Lifestyles of the Fast & The Busy

Above: KFC in Roseau... in the foreground, the empty tables of the Roseau market.

"YOU ARE.... WHAT YOU EAT."

A few weeks ago, a new restaurant lit up its new fluorescent sign in Portsmouth. And on it was a big picture of Colonel Sanders in his red and white apron, tilted over and smiling. I have to say that the opening of the KFC is something that both was a win and a loss situation. On one end: It's great to have some real fried chicken in the area now, and to get dinner there could save one a few more bucks (along with time) over Subway. On another end: This stuff can kill you (if you eat it often enough, that is).

A recent report from CNN says the proximity that one is to fast food restaurants in their neighborhood is directly related to the occurrence of stroke. I don't know how much that really applies to Dominica (where there's only 4 total fast food establishments, 2 of them being Subways), but this finding in the United States is rather interesting. I guess then, that me, in my hometown back in Chicago, with 5 fast food joints within 1 block (let's see if I can remember: McDonald's, Burger King, Dunkin' Donuts / Baskin Robbins, Pizza Hut, and Nick's Gyros & More), I'm at a higher risk of stroke.

One of the most interesting points that ran across my head when I read this study, is when I read that socioeconomic implications weren't included. I gotta say that in the states that this might be the case: when someone wants some food fast, the best part is that it comes cheap.

However, living in Dominica, it seems different:
Fatty, greasy fried American fried chicken seems to be a commodity in Dominica.

Although KFC is faster than the Subway on the Ross campus, I've found out that its still not exactly as fast as it is in the states, but people are still there for the "fast food." Not to mention, seemingly with the hassle of shipping things over from the states & other various regional factors, not everything on the KFC menu you see in the states comes over here in Dominica. Case in point: every meal on the menu comes with french fries, unlike the standard homestyle options as presented in the states (you know, the cole slaw, the mashed potatoes, green beans, etc etc.... in Dominica, these are all separate options). In addition, the stuff is quite a bit more expensive than the traditional Dominican way of purchasing fruits and vegetables from the market and cooking it all by one's self. However although this was the case: the place is still packed with Dominicans (and obviously Ross students).

So, let's put it together: could the equation of Dominican Demand + KFC = Lesser lifespan of Dominicans?

I forgot to tell you one important thing... According to a BBC report in 2007, one thing that Dominica can lay good claim to is a large proportion of centenarians (22/70000, which is about three times as high as that of many developed countries). My university, Ross, is trying to figure out why this is the case. However, with the above story, is it possible to have an affect upon this proportion? Remember that before, there was only 1 KFC and that only appeared from what I assume (based on the decor in Roseau), in the last decade.

Like I said KFC's addition to Dominica has its good and its bad, but only time will tell to see how much affect it will upon the health of Dominica. It's something I'd like to see: the real effects of fast food damage on a Country's health over time. It could be bad, but knowing that there's still only 2 KFCs in all of Dominica, and with it being a "luxury" commodity in Dominica, I think that we'll still see more centenarians to come.

Don't get me wrong... I still dig the colonel, and it's quite good here in Dominica.... even with that risk of stroke. :D

Source: CNN

Perspective: Private Practice

^ Above: Neil Patrick Harris as Doogie Howser in the famed early 90s sitcom.

"INDEPENDENT PRACTICE HAS LONG BEEN THE

BACKBONE OF AMERICAN MEDICINE."

It might not be an accurate representation of the medical field, but one of my sweet tooths for television is the show Doogie Howser, M.D. (I hope y'all aren't too old to hear this). For those of you who don't know about the show, Doogie was a 30 minute sitcom that aired from 1989-1992, starring Neil Patrick Harris (currently on How I Met Your Mother, CBS) as a 16- year old medical child prodigy and his adventures of being a teenager and dealing with the stresses of a career in medicine. Throughout the show, there were attempts to pull him from his niche at the hospital. At one time, his dad tries to convince him to join him in his family practice in the neighborhood, and at another, a local pediatrics group is trying to get Doogie to move in with them, luring him with higher pay. However, each time, a specific case, patient, or colleague he cares about leads him to stay where he is.

