Overcast

Above: The Ross University Entrance in its same glory...

captured either in August 2007 or April 2009.

IMAGINE...

Flying on a plane to an unknown destination...

The plane is coming to a landing...

The destination is near, beneath the gray haze that looms...

However, when the haze and the clouds clear...

You see the green nature isle called Dominica.

---

Rubie, once again from the Big Apple, says:

"As a future prompt, I'd like to hear more about the antagonists in your story."

I have to say that this is quite a story to tell about my five semesters in Dominica, but there's a lot of importance in how it really shaped the way that I started to look at things. I'll try to sum it up in a nutshell, but I'll warn you, that it is a complex story with a simple explanation. I'm also going to warn you: this may paint a darker story on my time at Ross than the one I actually experienced, but I wanted to hash out the ideas as best as I could.

AUGUST 2007. To me, the car is one of the best places to meditate. As I was closing out my final semester at the University of Illinois, there was one night that I took my 2002 Ford Focus out for a drive at four-o-clock in the morning from Champaign all the way to Decatur, Illinois, and back. Driving in the middle of nowhere at that time, it was expected that the road and me would be spending some quality time with each other. Although it was clear that night, there were times I'd actually slow down to 40 mph, and put on my hazard lights, and drive right into a deep patch of fog. With it already being pitch black, I could barely see past the fog. It was scary, but there was no turning back across the median, as going off-road wasn't exactly a specialty of my vehicle.

However, that night, I know I said to myself then that my time at the University of Illinois was one that I could not be more thankful for. Four years at the Big Ten institution helped me to define myself. One of my greatest experiences there was working as a Resident Advisor. Although not exactly perfect at times, I loved the people I worked with, many of my residents, and for the most part the great positivity and the teamwork to face challenges in the halls (i.e. getting ideas together for programs, directing people on move-in day, and of course, directing traffic on move-in day). With great direction under my series of resident directors (Tanya & Jenni in my undergrad era, Steve & Chad in my graduate era), I felt like they led me towards allowing my leadership skills to grow and to shine.

However, little did I know my abilities soon would be stifled...

SEPTEMBER 2007. I reach Ross University, after my final summer in Champaign, with 50 lb of luggage in one hand and a backpack in the other. I remember my first trip down a Dominican road, and me just laughing at the absurd curves and switchbacks I was going through. My enthusiasm for Dominica was there... I mean after all, how many times have I seen on those PBS travel channels the beauty of a developing third-world nation. And now, I was living it!

But then I head out to the social that night at the Portsmouth Beach Hotel, and something didn't feel right. There was a cloud I had to shift through to find genuine positive people... That cloud surrounded me... with ideas about attitudes about the island, the stresses of med school taking its toll on students, and even an aura of pompous worn by some of the student body. I remember calling my great friend Don on the phone in that first week, complaining about the cloud that had surrounded me... I felt that positive aura that became a part of me was left back home...

Now, reading the wikipedia definition of antagonist:

An antagonist (from Greek ανταγωνιστής - antagonistes, "opponent, competitor, rival") is a character, group of characters, or an institution, who represents the opposition against which the protagonist(s) must contend.

Rubie, that's the thing I like about this definition: antagonism at Ross was so complex - everywhere from attitudes about Dominica, to gossip, to things not working out, to people's outlooks - that I couldn't attribute it to a single person, or a whole group of people... it all goes back to that cloud. It made things not feel right: I wasn't sure of my own actions, what I was learning, and or even interact with others as well as I did back in my heyday at U of I. And that's the thing too, there wasn't a Jenni, Tanya, Steve or Chad to step in and give me words in the right direction. A few weeks ago, I wrote an entry on trusting myself... in the first four semesters, I really didn't feel like I could even do that.

I felt the cloud had already defeated me...

APRIL 2009. After traveling on a plane over and over again, I've gotten used to replacing the car with my plane flights as great places to meditate. I started to think about that cloud and how it affected me at ross. Every time I saw each instance (many of them left out for terms of conciseness in this entry), I saw that the monster wasn't in that cloud. It wasn't even the people I interacted with... and in that plane flight seat my eyes grew out of their sockets when I discovered...

The monster that was behind this was... my apathetic self.

