Routine Eye Exam

Two weeks later, after being pensive and reflective about my 5 semesters on the island, I am wide awake at 4:00 in the morning with not enough energy to work on Kaplan, but too much energy to fall back asleep and a lot on my mind.  ::sigh::

I’ve been out of touch intentionally–I can’t imagine that reading about someone who lives in the middle of nowhere waking up and studying everyday can be that interesting.  So instead, I think I’ll discuss the non-studying outliers.

Yesterday was my annual eye appointment check-up.  This was the first follow-up appointment since my big eye crisis last year where I was afraid that I was going blind/had a brain tumor.  I went to the office with the intention of getting contacts fitted and mentioned nothing to the flippant eye assistant who was updating my history about last year’s traumatic events.  I mean, after all, it should all be there in my chart anyway, I haven’t had any follow-up symptoms, and technically she asked me if I’d had any previous conditions and at that point I still didn’t know what the technical term was for what happened to me.  Eye-numbing drops, dilation drops, and subsequent ennui associated with waiting for my eyes to dilate were all routine.  Eye exam went fine until we got to the part where my ophthalmologist was in the room and went to do the advanced ophthalmoscopic exam; he spent 2 or 3 minutes shining an extremely bright light into both of my eyes then said that it looked like there was something “floating around” in my left eye (the bad one) and that he’d have to “give the drops more time to work” (i.e. more dilation).  Crap.

Half an eternity or 20 minutes later, he came back with a brighter light and after about 5 minutes of looking around, told me that I still had drusen in my left eye.  Oh, so that’s what it was.   Drusen.  We’ve talked about this in class before–now what was it concerning?  Also he mentioned that where the optic nerve enters the eye, that the vessels were still enlarged.  Papilledema?  But just on the left side.  He seemed puzzled but not panicked at all.  I calmed down.  But then he kept talking.  He also said that I needed to make sure that I kept coming back every year for check-ups, that he’d noticed a spot on my left lens.  He said it was below my field of vision, but then proceeded to show me my chart where he had marked the site on a diagram of an eye and scrawled PSCC below it. Wait a minute.  What involves a C and spots on the lens? “…cataract?”  I asked, before he could explain what PSCC completely stood for.  “Yes, how did you know that?” He responded incredulously.  At this point, I sort of tuned out.  I heard “…not anything to worry about right now…can be fast growing…” and then found myself alone in the room again, waiting on another assistant to come in and fit me with my first pair of contacts.

Before I could pull up wikipedia on my phone, I was staring at the ceiling with nervous anticipation as a freshly-washed, yet ungloved finger ::shiver:: with a small bluish disc on the tip came closer and closer to the periphery of my vision.  All I could think about was the scene from the Star Trek TNG series of movies where Picard is transformed into Locutus and has an implant drilled into his eye.  ::Grips the arm rests tightly and tries not to blink::  Contacts weren’t nearly as bad as I’d imagined them to be.  They don’t feel like there’s a disc of gel-like plastic stuck to the front of your eye, but more like you’ve got some peripheral non-compliant eyelash intruding into the white of your eye.   Before wikipedia would load on my phone so that I could get back to my previous crisis, my doc was back to check my vision with the contacts in.  20/20.  Asked me in passing if I’d been on any steroids lately, “you know, for infections and stuff.”  Stuff?  What, like pseudotumor cerebri?  ”No.” I said.  “Oh.” He looked slightly crestfallen.  He asked me how the contacts felt and I admitted with honesty that I couldn’t even tell they were there.  He giggled somewhat sadistically and remarked that the anesthetic solution must still be having an effect.  And with that I was lead off to the contact room.

Much like last year’s experiences during my emergency visit to the local eye facility, I was getting to see a new room in the maze of exam rooms and rooms with sophisticated instruments and a line of 2 or 3 old people waiting outside.  This time, it was a high-traffic room.  I walked in to a room that resembled Olivander’s shop in Harry Potter–with the walls stacked with small boxes.  There were two desks with mirrors and sinks, and a chatty lady in dark blue scrubs on the other side of the desks who was rattling off numbers to a man dressed in business casual, yet not formal enough to be one of the aging doctors in snappy suits and bowties.  Hmm, must be a sales rep.  This must be the contact lady.  She greeted me warmly, but with the professionalism that’s come from the routine of breaking in hundreds of newbies with their first pair of lenses.  I smiled nervously.  She pushed a mirror towards me along with a few sheets of paper towels, a box of saline, and a couple of empty lens cases.  Then it was like someone pressed play on the VCR.  She held up and demonstrated both cases and the differences between the two; described the importance of sterile saline and the brand preference of the establishment; gave a brief lecture about the importance of removing contacts nightly as prescribed and the gruesome consequences if these directives were not followed; explained the process of starting out wearing them just 4 hours daily, then 5, 6, and so on; then just like a flight attendant, began demonstrating on her own face, the awkward poses necessary to remove one’s contact lenses.  Suddenly, I was yanked out of my trance of head nodding as she said “Ok, now you try.”  Wait, what?  You want me to take these things out?  But we just got them in, they fit so nicely.  Crap.  Like trying to play out a jingle you’ve got stuck in your head, I remembered and repeated the steps she’d acted out and low and behold, 30 seconds later, my contacts were sitting in a case in solution.  Sweet.  Now her video-like demonstration started again, except this time, the poses were even more awkward and involved more steps.  Ugh, you want me to put them back in?  Isn’t this the part they make fun of all the time on tv?  I followed the steps and on the third poke of my left eye, I managed not to blink and looked around just enough to make the contact make contact (heh) on all edges and slide into place.  That wasn’t bad at all.  ::Jinx:: 10 minutes, 8 or so re-washes and seemingly 50 tries later, I lucked out and got the right contact in after much reassurance that I was doing fine, it wasn’t taking long at all and that I would get it any minute, and would most likely be able to do it without a mirror in 2 weeks when I came back for my follow up appointment.  Wait, I have to come back and do this song and dance in front of you again?  With the distinct paranoia that she’d been lying to make me feel better and that I might soon be the subject of exasperated discussion–I’m hard on myself, no?–as soon as I was out of earshot, I went to update my insurance information, pay the “fitting fee,” schedule my 2-week follow-up appointment and be on my way back home.

