Tomorrow morning I fly out to Miami and then to St. Kitts.  On the one hand, I’ll miss the modern conveniences of home as well as the people, but on the other hand, I’m ready to get back to my friends and the island to finish up basic sciences.

Happy New Year, everyone.  2011 has been an interesting year but I’m ready for 2012.

Vacation–week 3

December 28, 2011

It’s interesting how your perception of time changes; after I admit this, my vacation is probably going to fly by, but I’ll go ahead and say it: it feels like YEARS since I’ve left the island!  I usually end up running out of time and not being able to get everything done but I suppose this trip home has just been really efficient.  Maybe it’s the extra 4 or 5 days that helps?  I dunno.

So since last I checked in, my newest niece has been born–on 12/21–and she’s healthy and gorgeous.  I had Christmas with most of my relatives which was really fun and I was completely surprised by the generosity!  I came home with the mindset that this upcoming semester will be my last on the island and I need to focus on bringing things back home (to the states) with me.  In other words, the more stuff I bring down to the island, the more I’m going to have to bring back and I’m sure I’ll be strapped for luggage space as it is.  I must say, its made things easier; I went shopping at my usual haunts today and couldn’t find ANYTHING to buy–that’s a first.  Finally after 4 semesters on the island, you realize that just spending 3 months there at a time, if there’s something you don’t have, then either you can live without it until you get home or you can find a version of it on the island that will do.  I thought it was going to take the most work having food that I could eat, but now, especially with the opening of the new IGA supermarket, that’s not been much of an issue at all.  You can have almost anything you want on the island if you’re willing to pay.  The hardest part is clothes.  In Med 1-3, it’s not that bad; you show up in whatever you want most days with the exception of lab days when you wear scrubs or presentation days (1-2 per semester, tops) when you have to dress up.  Med 4 involves dressing up 1-2 times per week; in the US that doesn’t sound that bad at all, but there are ZERO dressy clothing stores on the island, which means that if you didn’t plan ahead and bring down enough dressy clothes for the semester, you’re screwed.  There were some people, bless their hearts, who only had 1 or 2 dressy outfits and had to keep recycling them and washing them over and over again.  Then, too, there’s peer pressure especially among the girls to look the best and you don’t know what the other girls are going to be wearing until you’re already down here and it’s too late.  My advice is to get some essentials like black dress pants, black pencil skirts, a-line dresses (and obviously, matching shoes) that you can wear and then switch up your tops and cardigans each semester.  (Boys–KHAKIS and button-down shirts with dress socks and dress shoes)  Unfortunately, because there are no dry cleaners on the island and most of the students do not have access to dryers, you have to get forgiving fabrics that can be washed and line-dried.  It goes without saying, also, not to bring down something really nice either, because it will be worn out and close to destroyed by the time you’re ready to go home.

So most of what I’ve packed so far has been consumables–things I’ve gotten from Sams that will be tasty and get me through my last semester.  Specifically, candy is of low quality on the island and is very expensive, so I’ve brought my own this time.  Also nuts are VERY expensive–like $10 USD/lb–on the island, so I’ve brought them as well.  Oddly enough, French-Fried Onions are ungodly expensive–$20 ECD or almost $8 USD/can–and though they’re random, I know, I brought down a huge bag that was less than $4 USD at Sams.  (Don’t scoff, they’re good on EVERYTHING and make great, crunchy, lowER carb salad toppers).  This will be my third semester where I drink the majority of my meals in the form of Slimfast, so that has to be brought down as well.

Haven’t bought any books for the semester because Kaplan books are included in the tuition and they’re given out during Med 4, so they’re already at my apartment.  That frees up a lot of luggage room.  Also have enough school supplies at this point to get me through the last semester.  Paper can be surprisingly heavy.  While there are certainly household items that could make my apartment more comfortable, it’s not worth it to bring them down for 3 months and then worry about what will happen to them.

So, other than packing and crossing things off my list, I’ve been visiting friends and having the foods I miss.  Cooking is fun, too.  Oh  and did I mention I have missed my pets?  It’s so much fun having companions again, I’ve missed them.

Catching Up

December 19, 2011

Still at home, blissfully enjoying vacation.

