Mile 768: The Learning-Teaching Pairing

Above: The Chicago skyline on the NB U.S. 41 Lake Shore Drive to SB Interstate 55 flyover. I love flyovers!

"SEE ONE, DO ONE,
TEACH ONE."

2007. I recall one of our professors in the anatomy lab at the campus in Dominica was talking to us about how things "roll" in the anatomy lab. After our class was split into three groups, one of the groups each day would go on in to the lab and dissect a part of the body. For the people who weren't dissecting on a given day, they had to come in and watch the group that was currently dissecting give a demo on what they found out on that day. And for the next day, we'd rotate a group, and the process was repeated over and over again throughout the semester.

Dr. Martin said this was his philosophy, to see one, do one, and teach one.

---

There's truth to that statement, and I'm seeing how it works firsthand in the wards. For instance, this past week, our attending doctor had demonstrated to us how to perform a neonatal physical (see). As a group, we then spent time everyday to perform the physical exam (do). Finally, when a new group came in to work in the ward with us, we spent the time to teach them the procedure if the doctor wasn't available (teach).

And through doing all three, I would have gone through either a procedure or a nugget of information, three times (and the procedure amazingly stuck!). Most would agree that in order to teach one has to learn. However, for me (but not for everybody), to learn one has to teach. It is commonly said that becoming a physician is a career of lifelong learning.

Right now, at this stage as a medical student, this is how I see it:

Throughout our careers, we have to keep up with the continuous research that goes on, filter out what's appropriate, and pass that information to improve the care of our patients. When we teach them what we learned (one way is through a doctor visit), I think that we have to pay attention to our patients, such as if we are communicating our ideas effectively to the patient or how well the treatments we plan are working. If something's wrong with that, we have to go back to the drawing board and start learning about that issue from square one again.

So after all that, I'll have to say that teaching and learning go hand in hand, and for me, one can't go without the other. For me, being enthusiastic about medicine (or just about anything) can make the processes of learning and teaching exponentially addictive.

Retrospective: Red No. 40

Above: Robert Moore, Director of Patient Simulation, Ross University School of Medicine - Bahamas campus demonstrates use of a patient simulator. (From Derek Caroll, BahamaIslandsInfo.com)

IN MY DAY,
WE CALLED HIM STAN.

2008. I remember during fourth semester in Dominica, I was ready to draw blood for a blood test on the patient. My proctor was watching me as I went for the median cubital vein for the draw, and I only pulled out air. He said, try again, and as this was my first shot at drawing blood, I mistakenly pushed the syringe in the wrong direction, pushing the air into the patient.

STOP! WHAT DID YOU DO!?
He shouted.

Back then, I didn't know. He told me I almost triggered an air embolus in a patient. Fortunately, I never harmed the patient. After a second try, I hit the median cubital vein, and I drew blood properly using the syringe method. Okay, I fibbed, it wasn't blood... more like a watery substance colored with loads of Red #40 food coloring.

----

If you didn't catch it by now, I was working on a full-blown human simulator.

I'll admit that it wasn't exactly like working on a real patient: the simulator couldn't give feedback (only through what our proctor interpreting as the patient), techniques that require fine hand skills (e.g. placement of IVs or drawing blood) could only be coarsely worked upon, and we always had a second chance if one of us did something wrong. In the case of the failed blood draw on my part, I was glad I did: an air embolus might have killed the patient.

However, it was different in years past. From a recent New York Times article by Pauline W. Chen, much of her clinical experiences on patients was done directly to real patients with that risk, and teams reviewed their cases on videotape. Now, patient simulators can be used for full clinical situations, putting away that risk that lies with working with patients needing critical care. It seems to be the answer to the ethical dilemma of if its acceptable to use patients as "airplanes or machines" (according to Dr. David M. Gaba from Stanford University School of Medicine) to test on.

With the simulators at Ross University in Dominica, we were able to work in teams of eight directly on a simulator with a professor as a proctor. And if a group of eight of us, for the first time, had issues with figuring what to do in such a critical situation, imagine us doing the same with a real patient. We'd definitely scare them, and not to mention put them at harm. The simulator room gave us a "safe zone" where we could try our best to develop a team dynamic so we could work efficiently towards the patient. Seconds count with the simulator, but fortunately running out of them doesn't mean life or death (in real terms, anyway).

The one thing I found initially annoying though was how easily the program running the patient could be manipulated. Sometimes our proctor would go right to the controlling computer and click a button, and all of a sudden the patient would be undergoing a deadly arrhythmia. However, I responded exactly as I would have with a real patients, with greater alertness toward the situation, and our team made the appropriate actions. This flexibility enhanced the realism and educational benefit of a simulator session, and in the end, I actually appreciated the switcheroo.

I really hope that simulator technology improves for the next generation of doctors, as I found it very valuable in my medical education. Thanks for the memories, Stan.