With a growing, familiar unsettling feeling of camaraderie with the older patients waiting to be tested on the sophisticated machines in the unvisited rooms at the eye doctors’ office, I googled “pscc.”  Too vague.  “Ophthalmology pscc.”  From what I could glean, it is a type of cataract and is fast-growing but is NOT usually seen in young patients.  Great.  The same unfamiliarity with association with my age group was the case with “drusen” although even more unsettling was the association of drusen with “macular degeneration.”  I read on.  There was a subtype of drusen called ODD or optic disc drusen.  Wasn’t it my optic disc the doc was talking about when he brought up the term ‘drusen’? It makes me very nervous to think about what I read concerning that subject.  Here–knock yourselves out: http://en.wikipedia.org/wiki/Optic_disc_drusen.  In particular, the sections entitled “Epidemiology” and “Prognosis” are daunting.  Hmm.  Good thing I don’t want to be an air force pilot?

The rational part of me reminds my panicking self that I could be barking up completely the wrong tree.  I didn’t clarify with the doc exactly what my conditions were, HE didn’t seem to be overly worried or concerned, plus I have NOTHING as far as risk factors or family history or associated conditions that are mentioned on the ODD page.  Positives: I can see FINE right now, I’m losing weight thereby reducing my risk of developing NIDDM & HTN [and the associated ocular manifestations], and my main objective of visiting the eye doctor for my yearly checkup and leaving with contact lenses was a success.

Reflections on Med 5 and what I would have done differently

Side note: the Med 4 equivalent of this post that I did last semester is on valuemd if anyone is interested

WARNING: LONG POST.

Ok, so what I can I start off saying about Med 5?  Well, I think it’s probably one of the most frustrating Meds at the school.  There is no doubt in my mind that it has the WORST schedule, even worse than that horrible 4-hour block of afternoon classes in Med 4–at least you had the mornings off there.  Med 5 starts at 8am, so there’s no one in the building except you and the Med 1′s.  And then you go ALL DAY until Kaplan is over at 5:00, during the first 3 blocks, then after that you have 8 hours of Kaplan which is just torture.

The first class of the morning is ICM lecture.  It is taught by Dr. D, who is brilliant and really dedicated, but just doesn’t put that much pizzazz into lecturing.  She has anecdotes just like Dr. I from last semester, but there are no cute breaks where she gets that grin and gaping expression on her face, earnestly waiting for the class to burst into laughter like he did.  In fact, she has a really scary story about where her son almost died after an esophageal bleed secondary to a strong burp.  Anyway, I’m digressing: ICM lecture.  Unlike the short PD lectures, this lasts for an hour and a half and that extra half an hour is killer.  The late people in your class, you know who I’m talking about, learn that Dr. D isn’t terribly bothered, or at least isn’t terribly vocal about being bothered, by tardiness, so they slowly start to come in to lecture later and later until it’s not unusual to see a quarter of your class ambling through the door groggily at 8:30.  Attendance is accomplished by passing around a sign-in sheet and you’ll often notice that by the time the sheet gets to you, there are often more signatures than there are bodies in the classroom.  ::sigh:: Some things never change.  The powerpoints aren’t as long as Dr. I’s and have some great information, but they are still quite lengthy and if you’re someone who typically writes them out like I do, don’t bother.  Won’t help you.  Focus on the slides she’s got starred and remember the important things that are in bold.  You learn a lot of good clinical information.  This is somewhat of an Aha! class in that many of those little things that doctors do that you’re worried you missed/won’t learn in school or that you think you’re missing by being at a Caribbean school are elucidated in this class like, um…for example…why do I give my patient a liter bolus of normal saline instead of a liter bolus of D5water?  Or…what’s the order of drugs you use on a patient who comes in with previously untreated CHF who is having trouble breathing or presents with pink frothy sputum.  It’s a good class, it really is, it’s just tough to get through at 8:00 in the morning, every day with a monotone.  Oh, there are lots of little assignments like article worksheets and quizzes and such.  Don’t scoff at them, yes they seem right out of third grade and the frequently infrequent due dates get annoying, but you can pick up a lot of good information from them and that information WILL show up on tests and, surprisingly, on shelf exams.  She tells you not to work with other classmates, though most people do.  I would just make sure that YOU understand the work and that you can reproduce it.  Also important for this class is that you gain your BLS certification in CPR–I did mine over Christmas break at home, though it’s just 4 or 5 hours on a Saturday or Sunday if you do it on the island–AND at the end of the class, Dr. D offers you modules so that you get training in infection control and HIPPA which are required for clinicals.  If you don’t complete that, you have to pay $25 to complete an online module through the MUA clinical website, so go for the free one.