Last week, though filled with more activities than normal during a break, ended up going really well and being quite productive.  CPR class is done.  Shadowing was accomplished.  Got some reading done.  Have been going to the gym a surprising amount, almost daily.  Almost.  I’ve given myself the requirement of 5 miles per day (which is more than even on the island–no 2 days off/weekly) but I think that’s reasonable considering I have no obligations here and ready access to a car.  Still, I’ve fallen behind ~10 miles.  The hours at the gym are rather limited on the weekends, though I cope by making the most of my trips during the week and biking extra miles to make up for my absences.  I managed to go today during the 4 short hours the gym was open…and biked/treadmilled 10 miles!  My left hip is a bit sore, but that’s not bad considering all the weight its had to bear for all these years.

Due to…ahem…the unusual sleeping schedule of my family members, my sleeping schedule has also been thrown off.  I  find myself stricken with bouts of insomnia (after mornings of sleeping-in once my folks have gone to work), though it’s an enjoyable problem.  Tonight I baked cookies.  I’ve got 2 or 3 books I’m reading, so that’s a good solution too.  Oh, and did I mention I’m hooked on playing Yahtzee on Pogo?

Meanwhile during my days at home I’ve been taking time to notice, enjoy and appreciate modern conveniences and things I miss while in Nevis–indoor washing machine, dryer, room to spread out, a dresser, drive-thru’s, fountain drinks, ice, cars in great condition, being able to understand the people around me the first time they say something without straining my ears and asking them to repeat, cheap groceries, nice grocery stores, an electric oven/range, a full-sized microwave, cold weather, stable internet, water I don’t feel obligated to filter, choices where I shop, a town that doesn’t smell like sewage, unlimited access to internet sites because they’re authorized in my country, cheap gas, using my card at the pump, local ATMs, diversity in food & drink choices, MEXICAN FOOD, flannel sheets, sales at the places I shop for reasons other than the food is about to/has already expire(d), EMILY (my 13-year old, blind Siamese cat), internet that isn’t on a timer, central heat/air, carpet, having a designated place to take my garbage, having almost all of the people I love within driving distance, long hot showers, not waking up with insects crawling on me, decorating, down pillows, having a legitimate cause for using chapstick, a fully stocked recipe box, cushy toilet paper, life without ant traps, a full-size kitchen, parking in a garage, driving on the side of the road that I learned to drive on, going to a real gym that smells nice with fresh towels and nice attendants who have gone to school to be personal trainers, family photos to walk by and enjoy, leaving/receiving notes for my parents in the morning, the ability to go to a store and pick up an outfit if I feel like I need something to wear, a bathroom counter where I can spread out my toiletries, getting out of the shower and not sweating, bookstores.  Go ahead, think me frivolous, but it’s surprising what living on a “developing” island for a year and a half will make you stop and appreciate when you’re back home.

Life at Home

December 14, 2011

Really enjoying the break from school and the odd emptyness that comes from going from no free time to loads of free time.  Spent the weekend baking holiday goodies my with Mom and pleasure reading things that aren’t remotely medical or scientific like Nancy Drew and other novels.  Monday  I had the house to myself while my folks were off at work–I left the house to go to the gym but otherwise spent the day cooking and reading, two things I really miss when I’m away.

Tuesday was busy.  Suddenly obligations are creeping up.  I’d noticed that the Med 5’s had given up a couple of weekends for CPR classes last semester, so I had the bright idea of trying to take a renewal BLS class while I was at home.  There just so happened to be one last 8-hour class in 2011 on 12/13 and 12/15 from 6:00-10:00 in the evening.  Excellent.  I signed up at the last minute, got my book the day before the class and then realized that those were the only two days where I had commitments.  Great.  When it rains, it pours.

Yesterday, I had a dentist’s appointment at 2:40 in Marion, 45 minutes away.  This means that I have to start at 12:00, showering, getting ready.  Brushing my teeth.  Flossing.  Brushing my teeth again.  Rinsing with Listerine.  Brushing my teeth again.  Flossing again.  The same kind of neurotic things everyone does when they know their mouth is about to be scrutinized.  Then I have to leave by 1:30 to make sure I’ll get there in time, since much of the trip involves interstate travel and there could easily be a wreck and traffic.  Barring unforeseen cavities, I get out of there by 4:00 then am home by 4:45.  That leaves 45 minutes for dinner before time to leave for class.  Busy from 12:00-10:00?  No way.

Thursday I have a hair appointment, in town at 11:30.   Also Thursday I am supposed to go shadow one of the local doctors in the afternoon immediately after the hair appointment, right up until the time BLS class starts again.   So not only am I busy from 11:30-10:00, but I also have to find a professional outfit to wear to the doctor’s office.  This feels a little bit like work.