I wasn't being a leader. When things wouldn't work out because of the cloud, I wasn't acting in the same ways I would as a RA, by taking direction. However, I wasn't alone, many of my good friends were also affected by the cloud. I simply shuttered myself from the action, took things passively, and let the pompous take the wheel. I knew I could have stopped the cloud deep in its tracks from surrounding me, but I let myself be apathetic to it. I wasn't active enough in trying to keep those attitudes away from me, thinking I could do nothing to change it. But by fifth semester, I had to relearn that I could still create change by taking action.

Would I say that my experience was ruined by the monster inside of me? Rubie, the answer is a definite: no. My medical experience at Ross is something I value as a great thing. As lengthy as this story was about antagonists, that monster still had not taken me away from some of the greatest moments I've had with my friends, my student groups, and my professors (there were a lot of them, some of them I have wrote about already and some will write about in the near future). However, it was a wake up call: I need to live once again like that night on the interstate alone... If I see fog, I'm going to drive into it head on.

I hope this answers your prompt. Sorry about the delay, I'll admit that my study manuals and me have been on frequent (yet, enjoyable) dates. :P But keep the prompts coming.

Bookstore Junkie

Above: Semester 1, November 2007, studying in the Dominica Anne Ross Library.

After hours of studying, and creating flowchart after flowchart of material that I still haven't got a gist of organizing, I look up at a giganormous mural of Mary Shelley, Walt Whitman, and some author who goes by Melville (sorry, I'm not a literary major, so all this does is remind me of Dominica's Melville Hall). As I stare with loads of information floating through my head (the loads of pharm, for instance, I've been going through lately), the mural, with its oil-like paint renditions of the three authors / thinkers seem to stare back at me with serious, yet welcoming expressions. Sometimes, though, I get so caught up into a staring contest with them that sometimes, it seems that they're whispering back in my ear, saying...

"ATTENTION BARNES & NOBLE CUSTOMERS... WE WILL BE

CLOSING IN FIFTEEN MINUTES."

I turn around and nobody's there. I think the PA system was feigning the voice of a low-fidelity impresison of a college-bound Walt Whitman. I'm back in the real world, sitting in the Cafe of my local Barnes & Noble (the latest thing open in the suburbs conducive to my studying). I look at my watch: minute hand at the three-quarter mark, hour hand about to hit the tenth notch on the dial. Then I grab my books, and I'm out the door.

---

I'll admit there's truth to "setting the mood." As I've turned into a "Medical Nomad" over the last several weeks, going from library to library, bookstore to bookstore, I've learned that being surrounded by stacks and stacks of books, pamphlets, magazines, etc. that are abound of information and by people who have a thirst for knowledge (even not medical) really helps me achieve that same thirst. That's one of the main reasons I can't exactly study at home: surrounded by a comfy couch, a big screen tv, cable internet, and a loving mom and dad (they definitely deserve credit)... I've declared home as a refuge for relaxation... and of course, typing up blogs.

Rehearsals

Above: Michael J. Fox on the cover of his 2002 memoir, A Lucky Man

"IF YOU WERE TO RUSH INTO THIS ROOM RIGHT NOW

AND ANNOUNCE THAT YOU HAD STRUCK A DEAL -

WITH GOD, ALLAH, BUDDHA, CHRIST, KRISHNA, BILL GATES, WHOMEVER -

IN WHICH THE TEN YEARS SINCE MY DIAGNOSIS

COULD BE MAGICALLY TAKEN AWAY, TRADED IN FOR

TEN MORE YEARS AS THE PERSON I WAS BEFORE,

I WOULD, WITHOUT A MOMENT'S

HESITATION, TELL YOU TO TAKE A HIKE."

©2002 Michael J. Fox

I remember sitting with my mom and dad watching the Back to the Future movies when they used to come out on network TV all the time in the early late 80s/early 90s (a quirk about us is that we NEVER ever had Cable). And there was a young actor on the screen (his name, Michael J. Fox) portraying the timeless character Marty McFly. I'll admit that his squeaky voice and priceless looks of shock when the time was right made his acting quite convincing. It was from then on that I became a fan of Fox, as I was always trying to catch reruns of Family Ties on vacations away from school (I was already too old to catch the first-run episodes) and moved onto some of his other films, one of my favorites (go figure) was Doc Hollywood in 1991.

And it is with that movie that Fox begins his 2002 memoir. With the recent release of Fox's new 2009 book, Always Looking Up, a story of how he has maintained his optimism with the onset of Parkinson's disease, I've decided to go backwards and read his last memoir (as my going to bed book), A Lucky Man.