And what does a 16 year-old prodigy have to do with a 23 year-old typical medical student?

I FACE A SIMILAR BATTLE... Do I really want to work in a hospital environment or do I want to try to establish my own medical practice? Each one has their pros and cons. However, I was reading an article in the New England Journal of Medicine about the decline in the independent practices over time. The amount of costs (everything from getting electronic medical record keeping systems to the tradeoff for independence for declining incomes) has driven many independent physicians towards working in groups (usually as employers) or as a person who works salaried in the hospital.

Most americans get their care from private practices (about 9 out of 10 of us), the NEJM article above has shown. Some studies have showed that being a private consultant has given patients better and more flexible treatment and care, others don't. Independent practices also allow doctors to build the rapport to improve patient compliance, resulting in better results (remember, that although a doctor might give out a treatment, its really up to the patient to improve their lifestyle or take their medications appropriately).

In my case I value working in a hospital or a group, because there's that support network available. In case I or one of my colleagues come upon a case that's pretty darn complex, I can network with them towards a quick solution. However, independently, I would either have to refer my patient or take some time off to do some research on my own and make some phone calls. The negative part to all this is the backbone as to which hospitals have to allot their care: will it limit my decisions to provide treatment?

The independent practice releases me from that (don't get me wrong, I still have to work underneath limitations & restrictions imposed by law & insurance). According to the NEJM article, there is an increased amount of charity care that takes place among independent physicians, improving their role in underserved and poor populations. I'd like that extra freedom to have an option to treat these patients appropriately in this case. However, don't get me wrong, I still want to make an enjoyable living. The ratio of amount of work to amount made to make a living is pretty poor, compared to working in private groups or in the hospital.

I guess everything is a trade, right? I haven't completely thought this out, but I hope that going through rotations and doing some more research can help me get a greater understanding of what's right for me: to play a role on ER or Private Practice?

Stay tuned... :P

Source: Isaacs, Stephen L., Paul S. Jellinek, and Walter L. Ray. "The Independent Physician - Going, Going..." New England Journal of Medicine 360 (2009): 655-57.

Master Plans

Above: Peter & all of us at Sister's Sea Lodge, Dominica, 2/14/09.

TWO DIFFERENT LOCATIONS…

ONE GREAT FRIENDSHIP.

As I celebrated my good friend Peter's 24th birthday, it got me thinking: no matter where I was: high school, undergrad, grad school, even medical school, I’ve noticed that I’ve always had a core group of friends.  However, unlike other educational milestones, our medical school group got split this semester as we all had a choice to go to three different campuses (Miami, Michigan, or Dominica).  But even as distance has split our group, we all were in on Pete’s birthday as much as I was here in Dominica.

HOW SO?

Friendship dynamics probably have changed in the last several decades with the advent of new technology to keep us all in touch together. Yes, I could basically be talking about the internet & the phone , but it’s what we can do with them that really makes a difference.  With the advent of the computer came e-mail, then instant messaging, and social networks, such as Facebook. However, now with public sites, such as YouTube, you can send personal video notes and greetings over the internet after, of course, recording it with the great invention called the digital camera.

We took quite the advantage of it. I e-mailed one of my friends, Jackie, to record as many of Pete's friends in Miami saying greetings of happy birthday. During church this week, I pulled out the surprise on him during announcements, by pulling up YouTube on the projector... and there went person after person coming up on the YouTube playlist (okay, excluding a few that weren't church friendly) saying "Happy Birthday" (along with their little spiel) on the screen. The look on his face was one of absolute shock. I swear he never expected to see any of them greeting them happy birthday. After a well-executed surprise party with all of his on-island friends on the previous night, this event wasn't even coming up on his radar.