ICM lab.  THIS is your Med 5 class to look forward to.  I LOVED ICM lab.  Wanna know why?  Dr. B.  She’s awesome and easily one of my favorite teachers at the school.  We met her briefly in PD lab in Med 4 when we were learning to take histories and didn’t really get to see much of her personality.  In fact, I didn’t think I was going to like her because all that we saw of her was her making fun of people’s histories when we hadn’t really had much direction on how to do them–it was frustrating.  Anyway, she’s amazing.  She’s funny, very intelligent, and will teach you how to work with patients realistically.  She still works back in the UK and has tons of experience in family practice and can give you all kinds of helpful hints and advice.  To start off, she passes around a sheet where you can sign up into groups.  This is TERRIFIC because you can sign up to be in a group with your friends; you’re not stuck with the people who are nearest to you in the alphabet.  Our class, a big one, was split into 4 groups.  The significance of these groups are that these are the people you’ll go to lab and tutorial with every week–you meet at the same scheduled time and you have discussions and diagnoses together.  Once you are into the big groups, she’ll have you split up into groups of 3 for lab days.  Again, PICK PEOPLE YOU LIKE because you’ll be in lab with them and will be trying to diagnose them.  These groups stay the same for the duration of the lab so choose wisely.  So the way ICM lab works is that each week, you meet between 2 and 3 times for labs and tutorials.  Tutorials are days where Dr. B will pick a subject and will lecture you on the subject, then give you mock patients that you’ll try to diagnose as a class.  It’s very fun, lots of group work; very free-form, people just shout out answers and you’ll be surprised with some of the things that people come up with.  You work on history-taking, what questions you’d ask, differential diagnoses, AND the best part is that she helps you learn the last couple steps: what labs/tests you’d order and what treatments you’d begin.  Loved it.  Goes along pretty well with the schedule of the lectures but she adds in some subjects that aren’t discussed in lecture that are helpful–like Peds.  (LOVE the way Dr. B says baby–”baybeh”) Lab days, Dr. B will email you a diagnosis and you have to make up a mock patient with that diagnosis, figure out what their test results would be, what their symptoms would be, then you break off into your groups of 3 where one person is the patient, one is the attending and one is the doctor.  It’s fun, unless you get a jerk in your group who makes up weird symptoms or tries to confuse you.  (Like I said, choose your groups carefully.)  Dr. B makes rounds to all of the groups, so don’t be nervous when she comes in–she’ll help you and give you constructive criticism.

How the grading works for this class is that there are the quizzes and worksheets for the lecture, then block exams as well.  There really aren’t graded assignments for lab, except for the clinical skills assessment at the end of the 3 blocks.  It’s similar to the PD exam, where you have to go in and correctly examine a patient, but this time, you don’t choose your patient and there is already a scenario given to you…like…your patient is a 54-year-old man with chest pain, then they’ll give you his vital signs, and you’re expected to go into the room, examine the proper body systems, gather a good history, and present your patient to the faculty member, in addition to mentioning what tests you’d order and what your plan of care would be.  It counts for something like 30% of your grade, so there’s definitely a lot of pressure to perform.  Make sure you consistently practice the skills you learned in PD like how to do a chest exam or an abdominal exam, because you’ll lose points if you forget that stuff, and all those steps are very easy to forget.  Oh–the shelf exam is fine, little tricky but very do-able between what you learned in ICM lecture and in PD lecture.

Pathology.  Ugh.  It’s a direct continuation of Med 4 pathology, except that you have path for 3 hours daily.  It SUCKS.  You get less of Dr. Y this semester and more of Dr. Sr and since I have a deeply-seeded hatred for him, that sucked for me, but ::sigh:: he is at least a good teacher–he gives you all the information you’ll need to know for the shelf.  The exams are still tricky and very detailed, BUT it’s all useful information that is helpful on the shelf…just not in that much detail.  The dreaded microscope test that they made you leave the Med 1 classroom for a week for, back when you were in Med 1, is a joke.  It’s basically a histo lab session, then the “exam” is really just another histo lab test except it’s for bonus points.  Don’t sweat it.  Our slides suck and it’s hard to see anything.  Most high-yield stuff for the class?  Pay attention to the leukemias and lymphomas…that stuff never goes away, GI ISN’T very high yield (suppose that’s why it’s given to Dr. Y), cardio and respiratory come up quite a bit, um liver I thought was mostly review from Med 2–I thought Dr. Sa did a great job with that, they like to trick you with gallbladder stuff so you have to learn the basic differences in terminology.  Really, just don’t forget to review the stuff from Path 1 before the shelf–bone cancers, tumor markers all that annoying nit-picky stuff that you find yourself just memorizing.  The worst thing about this class is the time.  3 hours of path is torture, even with Dr. Sa teaching, especially now that he got rid of his jokes.  Just be careful with your absences; there were a lot of people who got really close to the limit.  Oh, and Dr. Sr failed 3 people.  People cheat on the shelf–that’s why our average is so high.  It’s not due to any particularly remarkable teaching, like Dr. Sr thinks.  Don’t cheat or you’ll regret it when it comes down to the comp, you have to know this stuff.

Kaplan.  Sucks.  Basically you’re made to sit there and watch videos at regular speed that may or may not be on material you’re studying.  One of the professor’s wives sits there and watches you like a hawk.  She won’t let you eat.  Attendance is done by signing a sheet, but she has a paper with everyone’s pictures on it, so she knows if you lie or have someone sign in for you.  If you leave early, she’ll mark you absent.  You are allowed to miss 40 hours; this seems like FOREVER when you are just doing the 2 hours daily during the first 3 blocks, but DON’T give in to temptation and waste all of your absences; save them for the 8-hour days when you really need the break or want the time to study.  Most people get through Kaplan by listening to their headphones and working on path notes, or watching Kaplan at their own [faster] speed.  There are “post-tests” you have to go take in the testing center when a section of Kaplan is finished; they’re either questions our profs have made up or Q-bank questions related to the subject.  Most people will answer one question, then click proceed and walk out of the testing center to have a free afternoon since the grades on the post tests don’t matter but I WOULD NOT recommend this.  Just sit down, give the test an hour and see what you know and what you need to work on; otherwise it’s a wasted opportunity.    The thing that kills people in this class are absences–KEEP TRACK of yours closely.  Every now and then there will be a “short day” planned where you’ll get out 30-45 minutes early.  Rejoice, they’re a godsend.  If you absolutely need a break, I’d recommend taking a Friday off every now and then to get a jump on your weekend.

Comp.  ::sigh:: People cheat on this too.  Yet again, this is why the pass rate is so high.  I, admittedly, slacked off on studying during the last 3 vacant weeks, and passed by the skin of my teeth but even the people I know who studied their butts off barely made it into the 70s or 80s.  A 68 is passing.  It is VERY DIFFICULT.  It’s not stuff you’ve memorized before, but new concepts where you must apply your knowledge.  I understand why most of the class used to fail in semesters previously; if you’ve just memorized along the way or haven’t learned or understood concepts, you will fail.  Practice questions are helpful to get you in the mindset and get your timing accurate–I recommend ExamMaster from the muacampus.org sign-in page, and Kaplan Q bank, though the Q bank questions can be lengthy and difficult…well…I guess a better way to describe them is to say out of left field.