1990. Gainesville, Florida. According to Fox in the first chapter, he mentioned how he initially thought that the first signal to his actual condition was the shaking of his pinky. He went to the University of Florida, near the location of his current filming to get a diagnosis. As I was reading, Fox's account of what the doctors had him go through seemed quite proposterous, including tasks similar to those of Sobriety Exams when the highway patrol pulls drunk people over and intense explorations of the opposable thumb. Unfortunately, the doctors didn't identify his disease through these series of examinations (also potentially due to the unusual age of the onset of his symptoms).

Now, let's flash to where I get my perspective on the same exams that Fox describes.

2009. Roseau, Dominica. In the weeks before our Physical Exam practical (see the entry "Inside the Mind of an Examining Med Student") a bunch of us Ross fifth semester students would get together in a room and drill through the numerous examination routines that we'd be tested on. Kinda just like a rehearsal for our great acting debut. In medical school, we have quite a long list of tasks grouped by each organ system (i.e. gastrointestinal, respiratory, etc.). And one of the great systems was Neurological. It wasn't exactly the most loved of all our exams as it was the longest. With our time limit of 10 minutes on the real exam to get through a whole systemic examination (selected by random) required much luck (or forgiveness from our respective proctors).

Above, as Fox describes those "intense explorations" of the thumb, I'm reading it with the perspective of a med student: during our scripted routines, we learned that rapid movement examinations, such as those involving the thumb, are checkups on our Cerebellum. One of the cerebellum's functions is to make sure we can do rapid, repetitive movements on a normal basis. And those "sobriety exams" are out there to make sure that a patient's sense of balance (with contributions from the Vestibular compartment within your ear), control, and ability in walking are intact, making sure that those critical connections between the brain and the muscles aren't, per se, "cut."

However, at our stage you may find it weird how we took those same dramatic routines that Fox described: With laughter.

It's odd. Sometimes as a medical student (inexperienced and all), I'll look at the stuff we do with a patient's perspective. It makes sense as I've been a patient for 23 years of my life, but in medicine technically only for almost two. As I was reading Fox's 2002 memoir, it made me realize that I need to start looking at the stuff we do in a new perspective: not anymore as those silly movements that any normal person could do, but with that idea that "everything has a purpose." Fox isn't wrong: the actions in the neurological exam have great ability to make even the smartest person in the world look like an idiot (they probably had him do the follow-the-finger-with-your-eyes-like-a-little-kid test for the muscles that move your eye). But in order for me to move on and be a clinician, I have to realize that these tasks we have to rehearse over and over in medical school, as silly as they seem, can carry multitudes of information towards potentially making a difference in someone's life.

---

Fox turns out to write a lot like me, utilizing italics in his manuscript to stress points and always interrupting his narration with self-thoughts and contradictions in order to get his point across. I highly recommend reading Lucky Man, and I'm definitely looking forward to reading Always Looking Up.

Page Turners

Above: Tristan Thorn and Yvaine from the 2007 movie, Stardust.

"AS ANOTHER CHAPTER OF MY LIFE

CLOSES..."

As you can tell, I get really retrospective when I leave experiences in my life that I consider significant. There's a lot to ponder, think, reflect, and analyze, especially after I recognized that a lot about me and my knowledge of medicine (of course) has changed over the last 20 months. Yet, to me, it is perplexing how such a short amount of time can change me.

The great chapter cliche is one of my favorites, used quite frequently as one traverses from one giant part of life to another. However, as I was sitting in San Juan International Airport at my gate for one last trip returning from Dominica, I noticed that there actually are lot of ways I can compare my life in Dominica to my experience of reading a really good fantasy book or story, for several reasons:

1) Having a unique main character.

Okay, I'm getting too cocky... let me rethink that. :D

1) Unique, admirable characters

I'm not going back to high school and use this time to list out all my friends that I've met here at Ross... that's not the point. The point is: I've met a lot of people here who I'm proud of being colleagues with, and just like those great characters that you see in fantasy novels (everyone from buccaneers to knights of the round table to helpful animals), each one of them have great qualities that will make them great doctors. Also, each one of them made life quite interesting for me here at Ross, either through adding spice to my day or by being supportive every day.

2) Antagonists that thicken the plot

However, the reality is that there were also people that I didn't really pleasure as much working with, people who think that they're something they're not. It's not like I can do anything to change them... my great medical adventure tells me that there's many more of those people I'll encounter in my profession. Just like every main character in a fantasy novel, although a lot of barriers will stand between me and my final goals, its my job to learn how to work with them.