I can't imagine how people stayed in touch with each other in the past without these advancements. Now I know how much people had valued pen-pal letters & long-distance telephone calls... why? Because even with the tools of yesteryear, it took a lot of time & resources to stay friends and never lose touch. Now, joy and off-key renditions of Happy Birthday can come with a single click of the mouse, and hundreds or thousands of miles of distance can be represented by being 2 feet in front of a computer screen. It might sound simple to a tech guru, but how technology connects all of us definitely amazes me.

Well, it might sound cliche, but it's the truth: It's a small world, after all.

Horn Honking

"YOU'RE IN... SCRUB UP!"

One of the best most memorable parts about driving to Roseau is the way that drivers love to use their horns on the road. I don’t know about you, but I am not afraid to use my horn whenever a driver passes me on the road back in the states, as the driver decides to almost slice the front bumper off my car with a not-so-slick pass on the expressway. However, in Dominica, although this can happen (Now, I’m thinking that being horn happy came as an after effect of the invention of the automobile), I’ve seen Dominican drivers use their horns for many reasons, such as:

1. It could be social: some bus drivers, when passing through the smaller towns, honk their horns and then wave to the people on the streets.

2. It could be out of courtesy: I’ve seen some bus drivers decide to use their horn to let someone know they could pass.

3. It could be for business: If I'm walking down the street by the bus depot in Roseau. Every single van's horn starts honking for me, to win me over in the bus-filling race that occurs there. (Although I'm flattered, I still pick the nicest looking van... I like the one with tiger-skinned upholstery. :P)

4. Most importantly... It sometimes could be attraction: like the Dominican driver that honks at women while he’s waiting to “pick them up” to take them back to Portsmouth... :D.

IT JUST SEEMS sometimes it seems that these customs are crazy to us in America. But what matters the people in Dominica have it work for them, and it works (yes, even purpose number 4... sometimes.)

How the heck does this relate to medicine?

Like I said in my last entry, one of my good colleagues, Alex, jumped in on a herniaplasty a few weeks ago in the Operating Room (actually, in Dominica its termed the Operating Theatre). Six of us med students were standing in our wide spectrum of scrubs - anywhere from "poop-like" brown (me) to a torquoise green (him). All of a sudden, the surgeon comes out and points at Alex and says, "You're in... scrub up!"

Bada bing and bada boom... He's ready to go. There he was standing in an operating room gown, with long latex gloves, pumping his hands in the air as if he was ready to take on a patient. And, he was in...

But there's a caveat... As soon as he had the handles on the tools, there was the doctor tapping Alex's hands on the forceps, and there my colleague was... caught completely off guard, semi-frozen. I really understand how he felt, because although the surgeon was telling him something, he had no idea what the surgeon meant by his friendly gesture. The surgeon then took my friends hands and placed them in the right position with the forceps around the suture in the right position. The doctor went over to the nurse, and also did the same tapping motion, and bam!, she was out there with the right suture string and placed it into the hands of the doctor, and I wondered how they figured it out so quickly...

It seemed that after many hours of working together, the nurse and the doctor somehow knew what every single gesture meant. Instead of taking precious seconds off of the clock to verbalize their intentions, those seconds went to use more efficiently ( a good case especially when circulation to a limb is cut off - precious seconds that could mean the difference between recovery to normal use of an arm or necessary amputation). That seems to be part to the art of medicine... finding ways to communicate make procedures more efficient and effective, using our creativity to its potential... and they're definitely not textbook, and even may seem crazy, by all means.

But remember: It got the job done.

Countrified

"ALRIGHT MAN... ALL THE BEST."

7:32 AM MONDAY MORNING, and I'm on my to Roseau, cruising down the Dominican "main road" on a Nissan Peoplemover (my way of describing the public vans that transport people around the island) at about 100 km/h with 7 of my other colleagues to Goodwill (one of Roseau's Suburbs, where Princess Margaret Hospital is). I have my headphones on and I'm listening to my favorite crusing music (most probably something on Eric Clapton's Complete Clapton compilation). The sun's popping out over the mountains to the east, and I'm just staring out and thinking... about what? I have no idea. But I know that it's another day I'm looking forward to working over at good old Princess Margaret.