As far as clinical stuff this semester, you don’t have to go to the hospital like in Med 4 but you do have to sign up for 1 Saturday where you go to town from 10:00-1:00 to the OB/GYN office with Dr. E.  People have had varied experiences–some, like me, only got to see an ultrasound, but others got to participate in exams.  Don’t go in expecting much and you won’t be disappointed.  You’re not grilled like you were with the surgery rotations at the hospital, it’s much more low-key, but ATTENDANCE IS TAKEN so don’t skip.  Also, on a personal note, don’t sign up for it on a block weekend.

One last thing.  For those of you already on the island, this probably won’t help much, but you can go ahead and schedule things for when you get home.  BEFORE YOU CAN REGISTER TO TAKE YOUR STEP I WHEN YOU GET BACK HOME, YOU MUST FILL OUT YOUR HEALTH FORMS!  This means getting a physical, as well as submitting titers to prove that you’re immune to Hep B and all the major immunized-against bugs.  You also need 2 TB tests.  This is what’s holding me back from scheduling my Step I right now.  MAKE SURE YOU GET IT DONE.

Well, I know that was long, but I hope this helps you kiddos going into Med 5.

Greetings from the Other side

When I started this blog over 2 years ago while I was still shopping for opportunity in the form of a legitimate Caribbean medical school, I didn’t dare think where I would be in 2 years and what it would feel like.

It feels great.

It’s finally sunk in that basic sciences are over.  Today, the first day of classes for the kids on the island, I am at home still in my pajamas in North Carolina while life on the island goes on without me.  There isn’t a classroom in that big shiny new building that I’m supposed to be in right now; I’m not missing the first few days of class to steal some last precious moments with my family before I miss them for a whole semester.  I’m done.  It’s very liberating.

It sounds cliche, but up until now I really couldn’t convince myself that it was over.  I actually found myself panicking last week because something in my brain was saying “It’s time to go back and you’ve not shopped for ANYTHING!”  I think back to preparing for each of the trips back, how the cynicism grew with each semester and admittedly, there’s a part of me that misses it.

Now down to business.  I have just under 2.5 months to take the USMLE step I.  After allowing myself a week back at home to acclimate and move back in, I’ve cleared out my bedroom/office of everyone else’s stuff that accumulated there while I was gone, unpacked and washed all my clothes and neatly stacked my Kaplan and DIT books on the giant L-shaped desk.  All that’s left to do is dive into those videos I’ve tried so carefully to avoid during Meds 1-5 so that they’ll be new and fresh and exciting.  With Dad retired and at home, I can tell it’s going to be difficult to study; he seems to find all these little chores and errands for me to complete and they seem so much more exciting than watching the animated Kaplan Micro lady or the dry Path guy, but I suppose I’ll have to be rude and draw the line somewhere.

Oh, the other thing I’ve done since I got home is to start trying to eliminate all the bad habits I’ve acquired both on the island and before I got to the island, which were rationalized by not having time or being stressed out because of all of the studying that I had to do.  These include eating horrible, quick & easy-to-prepare foods with little nutritive value; biting my nails; working out sporadically, when it’s convenient; and hoarding clothes that are YEARS old either because I think that I will wear them one day, or because I feel obligated to keep them because they fill a space in my closet that seems like it needs volume.  I’ve also come to the conclusion in going through my clothes, that I hate dark brown and when I wear it I feel like a giant piece of poop, thus I have removed all articles of this color from my wardrobe.  Small admissions of truth=victories.

The other big thing is that I’m back on the horse, trying to lose weight.  I did really, really well during Med 3 and 4, then kind of slacked off during Med 5, but managed to not gain all that weight back that was lost so quickly.  Now that I have access to lean protein and fresh veggies so readily available, between eating Whole30 meals and going to the gym daily for an hour of cardio, I’ve managed to lose about 12 pounds since I got home, bringing my grand total so far to just under 50 lbs.  I’m pleased, but I still have SO FAR TO GO that I am going to keep my head down and keep avoiding those carbs until I can get another 50 under my belt.

*In reviewing my immunization records, I have discovered that I’m a mere 15 lbs away from my weight before I went to NCSSM, so that’ll be the next victory.  Eep.

The Day Before the Comp Shelf

Oops, didn’t mean to take almost a month’s break.  I can’t say school things have gotten that busy but it does seem mildly stressful trying to wrap up 2 years worth of living here and move back home.

The week off in-between shelf exams was nice, though in retrospect, I think I would have liked to have another week of lectures and shift everything else back a week.  There was still so much neuro material on ICM that we didn’t get to cover in class, and then the 2-hour session with the new neuro prof was NOT helpful at all!  I thought back then that there wasn’t enough time to prepare for the shelf, but I think I felt well-prepared in most of the other disciplines.  Overall, ICM is one of the better taught courses we have here.

The Path shelf was a bust.  As usual, I studied and took it cold–no cheating–but apparently, you can’t say the same for my classmates.  The average for the shelf was higher than Harvard’s average; it was in the 500s.  Despite getting very good grades in path, somehow I was only 20 points above the average score on the shelf.  No that’s not fishy at all.  And the people who made the high scores on the shelf were not people who had done historically well in path.  Whatever.  Can’t cheat on rotations.  It’ll catch up to them.

The shelf exams feel like years ago.  Since they’ve finished, we had full-time Kaplan for a while with odd little breaks here and there where we’d have a day off or a half day.  I made a point to take Friday afternoons off and I highly recommend it.  Though it may be tempting to ditch the 2-hour afternoon Kaplan during the regular part of the semester, save your absences for the end so that you don’t have to sit there daily through 5-1.5 hour sessions every day.  It was interesting watching people try to finagle their way into getting credit for attendance.  They’d come in like 25 or 30 minutes late, then argue with the teacher to try and get credit for being there because they’d racked up something stupid like 38-hours worth of absences (out of the allotted 40).  The last week of Kaplan MANY people disappeared completely; they’d go off and study on their own.  I wouldn’t recommend that either.  They didn’t take any time off during the semester and then took the whole last week off, when we were given many breaks and bonus credits.  Moderation.  Take a break when you feel like you need one, but try to go into full-time Kaplan with at least 30 hours of allowable absences left.