3) Anticipation, Unpredictability and Excitement around every corner.

I'll admit that during every semester break, I was lined in with anticipation:

- NOT only would I be excited to return to the Nature Isle because of expecting the unexpected...

- NOT only because of pondering what adventures I'd go through with my friends...

- AND NOT only because of what new future doctors I would encounter...

BUT... because what I would learn next in the lecture hall. Even with the limits that the NBME (the ones in charge of deciding what we get out of medical education) puts on what we can learn in such a short amount of time, the world of Medicine is quite broad and filled with caveats and tricks about the human body that can enrich any mind.

4) Lessons learned.

Well, some of you may zap me on this argument, but I think I could learn a few lessons from a fantasy book (e.g. NEVER ever enter a dragon's den... Come on!) But I'll be honest that Dominica has taught me a lot not only as a medical student, but in a sense of moving on from myself. Some of the great stories that stress the importance of lessons and "growing up" include the movies The Lion King (You can't deny Simba and his lesson of Hakuna Matata) and Stardust (Tristan Thorn, who from his adventure grows from a nobody to a hero). My first 20 months have taught me some of the tools (as previous entries have said) that will be useful in not only making me into an able doctor...

... BUT also looking upon life in ways that I never imagined before.

5) Travels to Far Away Lands

Dominica, I'll be honest, is the furthest I have been away from home. Depending on how my flights to the island lay out, I could traverse to this different world in only 24-48 hours. Living in Dominica has taught me a lot about third-world countries. A lot of people at Ross complain about how Dominica isn't the States. BUT... that's the beauty of it: it isn't America. Come on people, when you signed to go to Ross, you should have known what you were getting yourself into. It's just another one of those instances where I see people not in "Carpe Diem" because all they can do is complain and not enjoy what Dominica has to offer in 16-20 months.

And that leaves off my last reason why my life Dominica was like a good book...

6) When I come to the ending, sometimes I just wish that story would never end...

But there's no doubt about it, every story (even the best of the best) has to come to a close.

---

Over the next few weeks, I'll be studying for several crucial exams for my med school career (comprehensives and boards, etc. etc.). During this time, even though my mind will be filled to the brim with info for these exams, I'll be bringing some reflections on some Non-Fictional layman non-fictional medical literature and also from recent news and events. I believe being a doctor doesn't just require just brains and loads of caffeine (Energy Drinks or Coffee, doesn't matter)... I've learned that it also is an art that requires a sense of humanity, critical thinking, and creativity, So, like I always say:

STAY TUNED.

Closing Time...

Above: My First Room at Ross University Housing in Fall 2007.

I'M A KEEPER.

I remember moving into college for the first time at my Alma Mater, the University of Illinois at Urbana-Champaign. I simply had a tub of clothes, a computer (okay not even that, now that I think of it), a few odds and ends items, and a few hangers. Little did I know that by the time I would graduate from the U of I, I would basically own everything from the practical to the extremely impractical. I had so many things that I kept since my first days at the University that I basically stuffed the back of our Ford Aerostar van.

Now, I'm basically at the same stage here at Ross. I'm about to leave, and with the limit placed on carrying luggage, I can't exactly stuff up my bag with everything here. Everything I have has a fate now: donated, thrashed, packed, or the one for the lazy, left behind.

Just like they say that a picture is worth a 1000 words, I have to say that a memoir is worth 1000 memories. And not all of the memoirs I've collected during my time here could make it back with me to the states. Here's some odds and ends that I picked up as I was sorting through my stuff before leaving:

1. A soccer ball bracelet...

Back in Semester 1, I got together with my friends Joelle and Chen back in Illinois. We all went and chilled at no place else, but Chuck E. Cheese's. When we got our tickets, we had just enough to grab for each of us four Soccer Ball Bracelets which represented all of us being friends (okay, so one went over to our friend Puneet). And when I said we were friends we definitely were. Our daily activities (other than studying with each other) included singing in front of the library and bothering everyone, creating jumping pictures, and spinning chairs in the back of the Annex during finals week of first semester. When I saw the bracelet after lifting up a bunch of papers that were on top of it this whole time, I kinda stared at it, and realized that its been already a year since first semester. Time flies.