PMH has grown on me. Mind you, I was really looking forward to this experience for quite a few semesters now. At Ross, with fifth semester you get a choice to go to fifth semester either in Miami, Michigan, or Dominica for what they call Advanced Introduction to Clinical Medicine (full-blown lingo for getting thrown into the real medical world). I have heard the stories about what you get to see in the hospital (i.e. in surgical observation) and how much you time you can actually get to study for exams (a lot more) were compelling reasons to stay. However, this was an opportunity to go back to the states, and finally enjoy America again...

SO I STAYED...

I'll be honest, working in a Dominican hospital has been more than I ever imagined. I've seen some of my friends participate in the operating room, get scrubbed up, and assist in operations such as herniaplasties (removal of intestines or other organs "sticking out" where they shouldn't be, like near your abs). We have access to all the tools needed (that PMH has) to assess a situation, and not to mention most of the doctors here are truly willing to help. Some of them even invite us to come back at our own time (provided we have the time).

However, one of the things that impresses me the most is how the Dominicans respect us. I remember walking in one day to interview a patient. He was sitting up on her bed, and she greets us with, "Good Morning, Doctor." ... But no, we're medical students! ... "Good morning, Doctor." The patient had treated us with the same respect as her real doctor, although we were truly there to just interview him and perform some physical exams simply for practice. When we left, he said to us... "All the best." (That's Dominican-Caribbean for our American "Take care.") We'll come back to check on her two days later and she'll still know us, and treat us with that same respect.

Not to mention, I enjoyed walking into the dialysis department with my wards group and feeling comfortable wishing everyone in the room a "Good Morning," and every person in the room saying back to me "Good Morning." Mind you, it's the morning, so not everyone is quite perky, but you could tell that the custom of respect has been so ingrained that it just becomes instinct. It occurs all over Dominica... on the sidewalk, getting on the bus, entering a store... there's always a "Good Morning," "Good Afternoon," and you guessed it, a "Good Evening."

In conclusion, this small-town feel is really getting to me. Getting appreciated what you can do, knowing that you made a difference, and being able to build that rapport with patients is what's compelling. However, that hospital feel of networking, working with a team & staff, and getting "exciting" cases is still very attractive to me. Princess Margaret Hospital in Dominica offers a great combination of both.

However, it got me to start thinking... is the country really for me? Being from the suburbs of a large midwestern city... only time can tell. This definitely won't be the last countrified post...

The Subway Line

"WE'RE OUT OF SPICY ITALIAN... AND A BUNCH OF OTHER STUFF TOO."

My friend Rubie, who's up in New York, asked me a great question,

"What exactly do you eat down [in Dominica]?"

As a medical student in Dominica, the options are limited. Let's start with things most Americans should know. We have 1 (soon to be 2) KFC and 2 Subways. Now, at ross we have the Dominican analog to a food court typically found in college... it's called The Shacks, and they look exactly like the name calls them out to be. In terms of cultural food, we have 3 Chinese places, appropriately called (Bob's, Brother's and Hong Kong), Italian (aka Perky's Pizza), and Canadian (okay, they serve American food...). You go a bit further from campus, and you literally can fine dine! For instance for $95 EC, approximately $35 US, we can get all you can eat lobster at a restaurant called "Sunset." Not to mention, classic Caribbean food is nearby, at local joints such as Big Papa's, Blue Bay, and my favorite, the Purple Turtle.

With my current health crunch, Subway is one of my favorite places to hit. It's literally just like the ones back home, with the selection of sandwiches, pizza and soup (pizza and soup finally made their debut this semester).

HOWEVER... there's a caveat to this: there are times I'll head into Subway, then I'll look down and... as a sense of shock flows through my body, half the meats are missing (sometimes the bread, and yes even sometimes the chips when I want a full meal). The Subways in Dominica are supplied by shipments from the Americas... therefore, when a huge hurricane stands in the way of one of the routes, it might be a while before my clamoring for my Spicy Italian on Honey Oat bread is satisfied.