The other aspect of Kaplan that was interesting were the subject-based post-tests.  Throughout the early part of the semester, they were viewed as nuisances; no one was following the video schedule because we had other classes [whose grades depended on our test performance] so no one was ready to finish a whole subject and take a review test on it.  Most people would just go in, answer one question, click proceed and leave to have the afternoon off.  ::sigh:: I can see where people would be frustrated and wouldn’t want to take the tests seriously but then make a bad score and have their ego crushed, but at the same time, it’s a wasted opportunity.  We found out when we went to go take the pharm and neuro tests that the post-tests aren’t made up of just Q-bank questions; they’ve got old review questions from our professors that remind you of things you’ve forgotten or things you need to study again.  Yes, my grades weren’t stellar on these tests because I didn’t keep up with the Kaplan review videos, but I would recommend that you don’t give into temptation and waste all these opportunities.

Most importantly, it’s definitely worth your time to take the practice 8-hour simulation exam seriously.  There were very few people (~10% of the class) who sat down and did all 7 sections, but having that experience to test your endurance was valuable.  In practicing 50-question blocks, you never really get that fatigued, but sitting down to do 350 questions at once is what you’re going to be faced with when you go to take the real Step I and I have to tell you, it’s exhausting.  I am worried about the kids who didn’t do it, how they’re going to do on the comp.

When not working on practice questions, I’ve been running around doing other useful things like taking breaks, going to the beach, participating in the Med 5 yardsales, and getting this stupid paper signed by all kinds of businesses on the island, saying that I don’t owe them any money.  It’s been a…special experience.  The problem most frequently encountered is that when we go to places like the electric company or the water company, when we don’t have an account in our name there (because it’s in our landlord’s name), the employees are reluctant to sign our form.  They want us to stand there and call our landlord in their presence to get the ok to sign the forms.  This is problematic because A) we’re skipping valuable study time to go into town during the day, during business hours to come see them and B) most of our landlords have other jobs and work during the day, so they’re not reachable by telephone during normal business hours.  If you see no account under our  name, then just sign the form!  No one is going to discipline YOU if we leave the island with an outstanding bill that WASN’T in our name; that’s the landlord’s responsibility and the risk they take by keeping the utilities in their name.  PLUS, if they’d take the time to look at the form, they’d notice that our landlords have to sign the form as well, so one would assume that if you owed the landlord money for rent OR utilities, that the landlord would refuse to sign until you’d paid up.  Broken systems frustrate me.

Hmm, less volatile topic.  Since last post, went on Ob/Gyn rotations at the local doctor’s office.  That was interesting and informative.  Unfortunately we only got to see one patient, for a post-partum ultrasound, but I suppose the opportunity of listening to the insight of the physician was helpful.  Also we were given a crash course in ultrasound that was very enlightening.  It did make me want to learn more about it and perhaps go take a class on it, especially since it is used for so many other things other than OB.  Even on the island here, we got to see renal ultrasounds, abdominal ultrasounds, breast ultrasounds.  The only thing I would have liked to do differently would have been to shadow the physician for more time.  I think an ideal use of the time would have been to have just 2 students (instead of 7) shadow the physician for a whole day, for one WEEKday during the semester.  Then you would be guaranteed to see patients in the office and may even get to go see patients in the hospital.  You’d have to do it during full-time Kaplan, though, because I don’t think it would be wise to miss ICM and Path, which presents the problem of class size.  With a class of 80 kids, you’d need 2 months and we just don’t have that much time.  Hmm.

Well, off to go study.

The In-between Week

Greetings from the Med-5 Igloo.  We had the ICM shelf last Wednesday and we have the Path shelf this Wednesday, so we’ve all been stuck in our own little bubble while the rest of the school is somewhere in the midst of block 4.  Let’s see.  Last week was fine.  Full-time Kaplan videos suck, but then having the Tuesdays before shelf off are great.  The ICM shelf felt really long–all of the questions were vignette-style (which means mandatory reading of the whole stem) so I felt really fatigued by the time I’d finished my first pass of the test before I went back to address my flagged questions.  Most of it was familiar, but there were a few “huh” questions where I really had no idea what the test-makers were going for, either regarding pictures or clues I’d never seen/heard before relating to familiar diseases.  This shelf, in particular, really tested your memory of previous subjects.  There were some anatomy questions that required thinking back to Med 1, some biochem from Med 2, a representation from all of the subjects from Med 3, and then a fair amount of pathology and pharm from Med 4.  I guess that’s what the comprehensive exam will feel like.

The rest of the week was pretty uneventful.  Everyone looked exhausted by Friday and there were many empty seats.  Was swimming Friday afternoon at Oualie and saw something raise its head out of the water, somewhere between where I was out in the deeper water and where some kids were playing in the shallows.  The kids swear it was a sea snake, however I would lean more towards a turtle.  Either way, I’ll probably be taking a break from the waves at least until I can finish up with these shelf exams.  I like playing in the waves at Windward beach better than the eerily still water at Oualie, however the drive is a big deterrent from getting down to Windward (Dad swears he’s never going back after the flat tire we ended up with last trip).

Saturday morning was the health fair at the IGA.  We did blood pressure and blood glucose screenings.  Great experience and many opportunities to teach others–teaching was unexpected and enjoyable.  Saturday night was a dinner party with homemade lasagna; as we have no Italian restaurants here on Nevis (aside from Pizza places), that was a real treat.

Now everyone’s in scramble mode trying to cram in every last fact that they can, related to path.  Later this week we have a visit from our clinical dean and Friday we have the Med 5 yard sale.  Doesn’t sound like I’ll have much time to watch March Madness games, but I’m still cheering for the Heels in spirit!