2. Sheet music from Seasons of Love and The Night that Christ was Born...

In 2008, the RCSA choir, which I was directing with my friend Chen at that point, engaged in doing performances for the semester Culture Show. I think that the name Culture Show was a misnomer because even though there were several cultural performances in it (including dancing from a Filipino, Persian, and an Indian group), there's more singing performances than you can imagine that takes place here at Ross. And that's when after a week of hard practice, our experienced pianist, John, and our dancer, Clara, along withour whole choir went out and sung our hearts out. Here's our final performance of Seasons of Love from Summer 2008.

Our following semester, we decided to follow up that performance with a little bit from the song The Night that Christ was Born, from the composer/singer Kirk Franklin. I sang this song as a part of my Undergrad Church Choir (The St. John's 10:30 Choir in Champaign, IL). It was absolutely amazing, and it was really cool to do it once again for our Fourth Semester mass in December 2008.

3. A printer cover sheet with MPS scores from Semester 3...

I remember in semester 3 how much I was freaking out because of the weird placement of the last term exam (nicknamed Minis here at Ross) which is 2 days before the Final Exam for that semester. As a result, you'd get your grades 24 hours after your last term and have 24 hours left to make up any deficiencies from the last term. I walked up to my friend Stephanie, and I said to her, what exactly were the Minimum Passing Scores (MPS) for your semester in order to make myself feel better. I passed that semester, luckily enough, but if it wasn't for the support of my fellow Ross friends (even just to ask what scores were like a semester ago), I wouldn't have made it this far.

4. A driedel-shaped ornament saying "Lil' Pinoy"...

My friend Carla and I used to sit in the cubicle section of the library (nicknamed the Icebox, due to the similarity of White Cubicles to Icecubes). We did some weird things back there, everything from eat our meals (although food wasn't really allowed in the library) to discussing the latest news within our class from cube to cube to taking pictures of our row of friends falling asleep. One day I walked back from getting dinner and this paper-shaped ornament, for the holiday season, was placed right on my desk. According to her and her devious friend Jackie, I was cool enough to be described as "Lil' Pinoy." (Pinoy a nickname for anyone of Filipino culture).

5. An oversized hand-made rosary from Dominica...

One of the last memories of my basic sciences days in Dominica. Every semester, our Ross Catholic Students Association holds a Fourth Semester Mass in tribute for all the people moving onto the great fifth semester. A token of leaving given is a hand-crafted rosary made locally here in Dominica. Kinda big for doing rosary on a regular basis, but a great keepsake of my spirituality here in Dominica.

WELL... I'm sure there were a lot more, but that's what I remember for now. Each one of these memoirs represents a memory that I've had in the past. However, there's gotta be a point where you have to come to acceptance that you can't physically keep every single memoir for your memories. Sometimes you just have to learn to let go, and be secure that the best place to store your memories are up in the ole' noggin.

So... goodbye Lil' Pinoy ornament.

- Sigh -

The Inquisition

Above: The San Juan, Puerto Rico skyline from the Best Western Hotel & "Casino."

WHY EXACTLY DID YOU GO

TO MEDICAL SCHOOL?

There's no doubt about it... the human race is a curious one. We always are finding ourselves asking questions for a multitude of reasons, either philosophically or scientifically. I don't think I can come up with a time that A) we're not ever asking ourselves a question or B) can't ever come up with one. However, one of the most intriguing things about being inquisitive is there are questions that I ask myself over... and over... and over again... such as:

Why do I want to become a doctor?

No, I'm not going to take this entry to try to rewrite the essay question that I answered (multiple times) as I was applying to medical school. For many people, that's one of the first times that they truly start asking themselves that question... why they are entering this niche in life. However, as an inquisitive human myself, I have to say that I've asked this question many times as I've sat down with books when I was studying. And I'll admit that the answer hasn't been exactly the same each time I've asked...

Coming to Ross is no joke. I've heard about the specific discrimination that some med students have in the states for med schools that say it's a "beach" of a time when you go to a caribbean school. I'll be honest with you: it isn't. I can go for pages about how the program does have the rigor of a US School, and sometimes how the school can sometimes catch me off guard with policy & administration changes.

It's the loads of sacrifices that I have to make that add to my weight.

- I'm thousands of miles away from home, mom & dad, my friends.

- I don't have a car to drive around.

- Living in a developing country, and not having the "amenities" and "distractions" present in the developed world.

- And I had to give up some of my favorite things in life: including the super slurpee that I'm craving for right now.