Thankfully I have Wednesday (today) in between with only a trip to the Jeweler’s and some other small errands in town on my to-do list.  I get to go back to the gym, but now I have 7 miles to make up for my absences on Saturday and yesterday in addition to the 5 I’m supposed to cover each day, which means I’ll have to cover 7 miles each day for the next 4 days to get out of the hole.  Hate being OCD but it’s getting me the results I’ve always wanted.

The gym at home is weird compared to the tiny gym at MUA.  On the one hand, I don’t have to worry about walking inside and it smelling like mould and dirty butt, but on the other hand, there are machines with touch screens and loads of other people, almost all older than me, many in much better shape.  It’s a real, proper gym.  I almost feel like I don’t belong.  There are attendants, lockers, towels, showers.  The machines feel weird.  I’m used to an elliptical with an upward tilt to the pedals, yet this one tilts down and adds pressure to my quads.  I have a choice in bikes–not just the one where you sit, stretch out your legs perpendicular to your torso and ride with your hands gripped parallel to your thighs on the heart-rate monitors.  Actually, I quite enjoy the upright bikes now that I’ve discovered the “Calorie burn” mode is NOT the same thing as the “Fat Burn” mode I’m used to on the island.  The one similarity is the treadmill.  Different models from different companies but in either case, 3.5 mph with a 5% gradient is enough of a challenge to put my heart rate into fat-burning category, yet keep me from turning into a panting, gasping fool who shakes the floor with each footfall.

The rest of the semester

December 8, 2011

Well I know the last post seemed a bit dismal, but things have been looking up since then.

Monday was the pharm shelf.  Lots easier than the internal final.  The average ended up being a 540, so that means that most of the class had copies of the shelf cheated.  That wasn’t obvious at all since there were people out of the shelf in a little over an hour.  I didn’t cheat and I’m glad–it’s always nice to have an honest appraisal of how much you learned over the semester.

Tuesday was a day off to study and pack.  I spent a good part of the day at school reviewing the first couple of blocks of material for path.  Finished cleaning the apartment and packing up all 3 suitcases.  Took most of my notes from Med 1-3 home, along with jeans and workout gear to wear in the cold weather at home.  Had a nice dinner out at Tea House with friends and made it to bed by 2:00.

Wednesday (yesterday) was hectic.  There’s the whole adventure of flying back home to the states, but in addition, starting out the day with a cumulative final exam for pathology.  Woke up at 7, still feeling guilty that I hadn’t studied enough so was trying to juggle studying and packing carry-on.  Had to run and pick up friends and luggage since there wasn’t going to be much time between the end of the exam and 1:00 when we were supposed to take a boat over to St. Kitts.  Got to school and everyone was ready for it to be over–think we’re all  a bit burned out.  We’d received an email from the head prof, who was already back in India, that the exam was do-able, to study the reviews.  Hah.  Those who studied the reviews did not do well–just like the internal pharm final, there were block-level questions of detail.  I did significantly better than on the pharm final, but only because I didn’t trust the profs and prepared for what I knew the exam would be.  No surprises this time.  After a 7 pt. curve, the average was a 77 so it sounded like everyone else prepared well, overall.  They failed 5 in path and 4 in pharm.  After the exam was over, we collected luggage and rode to Oualie beach.  We boated over to Reggae Beach on St. Kitts on the Black Fin, a fishing boat.  After an interesting taxi ride, we got to the airport and waited around for our flight.  Shockingly, it was on time.  After arriving in Miami, we raced through Customs in record time and went to Wendy’s with enough time for everyone to make their connecting flights.  After grabbing Starbucks to go, I walked each of my friends to their gates and waited with them until they flew out.  My flight finally left at 10:15, also on time, and I landed in Charlotte just after midnight.  It was good to see my folks, but we were all tired.  We got home and everyone was in the bed by 2:00.

Today has been a nice lounge day.  I got to sleep in, then finally cook in a real, full-sized kitchen with full-sized appliances.  It was great trying on old, too-small clothes only to find out that they fit with room to spare!  TV channels have changed since I was home, so I gave up after 20 minutes of squinting at the guide and have just left it on BBC.  Can’t make up my mind what I want to read while home so I’m taking today off.  It’s nice not having obligations.  Even if it’s only temporary.