Sources: BahamaIslandsInfo.com & The New York Times

Retrospective: The Flight of Hell

Above: A McDonald's. In America? Nope.

Being at a Caribbean Medical School seems awesome in many aspects: you get good weather, get to taste a different side of culture, and it is an experience of a lifetime. However, last week marked the one year anniversary of an event that was best put as a Hall & Oates song title:

SO CLOSE (YET SO FAR AWAY).

See, the one huge disadvantage about going to school in the Caribbean was moving my life away from the States and taking it someplace else for such a short time. I had to take my life, and restart it over in the Atlantic. But I amazed myself on how much I actually accumulated in terms of experiences and physical things. Talk about baggage... and I only had 70 lbs (sometimes 50 lbs) of it to carry it back home.

Last year, when I was heading home after my fourth semester at Ross, I had my biggest flight nightmare ever. My itinerary had me leaving Ross on the 19th of December in the morning, and arriving late at night on the same day. I was definitely grateful to have a schedule without a layover... unfortunately, one unexpectedly came my way.

PRELUDE:
When flying to Dominica, there are two major options: LIAT and American Airlines. The advantages of flying American Airlines is one layover (24hr) in San Juan and a direct flight from Dominica to San Juan, but the disadvantage is that it was a hefty ($1100 two-way) trip at the time. Utilizing LIAT, you could save $200-$300 depending on the flight connection combinations, but those combinations could result in disastrous transfer times of less than 60 minutes at unfamiliar Caribbean airports. Utilizing my budget mind, I had booked my flight to Dominica that semester on LIAT. I had survived 7 flights, over the past 4 semesters, utilizing my budget itineraries and a handful of crammed transfers.

I guess eight is a charm.

DECEMBER 19, 2008:
Posting my 11 AM flight out of Dominica from the small, but nicely refurbished Melville Hall airport in Dominica, we noticed that our LIAT Airplane was an hour late. Fortunately, during that time I had caught up with my friends Jo and Jemini in the waiting room. They also had similar flight connections with me, as they both were heading back to Chicago. The caveat was that Jo had an international flight to Asia the morning after she arrived. As soon as the plane arrived, we were engulfed with constant promises (and apologies) from LIAT, but I really started to feel unsure about the rest of my itinerary, with a short transfer time in Antigua, I thought everything had screwed up.

Fortunately, we made it. Home free? Not exactly. When I was going through the transfer desk in Antigua, I noticed that my baggage tag copy did not have my name on it. It was someone elses. Because of this tag mishap, the LIAT staff sent me through customs (which was a much longer process). Being the talker that I was, I started talking to people in line about my issue, and I started to talk to someone else who had the same problem happen to him. The name on his tag: mine... and my tag: his. With a jump for joy, I got out of the customs line and went back to transfer after we both gave each other our respective tags. It was then that I had a quick hot dog with one my fellow Rossies, John (which I do truly recommend from the Big Banana Food Bar in the waiting area), and soon Jo, Jemini and I we were ready to board the flight to our next stop, St. Maarten.

When we reached St. Maarten, I ended up staying behind at the luggage carousel to pick up my baggage for my next flight (due to my switching of airlines, I had to re check-in). After a long wait where my patience was tested, my bag did not appear on the belt. I had to spend time to report it. Just great, more hassle, I thought.

At that point, time was of the essence, so I ran through customs and right to the check-in desk... My next flight was a U.S. Airways scheduled flight for Charlotte, N.C. If you imagine the scene in the original Home Alone where the McCallister family is running to catch a flight, you're imagining the way we were running to catch our next flight, with 45 minutes on the clock. As soon as I got to the desk, they said that they had their policy for international flights is that 60 minutes before boarding check-in stops. We pleaded to get on the plane, as the plane was still at the dock, but unfortunately that was a no-go.

Jo, Jemini, and I decided to wave the flag that night, and U.S. airways was happy to reschedule our remaining flights to the next day (making me on target for arriving the next day). We ended up gathering another follower to our "screwed over" group, George (who was heading for Detroit). We ended up staying at a hotel and splitting the bill in St. Maarten. It was good though that it was a touristy area, and everything was close to the airport (including this grand Steakhouse called Ranchero, which we dined at for dinner). After splurging on McDonald's (because haven't had any in a while), we decided to rest before heading home the next day.

DECEMBER 20, 2008:
After grabbing a quick breakfast at the Mickey D's, we scheduled our Taxi for the airport. Jo had left our group earlier that morning, as during the previous night she spent time contacting her husband in America to schedule a flight for her on another airline. Our midday flights out of St. Maarten would make her tardy for her international schedule.

Jemini, George, and I made it to the check in desk to find out that our new schedule combination was not reserved, so we ended up going to the reservation desk to hassle our way to get our way back home today. We were soon rescheduled on another flight just an hour later, also to Charlotte, so we were relieved. Once again... Check-in... customs... wait. When Jemini and I caught ourselves at the gate, we congratulated each other for making it through finally.