And that's when the self-inquisition sets in. For the economists: it all comes back to a game of costs and benefits on myself. I'll start questioning whether or not being away from the comforts and cares I had in life is worth it for the long and winding road. I've also pep talked my friends into rethinking that big Why? question. Some of the answers that truly worry me about getting into medicine (especially if its the only reason) include the following:

I really want to care about people.

I am doing this for my mom and dad, to make them happy.

It's a great field with great job security & benefits.

And every time I read those answers... I say those can be some ways to get involved in medicine, at least for the short run. But where's the self-drive in those answers, what's going to keep people passionate about what they do everyday... to strive even more and to be happy with working hard.

I sometimes think that the commonly heard 40 year-old depressed doctor comes from the wrong rationale behind going to medical school. I keep hearing quotes - and also keep forgetting where they've been coming from - that sound like, "You can't take care of other people, until you take care of yourself." I believe that a person needs to empower themselves with a rationale for their own self-benefit to succeed at what they do. And that's where I draw the line between primary and secondary self-drive (my lingo for motivation).

1) Secondary Self-Drive

Let's start with the more concerning of the two. I'll admit that job security and benefits is a self-drive, but I would call that more of a secondary. I'm thinking secondary in terms of going through a physical outlet to achieve that "final satisifaction" for what you do. It's not a direct hit. For instance, in job security, the road to getting to getting that happiness and satisfaction looks like this:

Medicine => Secure Job => Satisfaction

Let's say that A) you don't get into the match... satisfaction isn't going to set in.

Let's say that B) you get to the secure job... you've already accomplished it... so what's new that's driving you?

It all goes back to if that secondary self-drive is removed... how can one make it to the goal of satisfaction with the loss of that driving factor? It's good to have secondary self-drives, but it needs a backbone:

2) Primary Self-Drive

I honestly believe that a primary self-drive is what actually will drive me to being successful at what I do and keep me motivated. A primary self-drive looks like this: I'm in medicine because I really am motivated to learn more about how our lungs work and potentially improve the prognosis of patients who develop lung cancer. And bam...

Medicine => Satisfiaction.

Take a look at the direct link back to the subject topic - the academic world of medicine - and how there's a pure interest in what this person would be getting into - the subject topic & improving the situation. There's a reason for looking into those books and to strive further than any man has done before. It can be applied to any situation... i.e. going to a bar for the ambience.

It's tough to define... but think of it this way: name a way you wouldn't satisfy the example above... the only way is if you never find the answer to the problem. BUT!... Remember, how I said we're a curious group of people? Unless you're not human... you'll be satisfied & content with what you do.

Okay, so the rationale is done primarily & secondarily... finally keep in mind of one big hole...

3) The Black Hole of Vagueness

I think that one of the greatest things that I learned at my Alma Mater (the University of Illinois at Urbana-Champaign) is that a goal in life needs to be defined well. It's great to define your self-drive, but don't forget about defining the ways or coming up with a game plan to go about it (i.e. doing medical research, reading up on journal articles, etc. etc.). A game plan is crucial to laying out what needs to be done so one doesn't fall off track that the drive has them on. So with realizing the answer to this big Why? question, make up a game plan to make it happen.

And when I look at it all, for being successful and being happy with what I do, which is the way I define satisfaction, there are going to be primary and secondary self-drives that motivate me. However, in the end, but it will always come back to what you're truly passionate about... the primary self-drive about what the field you're in or what you're doing.

So next time you have a friend who's about to join into medicine or even just entering college, tell them that its okay to be selfish. Because if there is a self-will, there's a way to travel down a successful and may I say, enjoyable road. And yes, you'll still be able to take care of that humanitarian side of you, just remember to take care of yourself first. No matter what field you're participate in with life, it's a good thing to just remind yourself of why you got into that field in the first place. Perhaps you'll realize that all the sacrifices you made were worth it.

Ahhh.... Curiosity is such a beautiful thing. :D Yet, it is so, so complex.

I bet you're curious now... why exactly am I becoming a doctor? You're probably tired of reading... so I'll be telling you soon enough...

The Mind of an Examining Med Student

One of the biggest things I've learned in medical school is that my perception of time is absolutely messed up...

At the end of fifth semester in Dominica, we have our Final Physical Exam Practical. This is where we're tested on our "Doctor Skills", but with horrendously strict time limits. For instance, we have to question the patient on his/her condition (a.k.a. Taking a History) or perform a physical examination on some organ system of the patient (i.e. heart, lungs, stomach) in a less than comfortable 10 minutes.