Pharm flogging

December 5, 2011

Now that PD is over (still waiting for grades) and half of pharm is over, I have a bit of less-emotional, less-rushed time to catch up.

Yesterday, Sunday, was the pharm internal final exam.  Originally, it was explained to us that even though we pay for new shelf exams as part of our tuition every semester, the not-so-new pharmacology (and biochem) shelves that the school has were “compromised,” meaning that somehow, many people have access to the questions and answers on the test.  Great.  To cope with this, the pharm profs write their own cumulative final exam and we take that the day before the scheduled pharmacology shelf.  Now one must wonder, if this shelf is compromised and truly useless, why bother taking it?  Well, apparently there’s this rare chance that we could get a new shelf that people don’t have copies of, but no one really knows for sure.  I know, it’s very suspicious and very confusing.  What’s even odder about this is the grading system.  We were told initially that the sum total of our grades on the internal final and the shelf would be weighted to 25% of our total grade in pharmacology for the semester.  But, the catch is that if we took the old shelf and everyone cheated and did well, that grade would only be worth 5% of our grade while the internal final would be worth 20%, but if we got a new shelf, it would be vice verse.  This begs the question if the unfamiliarity of the shelf is the deciding factor of our grading schematics, then why not make us take the shelf and THEN give us the extra internal final if the grades look wonky?

For whatever reason, that’s not how it happened.  We were made to come in on a Sunday, just like the kids last semester, and take the final cumulative internal exam that both of our pharm professors wrote.  I’m not going to lie, it was horrible.

Most med school final exams have been notoriously easy to me, because they go into much less detail than block exams.  They test that you’ve understood major concepts and have developed the logic to make decisions with unfamiliar material, since in the case of pharm, you can’t very well remember individual details about 5 blocks worth of individual drugs.  I’ll give you an example–Bacteroides fragilis is a special anaerobic type of bacteria that often wreaks havoc after gynecological surgical procedures and can cause women to have terrible peritonitis.  To treat/prevent it, the most commonly prescribed drug is a second-generation cephalosporin called Cefoxitin.  Now those of you who are familiar with cephalosporins know that the naming situation of them is hairy–there are 4 generations of drugs, most of which begin with ceph-/cef-.  So, I remember we had a question on the BLOCK exam about B. fragilis and what you’d prescribe for it and we all had studied our antibiotics well and knew that it was cefoxitin, but that’s a pretty picky detail to remember outside of the block exam.  (All-in-all, I’d say we had to know 15-20 cephalosporins, all with individual details about you prescribe them for this and not that, for the block exam).  An appropriate FINAL EXAM question would be “your patient has peritonitis from a surgical procedure, cultures come back that it’s the gram negative anaerobic bacillus, B. fragilis.  Which of the following classes of antibiotics would be most appropriate to treat this infection?  A) Penicillins B) Fluoroquinolones C) Macrolides D) Sulfas, E) Cephalosporins”  So then as a student you think to yourself, hey yeah, I remember that weird cephalosporin–can’t remember the name and no idea which generation it was, know it wasn’t first or fourth but I’m sure it was a cephalosporin, I’ll put E.

Well that’s just not what the profs did.  They took old block exam questions with that picky degree of detail and made a long, grueling 100-question exam out of them.  I’m told 2 of the questions came from U-world, but that about 10 were verbatim recycled block questions we’d had before. In the case of the cephalosporin question, the 5 answers were all obscure cephalosporin drugs.  I ended up getting the question wrong because I knew it was a cephalosporin, knew it was either 2nd or 3rd generation but couldn’t remember the name.  I remembered there was something special about cefuroxime and it stood out to me, so I chose that answer.  Cefuroxime crosses the BBB.  Wrong.

Needless to say this is a good representation of how most of the test went.  I sat down in the testing center to take the exam and ended up flagging the first 10 questions.  I’m notoriously liberal with my flags and have even been known to flag 1/3 of the test (don’t want to tire myself out on the first pass-through of the test), but I ended up flagging 49/100 questions!  I stopped after I realized I hadn’t answered any of the first 10 with certainty and almost felt like crying.  My worst nightmare had come true–the whole test was recycled block questions.  I hadn’t prepared for this amount of detail when I was studying–I knew major concepts, major side effects, etc.  I felt a sudden rush of panic but then reassured myself that I just needed a low 60 to keep my B in the class.  Surely that was do-able.