Some time later…

Oh I know, bad Jenn, bad blogger.  I went and got busy.  You know how it goes.

So, let’s see.  Finished block 3, didn’t last very long.  Was unique in that the block exams were split up; we had ICM on Friday instead of Monday with path–it went great, made my highest score yet.  Then Path on Monday was awful.  It was block 3 material plus cumulative material from blocks 1 and 2.  Naturally, instead of being a nice fair final exam, there were detailed block-level difficulty questions from all of the material.  Ugh.  I’m pretty sure it sealed my fate into non-A grade territory, but whatever.  I did the best that I could with the time frame, and given that some of the questions would have been unanswerable no matter how much I would have studied, I’m glad I didn’t sacrifice my ICM grade to get a couple of points higher in path and still be at the same place with my letter grade in that class.

After the Path exam last Monday, we dove straight into our semi-full days of Kaplan videos on Tuesday.  We went from 8:00-9:30, 9:40-11:00, 11:10-12:30, had a 12:30-3:00 break for ICM lab, then had one last session from 3:10-4:30.  When you didn’t have ICM lab, the lunch break was fabulous; usually used it to go to town or run home.  When you did have lab that day, the day just seemed like it wasn’t going to end.  You play the hurry up and wait game.  You have to rush to get to school by 8:00, then sit there bored off your ___ through the first 4 hours of Kaplan, rush down to lab, then fight to convince yourself that you MUST stay at school for the next 3 hours after lab is done, that skipping the last Kaplan session, no matter how tired you are and how useless you know it will be, will waste your precious allowed absences.

This upcoming week is when it gets interesting.  Now that ICM lab is over, we’ll have Kaplan literally all day.  That said, we did only go a half-day last Friday, and we get the Tuesdays before our shelf exams completely off from Kaplan, so I suppose it’s not as horrible as most of us have it built up in our minds to be.  It’s just that we’re all stuck in this classroom together.  It’s freezing cold.  Not particularly comfortable.  We can’t eat.  And no one watches the videos.  They play at regular speed and we’re all so ADHD at this point that we all end up watching them on our own at 1.5-2x normal speed as we take notes.  Then too, we have no control over what content is viewed.  For example, we have our ICM shelf coming up this week on Wednesday, yet we spent the entirety of last week watching Microbiology videos.  Not helpful.  The week after, we’ll have our Path shelf on Wednesday, yet instead we’ll be watching pharmacology videos.  My solution is to put in my headphones and listen to Golijan while reading Rapid Review Pathology.  I’m still feeling guilty over my block 3 grade and would love to kill the shelf.  ICM, there are no review books for the shelf–just the powerpoints from the professors, so I’ll probably start reviewing those tonight through Tuesday.

Speaking of ICM, we had our clinical skills assessment (CSA) exams yesterday.  The way that works is that we are randomly assigned mock patients and we have 20 minutes to go in, gather a history, do a focused physical exam and then present the patient’s case to an “attending” (i.e. one of our current/past professors).  I was incredibly nervous about it, as I was for the Physical Diagnosis exams last semester.  Don’t have grades yet, but didn’t do as well as I would have liked, based on how the exit interview went.  Was fully prepared for a case involving the completion of either a chest or an abdominal exam, yet ended up with a guy with gonorrhea and risky behavior.  Was so thrown by his chief complaint of a white discharge that I more or less skipped straight to the GU exam after I took his history and neglected the abdominal exam.   In my defense, his vitals were normal, he had no joint pain or associated symptoms, and was really embarrassed to be there and reluctant to answer my questions.  I apparently did well on the history-taking, presentation and nailed all the differential diagnoses and treatments, but yeah, probably lost a good chunk of points on the physical exam.  Oh well.  Now I know.  Afterwards, I found out that many people in the class already knew what the diagnoses would be–that’s right, they cheated–and so really all they had to focus on was their technique.  Sucks.  I hate cheaters.  These are the people who lose us our clinical spots because they constantly show up late and then don’t know how to do their job because they spent their time cramming and cheating their way through PD and ICM.  ::sigh::  Feel bad for our ICM lab prof–she tried so hard to make the exam cheat-proof.  We had to give up our cell phones when we entered the building, we were sequestered into a classroom with no internet (though the LAN was still up), she changed the diagnoses between the morning group and the afternoon group, and we were forced to leave the building when finished.  Yet they still found a way to cheat.  Bummer.  Just have to let karma take care of them.

I’m taking a mental health day today.  Going to Windward beach with Dad (who is vacationing on the island and enjoying his retirement) and friends to fly kites and play in the waves.  Hope it is fun.  Need to do something to get CSA out of my head and be able to move on and focus on ICM shelf.  According to our ICM lecture prof, the people who traditionally do well on the comp and Step I are the people who do well on the ICM shelf.  Now if that’s not an incentive to study, I don’t know what is.

Post Block 2

My goodness–meant to get back to writing before now.  Much has happened since last post:

Birthday–Was honestly dreading it because it happened the week before block.  Thought everyone would forget, or even if they remembered, wouldn’t want to do anything because they needed to be at home studying for blocks.  Also was right in the middle of a school inspection.  Was pleasantly surprised.  Got sang to 3 times throughout the day, had 2 cakes and got to spend dinner with my favorite people on the island.  A very happy way to celebrate existing a quarter-century.

Block 2 exams–Ugh.  Why does my class have to cheat?  The path exam was the fairest exam we’ve ever had from that group of professors–all of the questions were do-able, though there were a couple trick ones, but nothing like the crap they usually try to pull.  I came out of the exam feeling great and optimistic, though apparently so did everyone else.  The average after the quiz points were added in was an 85.  The ICM test went well too–nothing too difficult and actually felt really triumphant at finally understanding acid/base.  Average ended up being an 88.  Are you kidding me?!  I think the class memorized quiz questions (which were then recycled by the ICM prof.)–the majority of these people can’t answer basic questions in lab.  Either they’re geniuses who just decide to keep their mouth shut during ICM lecture and never answer and single question, AND do the same thing in lab, or they cheated.  Hmm…I wonder which is the more likely scenario.  The shelf will tell.