And there I was... one of those medical students about to take on that exam. I was dressed up in my white coat - with the great honorable Ross emblem patched above the right pocket - and my reliable blue shirt / dark blue tie combo. My white coat was loaded with the appropriate exam tools - an ophthalmoscope/otoscope, a reflex hammer, a cotton-ball, and of course, Doctor's Best Friend, the stethoscope.

As a side note: never ever underestimte the power of the hammer that your doctor uses to make you kick involuntarily with your knee. (That brown or orange rubber hammer isn't there just for show.) It could be very helpful to detecting more serious neurological issues, such as a stroke or a spinal cord injury.

There are three rooms of 10 minute tasks a piece. I had gotten through the first two rooms and barely survived, but then I came to the third room. I enter the room, greet the doctors that are proctoring the room, and then the doctors proctoring my room say to me:

"Make sure you manage your time wisely to examine your patient."

They had given us a paper before entering the room that said what the patient had. If you've heard about schools using standardized (acting) patients in their programs, well, in fifth semester at Ross University in Dominica, we use real patients in our examinations. The patient in front of me, as described by the paper, was complaining of weakness on the left side of his whole body.

The proctors told me that the time on the clock started with me pressing the start button on the kitchen counter timer that was about to being used to time it. I knew that when I clicked the start button... it would just be between the patient, the clock, and me.

... And, CLICK!.

10' 00"... 9' 59"... 9' 58"...

At Ross, we've been taught a script that we would digest to every patient we'd work with in an examination case, everything from introducing ourselves to mentioning things would be confidential to whether or not we've washed our hands (in that case we hope that the former was the case). As I was doing my examination, I started to notice that upon movement of the patient's arms, his arms were tough to move, with rigidity upon movement (med lingo: hypertonia).

When we're practicing for these examinations in small groups, we try our best to simulate our standardized patients: well get one of our group members to either falling asleep, act with minimal compliance, or pretend that he or she have no idea what the student is saying. However, we never really knew how to practice for real patients, because the scenarios aren't known until the day of the exam.

I then worked on the man's reflexes in his arm and leg carefully, and then I looked at the clock...

3' 22"... 3' 31"... 3' 20"...

At this point I realized I still over half the examination to go. I said to myself, "Clock it!" Which is my lingo for saying "Speed it up!" My heart started to enter a rush and I started racing through various sensational exams on our patient (i.e. testing whether the patient could feel vibration, feel a pin or a cotton ball, or know the position of their fingers). When I finished that, I started to examine the head, I started asking the patient questions about vision or loss of smell... but then I looked at the clock again...

0' 23"... 0' 22"... 0' 21"...

I clenched my teeth as I started checking out the patient's face to see if the patient could feel me touch his face. However, I still looked back at the clock...

0' 10"... 0' 09"... 0' 08"...

"Come on, let's really clock it..." At this point, I think I was basically speed-blabbering instructions... but after testing the patient's jaw movements, I looked again...

0' 02"... 0' 01"...

Now, if you would have seen the look on my face at that point, you would have probably described it as the "Oh, Shit" look. Forgive my language.

BEEP. BEEP. BEEP. BEEP....

After the proctors told me to write my findings outside, I thanked them and the patient for their time, but I had left a couple facial neurological exams on the table, which were quintessential to evaluating the patient. I guess for some people "That's life," but that's also a couple of points off my full exam. It was then that I walked into the library room and sat down with a pencil and paper and wrote up the cases that we just investigated in each of the exam rooms.

But that's my story about how my perception of time is messed up... Sometimes medical school can be tough, but it teaches you one thing: not all the time can we take our time to exam our patients and make sure we can do everything properly. There's going to be times when time is going to be of the essence. And it is then, I'll realize that only through practice are we able to do everything a doctor can possibly do properly in an efficient amount of time.

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And today was the "last" official day of classes I had here during my time at Ross. Next week, we'll be doing our BLS (Basic Life Support) and ACLS (Advanced Cardiac Life Support) training. On April 12 next week, I'll be on my last plane flight home from the Nature Island. So here's what to expect on the blog: over the next couple of weeks you'll see some retrospective entries on some of the greatest lessons and moments I've had during my 20 months here in Dominica.

Remember: If you have any prompts or questions about Life in Dominica or at Ross, let me know. I'm always looking for something new to write about.