At the same time, other people must have realized this.  I took my ear plugs out for a minute and heard panicked sounds inadvertently coming from the rest of the class.  A friend of mine, I later found out, had to take a break and go outside because she’d started crying.  We started the exam at 9:00 and I used all but 30 minutes of my time–this is longest I’ve ever taken on a test here except for the Micro/Immuno shelf–and I was still one of the first people out.  I clicked proceed just hoping to get the score I needed to keep my B and it was 9 points higher than that score–I was so grateful for wiggle room. Many emotions went through my head: I was grateful to have passed, just barely, confused at why the professors would do something like this (was it malice or did they not understand that we still had a pharm shelf to take the next day followed by another prof-written final exam in path on Wednesday?), and angry at how stupid and selfish they had been, screwing with our emotions like that in the middle of finals.

Now don’t get me wrong, I don’t expect finals to be like shooting fish in a barrel, but at the same time, I think we’ve moved on from undergrad where the profs write these killer exams just to prove that they’re superior and you know so little compared to them, where the averages are routinely in the 50s-60s.  That ship has sailed, we’re here to learn the facts and apply them.  Yes, we all know that the profs know way more than we do and we all want to be as bright as them after we’ve learned everything and had our chance to have clinical applications in the world.  There’s no denying that.  They don’t need to strike us down with an exam to remind us of that.

Outside, everyone looked sad and emaciated like their soul had just been removed from them.  Crestfallen doesn’t even begin to describe it.  I went to a local restaurant to grab a snack on my way to the gym and there were kids from my class in there who just looked like they were going to cry.  They were completely demoralized.  I got home and it got worse.  I had all kinds of people messaging me on skype and facebook, checking to make sure it wasn’t just them who had FAILED the final exam.  Did a lot of pep-talking, much psychological damage to undo.  There were people in a panic because technically they were now failing the class.  They didn’t know what to do about loans, they had plane tickets back in January that they were afraid would go to waste.  I even had one person tell me that they’d had enough and didn’t want to come back for Med 5 if it was going to be like this.

Well, after all that, most people I’ve heard from made scores in the 50s.  We haven’t heard a peep from the professors.  No grades are posted.  There’s been no hints of a curve.  Most people were so stricken with shock and [unwarranted] guilt after the exam that they went home and started studying path so that the same thing won’t happen in that class, rather than brushing up on deficient topics for the pharm shelf today.  It’ll be interesting to see how the shelf goes, after that internal final exam.

Much like a postcard, this is just to say hello, briefly.

Fellow students, I am thinking of you and wish you the best of luck.  With the exception of a subject or two, finals are never as bad as your imagination paints them to be.  Shelves are easy and if they are not, they are curved.  😉

For those coming to Nevis for the first time, congratulations and your mentors should be in contact with you soon.  Enjoy the holidays with your family while they’re close.

My finals are as follows:

PD lab final (last Wednesday) + bonus panic attack 30 minutes before hand.  It’s ok, I did fine.  Deep breath.

PD written final (yesterday)–lots of questions about poop and what it would hypothetically look like if you had (insert random unfortunate GI condition here).

Internal pharm final (tomorrow at 9am–that’s right, Sunday)–um…crap.

Compromised old pharm shelf (Monday, mid-afternoon)–5% of our grade–why again are we taking this?

Internal path final (Wednesday, 10:30)–couldn’t you be an unbiased NBME shelf instead?  The profs know they’re not supposed to recycle used block questions because they’re too detailed and picky and completely inappropriate for cumulative finals but that won’t stop them.  Crap.

And then…flying home!  25 wonderful days on US soil until I come back to this island [for the last time]. :D!

Meanwhile, I’m on my 5th load of laundry.  I have 3 loads to go.  My apartment is starting to look clean and shiny, except for the drying laundry hanging in weird places since my dryer (the sun) has left Nevis for the day and I don’t trust the monkeys by the clothesline at night.  I have 4 giant 3″ binders full of Med 1-4 which are riding home with me in my 3 relatively empty suitcases (along with a rice cooker–random, I know) which will be significantly fuller on their ride back to Nevis.  I’ve washed and packed up my fat clothes to give to charity because I’m determined I’ll never need them again and don’t want them there as a safety net for every Snickers craving I get.

Whew.  Ok, now to study for pharm.  Need a 60 to keep my B–wish me luck.