Valentine’s Day–Yet again, another holiday I thought I would be disappointed.  It’s not really fun being single on Valentine’s Day, much less spending it on the island the day after block exams when everyone’s tired and/or hungover.  Ended up taking my first afternoon off from Kaplan to go to a new beach with friends and play in some incredible waves there.  Also there was a restaurant at this beach which had a pool–first time in a pool on Nevis.  Very cool.  Followed up the afternoon on the beach with dinner at Indian Summer which was festively decorated with balloons and candles and mood-lighting.  Had magenta-colored, heart-shaped rice crispie treats for dessert.  Yum.

Another bake sale.  Joy.  No I didn’t learn my lesson from last time.  This one ended up being a cluster because the bakery that supplies the yummy addictive bear claws wasn’t taking orders for the week, so we got the bulk of our baked goods from the Jamaican bakery in town.  Not so good.  Ended up having to give stuff away.  Won’t do that again.  Also, when they were supposed to arrive at the school to deliver the goods, we got a call that they were cancelling–something about wires getting crossed, 2 large orders for the day, and they told us they weren’t coming.  We were steamed, but then right after we got out of ICM and were setting up for the delivery from Indian Summer, and here comes the bakery delivery person with our full order.  They show up, we tell them what had happened over the phone and they’re just as confused as we were.  Weird.  Samosas came and went quickly, always think we should get more of those, but pres doesn’t, so we stick with our usual order of 40.  Finally, ended up getting a late order from Nevis bakery of bear claws, raspberry danishes, and donuts though it was after we’d already lost the Med 1′s for the day and when other people weren’t exactly in the mood for pastries.  I think we ended up selling all the bear claws but had to give away a couple of the raspberry danishes.  Pres didn’t want to go to town to get plates and napkins, so we ran out.  It was awkward.  Pres.  didn’t want to go to the bank to get change, so we ran out.  It was awkward.  ::sigh::  Ended up getting my third absence in path because I sat down there for 5 hours manning the table, though happily a good chunk of that was with some new friends who were taking a break from home school.  And, all-in-all, pres tells me the bake sale went really well and we ended up making over $1000 EC.

Game night–Was invited over along with a group of friends for game night at our new friends’ house.  Ended up making giant pitcher of margaritas, and host cooked homemade Mac and Cheese, fried chicken, cabbage salad, fresh sliced veggies, seasoned carrots, and we had homemade ice cream for dessert.  Played a new game involving nouns and being very creative with them that everyone loved so much, we played twice.  Arguably one of the best nights I’ve ever spent on the island.  Had a WONDERFUL time.

First Kaplan post-test–Ok, this didn’t go so well.  I’ve been ignoring the Kaplan videos in the afternoons in order to work on my path and ICM notes for many reasons–1–I’m not at a point where I want to review that stuff yet, 2–videos are shown at regular speed which is waaaay too slow, and 3–they vaguely try and keep up with what we’re doing in path and ICM, but when the three classes are out of sync, it’s too much to handle being on 3 different organ systems.  Needless to say, I’m not the only one who had been skipping the Kaplan physio videos–most of the class does something else during this time, or at least watches the videos on their own but at higher speeds.  So the plan by most of those people was to go through the post-test choosing only one letter for all the answers–like C all the way through.  Apparently all of the questions (50) were from Kaplan Q-bank questions which we would see again anyway, also, the post-tests don’t count for a grade–it’s just to monitor your progress.  Well I felt guilty picking C the whole way, but at the same time, have no clue what’s going on in physio.  My conscience won–I sat there and attempted the test, at least making educated guesses on the questions–silently triumphing every time I knew the answer to a question and it was a non-C answer.  The result?  While I did better than I would have just choosing C the whole way through, I REALLY need to study physio.  At least I got to find that out in a way that doesn’t skew my stats on my personal learning page on Kaplan.  Did it shock me into paying attention to the Kaplan videos in the afternoons now?  No.  Not even close.  Can’t do it.  Can’t sit through 3 solid hours of path, only getting 15 minutes for break, then have the brain power left for anything else.  Schedule is just not conducive to it.  ::sigh::

Windward Beach–After the fun had by all at the beach on Valentine’s Day with new friends, as well as on game night, the same group of people was scheduled to meet up at the school and go to a new beach with guaranteed waves, yesterday.  The boys ended up flaking and deciding that they should study instead, but the remaining 5 of us went to a beach in the middle of nowhere out in Gingerland.  AND got to see the Nevis Horse track on the way down.  It was about how you’d imagine a horse track would be on Nevis–dilapidated and lacklustery, but it was still my first horse track and here I was thinking I’d never see the one on Nevis.  Pshaw.  The beach, once we got there, was oodles of fun.  The water was clear, the beach was wide, the waves didn’t disappoint.  We played in the ocean for close to 2 hours, then after having a snack, flew a kite, practiced cart-wheels and soaked up the afternoon sun.  Can’t wait to go back.

Emotions

All people deal with stress differently.  I get that.

But my goodness.  It’s not even comp time yet, we’re still only half-way done with path and ICM but everyone is terrified to the point of rudeness.  My classmates have done so well during our 4+ semesters together, but now it seems like everyone has suddenly slipped into this panic state where they completely forget their manners and become selfish little egotists.  Why?  You’ve all proven that you paid enough attention to get through the first four Med semesters–there isn’t going to be anything that odd-ball on the exams coming up that you haven’t seen before–calm down.

Hopefully I’ll be able to look back on this experience in a few months and laugh but right now, it’s disturbing.

