations are practically impossible. For example, while on the phone last week with my mom discussing reception decorations I expressed my concern that there would be no purple if we had too many potted green plants. My mom only hears "no purple" and starts to suggest other colors while promising me there will be no purple at all. So in response to this I'm screaming "PURPLE, I WANT PURPLE" at the top of my lungs into my computer. This is extremely frustrating. Am I going to walk down the aisle in a purple dress now??

Red Blobs

2008-02-19T18:02:00.004-08:00

I am not good at Pathology. This should not come as a surprise to me as I was never good at Histology. Histology is the study of organic tissues, both grossly and microscopically. Pathology is studying those tissues in disease states. If I couldn't recognize normal tissue, how am I supposed to see whats wrong with it in disease! Everytime the professor shows us a slide during class and asks us what we see I just want to yell out "RED BLOBS!" Here is a slide of the transformation of stratified squamous epithelium into columnar epithelium as is seen in chronic heartburn. I swear looking at these things is like taking a Rorschach inkblot test. What do you see??

System Overload

2008-02-07T14:58:00.000-08:00

My hard drive is about to crash, and I don't mean the one in my computer. I mean the one in my head! I was just trying to watch a lecture on mediasite (1 of about 12 that I am behind in), and I realized that I had no idea what the lecturer was talking about. Have you ever driven somewhere and completely had no recollection of how you got there? That is exactly how I feel. Logically, I know that I have been sitting here, in front of the computer, watching this lecture on steroid pharmacology for the last 20 minutes. However, I really feel as if someone just POOF! dropped me in this seat 5 seconds ago. Am I going crazy?

Don't they make a pill for this...

2008-01-31T05:34:00.000-08:00

Today is not good. I can’t really put my finger on it, but I just woke up and I can already tell that today is not good. I feel like a mess. First of all, its 9:15AM. Even though I can mediasite (watch lectures on the computer), I would prefer to get up early enough to have as productive a day as possible. Instead, I have no consistency. I got up yesterday at 11AM, and Tuesday I got up at 9:55AM (5 minutes before I had to be in my PACE session). Secondly, I still feel like I have no plan for studying. How can I have gotten through a year of medical school and not have a successful plan?! It makes me feel like I have just gotten by and that does not feel good, nor is it what I want. I know they are just trying to complement me, but I am sick of my fellow students telling me how smart I am and that I am lucky that I don’t have to study as much as they do to get the same grades. What they don’t understand is that I would kill for their discipline. Sure, I can work up the determination and motivation to really get down to business when I need to. But, I’m like a sprinter while everyone around me is running the marathon. I will probably cross the finish line, but will I be a great doctor when I get there?

Phil Arrives!

2008-01-30T16:09:00.000-08:00

Phil has joined me here on the island for my last two semesters. I thought you would like to hear a different perspective about this experience so I forced him to write an entry for my blog. It only took him a week to write it! Geesh!

"I made it! I have arrived on Dominica, the place bad dreams are made of. My taxi ride from the airport was fraught with danger and I was glad I have life insurance. I lost count of the near misses with other cars. Who taught these people how to drive?! The road I traveled to get to Ross is halfway falling into the ocean while the other half is being slowly reclaimed by the jungle. I have found that simple tasks like going to the store here in Dominica take up a large part of your day. I wake up at around 7am and make breakfast for Marisa. I walk her to school and then walk back to our apartment and clean and make lunch for Marisa. Then, I walk back to the apartment, clean and make dinner for Marisa! If I can accomplish one other thing besides those basics, I am happy. I overslept on Saturday and was unable to go to the farmers market but I will try again next week to see if I can get fresh fish and vegetables from the locals. Marisa was not exaggerating, this place is an adventure!"

Playing Doctor

2008-01-23T08:34:00.001-08:00

For our Behavioral Science course this semester, we are required to attend two labs approximately once a week where we meet with patients from the community. For the physical skills lab, we get into groups and practice how to perform a physical exam of the various body systems. Examples would be listening to lung sounds, taking blood pressure, etc. For the behavioral lab, we take turns performing a patient interview and getting a complete history. Our first experience of these labs was Monday. This seems very exciting and a necessary step in becoming doctor but here is the problem; no one has really taught us what to do! You basically show up at the lab rooms dressed up professionally with your fellow students and your cute little white coat and pretend to be a doctor. You walk into the room and there is the patient and your facilitator looks at you and says "go". Excuse me, what?! Go where?! Some of the groups didn't even have facilitators! I am beginning to realize why some people believe ROSS stands for Rely On Self Study. I got through it alright but it was a huge wake-up call. I may be getting through the basic science portion of my medical education just fine, but that didn't mean much when I was pushed into a room with a patient and expected to perform. I have a lot of work to do before next Monday! Oh well, at least I looked cute in my doctor coat.

Back on the rock

2008-01-16T06:05:00.000-08:00

I have begun to realize that my life here in Dominica consists of a series of crises with some medical eduction thrown in here and there. Some of the problems are larger than others, for example being homeless last semester was kind of a big one. But even when I think I have fixed everything so that I can concentrate on school, little problems creep up. Like yesterday, when I hiked home to my new apartment and realized that I had no electricity. I never knew how incredibly difficult it is to function in complete darkness. Thankfully, I am used to taking cold showers from living in PBH last semester so the lack of hot water wasn't that big a deal. But, needless to say, the night was pretty unproductive. Medical school is supposed to be hard, I get it. But, I don't think our US counterparts have to deal with constant diarrhea, killer centipedes, mosquitoes from hell, rolling blackouts, and limited access to supplies. I would kill for a Vons and a Starbucks! I just pray my computer never breaks because I don't think the local shack will be able to fix it. Oh well, if I can get through this, I can get through anything, right?!

DPS Practical 2

2007-12-07T12:38:00.000-08:00

Last semester, we had to invent a fictional patient and write up an interview for our Doctor, Patient, Society class. I posted my interview so everyone could get an idea of what we are learning in the class and see our progress in becoming a doctor. I received a lot of positive feedback about posting it so I have decided to also post this semester's report. For this DPS Practical, our instructions were to create a fictional patient with a clinical presenting problem and write up a case report based on the fictional interview. Click on the picture to read my case report.

So many tests, so little time

2007-12-05T21:16:00.000-08:00

The countdown to the end of the semester has now officially reached single digits! Even though the semester itself is winding down, the stress levels are ramping up. These last two weeks of second semester are truly hell. We have so many tests to take in this short period of time, in fact, I am not sure we do anything else BUT TAKE TESTS! Its like the last leg of a marathon when you are already exhausted but it is still uphill to the finish line. Here is our exam schedule starting last Thursday.

Thursday, Nov. 29: 8AM Neuro Lab
Friday, Nov. 30: 8AM Histology Lab; 1PM Anatomy Lab
Tuesday, Dec. 4: 8AM Anatomy Shelf Exam
Wednesday, Dec. 5: 1PM Neuro Shelf Exam
Friday, Dec. 7: 8AM Physiology Shelf ExamMonday, Dec. 10: 8AM Biochem Shelf Exam
Tuesday, Dec. 11: 8AM Histology Shelf Exam
Thursday, Dec. 13: 1PM Mini Exam 3 (all subjects)

The Shelf Exams are are subject tests created by the NBME (National Board of Medical Examiners) to provide interested medical schools with an external measurement of student progress in a required medical subject. At Ross University, we take shelf exams at the end of a completed course in place of a cumulative final. They are long, difficult and tiring and no one likes taking them. Their only redeeming quality is that they signify the close of this semester and the end of my first year of medical school (if I pass). YAY!