I could have complained, but that really didn't affect the way I looked upon my experience at Subway: I've learned to find enough different combinations of "favorite" sandwiches to take care of my palate. The best part of every visit is enjoying the rapport I have with the Dominicans who work behind the counter at the Portsmouth, Dominica Subway. A typical walk up to the "order counter" goes like this:

"How you doin' man?" - NOTE: A strong Dominican-Caribbean accent is present. -

"Oh, I'm alright, a busy day at the hospital. How about you, sir?" - NOTE: A strong Chicago accent is present. -

"I'm good. I'm good man. Good to hear that you're good." - Said as the guy/girl is nodding his/her head behind the counter, while smiling or laughing. -

And... just to see that the people behind the desk want to know how I'm doing always makes a stop at the Subway a way to top off my day. By the way they interact behind the table, I can tell they're enjoying life - even if demanding med students are out there to ruin it. I just instead separate myself from the idea of stressful med school, and for those 15 minutes in line, immerse myself in the way they're enjoying themselves. When I get my sandwich, I snap right back into reality, and its right into the books. However, I feel much more refreshed, even though I ended up with a Tuna because they were out of Spicy Italian once again. :P

The point is: you can't always get what you want, but you can always enjoy life in the way it presents itself.

Pictures: Subway Dominica, Roseau

A Great Pianist in the Making

"HOW MANY FINGERS AM I HOLDING UP?.... TWELVE!"

Here's your homework for the day. Ask yourself, "What would I do with twelve fingers?"

I had to ask myself that when I was reading this article the other day. In January 2009, in Daly City, CA, Kamani Hubbard was born with not the typical 10 digits on his hands on feet, but instead: twelve. In medicine, we call this condition polydactyly (poly = many + dactyl = toes + y = condition). This type of trait actually runs genetically in the families (for you sticklers on inheritance, in an Autosomal Dominant form, appearing just about in family's generation), or can be a defect as a kid is maturing in his mother's womb. However, usually the extra digit or digits are usually either webbed together (syndactyly) or are non-functional.

BUT THIS CASE IS DIFFERENT... All twelve fingers and toes of Kamani's polydactyly are functional. He can bend them, squeeze them, flex them... do just about anything the other 5 can do.

Whoa. Totally awesome, huh? :D

Now,Imagine how much easier it is to grasp objects, or even play the piano. Imagine the type of control the kid can have over a baseball... He could even be a spokesperson for people across the country with similar conditions... just imagine the possibilities (including how many new pieces of bling he can carry on his fingers now :D). However, things come with their cons, right? Six fingers could literally be the target of bullying and teasing from his fellow classmates... Can he find footwear with a wide enough toe to fit the sixth digit (extra wide-width?)... How about gloves with six fingers for those cold months?

SO... WHAT'S THE GAME PLAN?

Due to the non-functional nature of most polydactylies, most of these situations end up with the removal of the extra digit. However, like I said, all the fingers are functional. If I was the doctor in the situation, I think I'd encourage the parents to keep the fingers. I can just imagine the kid growing up and asking them "Why did you cut off my sixth finger?" I personally would be shocked to hear that I had a sixth functional digit as a gift. And let's say that someone started making fun of me for my extra digit. I think I'd challenge them to a stunt or a task that I could do more efficiently with six. Then, I'd show them who's boss.

I'm getting ahead of myself - I never had six fingers. Here's the point. From my point of view, why rob a kid from a perfectly functional gift... it's literally like returning something that looks promising before even trying it. Give it a chance... like I mentioned above the possibilities are endless. I personally want to follow this kid to see where he goes, and for me, with a good assumption he has strong, encouraging parents, I'm already predicting quite, quite far.

So, back to the question: What would you do with twelve fingers? Your homework's due :D.

Source: KTVU San Francisco