There’s this big push during the 5 semesters here to bank money for your class.  Every semester the school gives you money, and you can take that money and hold fundraisers: bake sales, raffles, etc.  The ultimate goal is to raise enough money so that after the white coat ceremony in Med 5, your class can have a nice reception at one of the hotels or at the botanical gardens.  Unfortunately, this usually costs about $20,000 ECD or $7,500 USD.  If you make a concerted effort throughout your time here, then it’s not that bad.  Alas, our class doesn’t like effort.  Effort usually requires work, dedication, and some degree of self-sacrifice.  Currently we have less than $10,000 ECD in our account, so we have less than half of the money we’d need for a proper reception.  Instead of being motivated and putting in a solid group effort to improve the situation for everyone, no one wants to help.  We had a bake sale scheduled for yesterday.  No one volunteered to bake anything.  No one volunteered to go to town to pick up the baked goods.  And worst of all, no one would sit downstairs (even for an hour) to help sell baked goods.  This was after an email went out the night before telling them that we had no help, whatsoever.  I had perfect attendance up until yesterday and didn’t want to miss class, but no one was going to do it and our orders at the bakery and Indian restaurant (Samosas) were already placed.  You can’t be flaky with the locals who already have a lowered opinion of the students and ruin the opportunity to have bake sales for the whole school and classes to come.  So the class president and I skipped ICM to ride to town to collect the baked goods and get change from the bank.  Then when we got back, the tables that we had reserved to place in the main hall were being taken away.  We had to chase down the maintenance department and ask them to please leave us just one table because we were standing there with boxes of pastries in our hands and had to put them somewhere.  We decided on prices and caught our class during its first break.  Sure, some people came down and bought pastries, but then they ran back upstairs.  I ended up standing there by myself, after the president snuck back upstairs to sit through pathology.  You’ve got hundreds of ECD worth of money sitting on a table (because no one thought to bring an envelope) and you can’t even go to the bathroom because there’s no one to cover.  I was so angry I could spit fire.  Then, to make matters worse, when our class came down on the next break and I had sold all but a box of the pastries, they have the audacity to come up to the table and say “Aww, you’re here all by yourself” and then WALK AWAY!  Flabbergasted.

Quit being selfish!  Think about someone other than yourself.  I am trying to make sure you have a nice graduation.  Sure, I’m probably going to go somewhere else with my friends and family after the ceremony, but I know there will be lots of people who don’t have family members come down and would like a proper celebration.  Ugh.

Post Block 1

I think I owe you all an update on how things have been going.  We flew through the last week of block 1–I say “flew” sarcastically as there doesn’t seem to be anything swift about Med 5, aside from our breaks and the rate at which our free time disappears.  My classmates and I debated about skipping the Friday before block weekend because, as we found out last semester, the reviews aren’t particularly helpful, however, unlike my classmates, I wussed out and went to all classes on Friday.  BTW, aside from ICM, the reviews were useless.  On block weekend proper, I found myself back in the anatomy lab, studying, as usual because my neighbors decided to have a hootenanny at the loudest volume possible.

It’s interesting having both blocks on Monday.  Med 1 they were split on Monday and Tuesday, Med 2 we had 3 on Monday, Med 3 they were split on Monday and Tuesday and were off by a week, and Med 4 PD had separate from Pharm and Path which were together on Tuesdays.

Go figure, yet another semester path sucked and made me very angry, just like last semester.  No matter how much you study and how many details you memorize, there will always be questions on the test that you can’t get.  They even admitted to putting questions on there from last semester.  It was crap.  They reviewed 10+ questions that less than half the class got right, yet comped us 0 points because clearly we’re the stupid ones who weren’t reading their minds.  I’m still so angry at the head prof and some of the b-s questions that I can’t go review my exam for fear that I’ll say something that’ll get me in trouble.  Ignorance is bliss.  Since then, I’ve been going to class with my head down and listening to headphones the entire time and working on notes without a care in the world what’s going on in lecture.  Apparently many people have started doing this and it bothers the prof quite a lot.  He yelled at a fellow classmate ruthlessly the other day (so I’m told–I wasn’t listening to him) for walking in late and having his headphones in.  Ouch.  Somebody has issues with attention.

ICM was pretty awesome.  It’s another class people are ignoring and treating like PD, but it’s that saving grace class that we were all waiting for that connects the book knowledge we learn in Meds 1-4 with the exam techniques of PD and answers that nagging question of “what would a doctor do?”  It’s powerful and fascinating learning how to put everything together and diagnose and treat patients.  Exam was tough but you know every single question is high yield and a likely situation that you will encounter.  Easily my favorite class this semester.  Look forward to the lab as well as it’s like jeopardy, but not restricted to any particular subject.  We are given detailed patient presentations and vignettes and  quizzed on drugs, exam techniques, lab values, symptoms–it’s like trivia night.

Outside of class, don’t have time for much.  Signed up for a 5k here on Nevis and have been running nightly in the gym to prepare.  Have gotten my 5k time down to 28:41, so I’m pretty satisfied, though will probably end up chatting with friends and walking most of the way.  Have also taken up baking this semester with a friend.  It’s challenging with the limited, cheap kitchen resources we have between us here on the island, but usually ends up being lots of fun and we don’t seem to have a problem finding people to test our products.   Also a great way to relieve path frustration.  Haha.

Half-way through my last block 1

School is going fine.  I’m trying to be more patient with ICM and Path lecture; this is directly proportional to the amount of sleep I get, so there are days I go straight home, take a nap and then go back for the gym if it’s not too late.  Gym every day is working out fine.  Muaha–pun intended.  Sore but don’t feel so guilty when I eat dessert–fat-free yogurt, handful of unsalted, roasted peanuts, and drizzle of honey.  Still working on drinking 2 liters of water daily; end up playing catch-up some days.  ICM lab is shaping up to be my favorite class–prof is hilarious, interesting, and not wooed by the stupid b-s of my least favorite classmate, who missed the first week of class and was trying to argue a point in Friday’s tutorial that he had NO CLUE about.  Moron.

I’m a whole organ system ahead of the prof in path.  I’m a whole organ system behind the prof in ICM.  Eek.  I know.  Bad Jenn.  But that’s what Sundays are for, in addition to cooking, dishes, laundry and tidying.  ::sigh:: Back to work.