We jinxed ourselves. The PA soon announced: "U.S. Airways flight XXXX has just been canceled due to mechanical issues with the airplane. Please come to the desk at the gate to reschedule your flight."

Jemini and I were in disbelief. We rushed up to the desk, and soon were about 40 people back in line. I reached for my cell phone... At this point, I thought that not even roaming charges could keep me from arriving home. I kept dialing the U.S. Airways number, but my phone was not only out of batteries, but kept disconnecting from the signal. It was fortunate that my cell phone could plug into a laptop and charge off of it. And that's exactly what I did (see below). I kept calling, but due to the holding time for an "available operator", my laptop battery had been burned just about to zero. I just had enough time to put in my schedule change (which was for a flight about 3 hours later to Charlotte), but my phone died when I was about to schedule in Jemini's and George's.

I ended up to be the only member of our group that day to land in America, as Jemini and George ended up taking a voucher from U.S. Airways to stay in St. Marteen. Getting out of Charlotte-Douglas International Airport into 50 degree temps and getting a little soggy from the pouring rain was actually an amazing feeling (especially since U.S. Airways picked up the tab), so I boarded my shuttle bus to head back to the Four Seasons hotel they had me post up in for the night. Not bad for a free night, I'd say.

My final flight was at 9 AM tomorrow. I prayed that this escapade would finally run smoothly that night.

Above: The cell phone laptop battery concoction I put together.

DECEMBER 21, 2008:
Awakening from my amazing sleep at a Four Seasons hotel in Charlotte, I took the earliest airport shuttle to the airport. Drowsy and tired, I was welcomed by long lines a the U.S. airways check in booth, and with 2 hours remaining until my flight, this sight was not one for sore eyes. However, things moved along smoothly, and after checking in, security and finding my gate were easy as pie.

I arrived in Chicago, IL at 9-10 AM that day, on time for the flight I was scheduled on, but almost a whopping 36 hours and 2 layovers later than my itinerary had originally proposed.

I visited the U.S. Airways desk at Chicago O'hare hoping my bags had made it... but they didn't. The U.S. Airways representative said that they would bring my bag to my home soon. About a day later, I got the call that it was here. However, by the time the delivery guy appeared at my door, I looked down and a small, blue bag was looking at me. It was unlikely some magical shrinking machine came to life (like the one from that Rick Moranis movie) and shrunk my big rectangular roller suitcase, so I had to come up with the other logical conclusion: this the bag of the man who got his baggage tag switched in Dominica with mine. I ended up sending the bag back to the delivery man (he seemed rather confused, as he seemlingly had rarely heard of this type of issue before).

Although I made it home, my flight nightmares had not ended. Now, I knew that my baggage tag was also switched onto the wrong baggage (talk about wreckless baggage tag placement by the LIAT staff in Dominica), and I needed to find it to study for my big post-break exam (the Comp). To put a long story short, after several calls to U.S. Airways about my baggage, I got in contact with Patrick, the man who I had my bag switched with (fortunately he too was also a Ross student). He told me that my bag was nowhere near Chicago... it had made it to L.A., and on a different airline. After a few more days of intense phone calls, my bag finally... and I mean finally, made it home.

I was glad to be in the right place for the holidays, at home. I was also fortunate enough to have American Airlines tickets to school up my sleeve for next semester.

THE AHA MOMENT:
To those of you to fall upon this long blog entry, and are just about to enter Ross or another medical school in the Caribbean, here's my tip for securing flights:

1. It's okay to have a lay over.
Make sure you select an area that you feel secure in laying over, and reserve a hotel ahead of time, if you are flying during a peak period (i.e. when everybody else is traveling to/from school).

2. Get your tickets early.
For some instances, its best to start knowing what you're going to be doing next semester and getting your tickets once you arrive at school. For Ross students, this could mean securing the limited amount of flights on American Airlines.

3. Make sure your baggage is tagged appropriately.
Always ask to see your bag tagged before you leave the counter.

4. Check all baggage restrictions for all your airlines.
At the point of time I wrote this entry, baggage policies are accepted on the first airline you board until you exit an airport. If you switch airlines after a layover, your baggage restrictions reset to the airline you board the next day (meaning this is the limiting factor). The last thing you want is a hassle of ridding your bag of meaningful things just so you can make it to your next flight... and I know of people who have ended up doing that.

5. Do your research.
Know the check-in and customs policies at each of your connecting airports. it would have made me think twice about my itinerary sending me through St. Maarten with such a short connection time.

Yes, some things do turn out to be the airlines' fault, but as a good doctor would say, prevention can help from a horror trip like mine from ever happening to you. Stress should end when a semester is over, not begin.

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 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.

----

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.

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

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.

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