jenniferhawke.com

dear Nevis,

i’m tired. and i’m glad it’s finally March.

that is all.

love,
me

it’s gonna be a looong pre-block weekend. i’m actually considering skipping Med Psych tomorrow to spend an extra three hours on Physio and Biochem…

… which is rather shocking (for me) and perhaps my most accurate “low energy! warning!” indicator. it could be worse. it can always be worse. but i’m running a marathon, not a sprint, right? i need to pace this mile a little slower.

it’s the only exam not included in blocks. we write one midterm (40%) and one final (60%). the NBME lumps ethics in with Behavioral Science, so we’ll see it again on the shelf at the end of the semester.

I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

IX. A physician shall support access to medical care for all people.

~ AMA Principles of Medical Ethics

yup, even the Canadians in our class are bound by the American Medical Association and American federal laws for the purposes of this exam.

as recommended by another island med student.

yum!

… and now for something completely different: a little peek into the things that keep my brain up way past its’ bedtime…

re-cap: hi, my name is Jennifer Hawke and in 2 & 1/2 years, i’m going to be an IMG trying to land a residency in Vancouver. i realize that before then, i have an awful lot of studying to do, a ton of exams to pass, a couple of national boards to kick, and clinical rotations to complete. why worry about something so far down the road??

well, one of those important pre-residency criteria will not be spent on the sunny remote island of Nevis so very far, far, far away from the city and home i love. one of those pre-residency criteria is a 72-week program of clinical rotations at a teaching hospital in North America. rotations are an essential med school process allowing you to form professional relationships that will strengthen the actual residency application. the whole point of clinical rotations is to spend time in a hospital working with folks so they get to know you and can (hopefully) later recommend you to the program of your dreams.

what happens if you want to do your residency in Canada, but have to do your clinical rotations in the USA? how do you form those essential professional relationships and line up the killer recommendations? well, that brings us to the topic of this post:

“I Can’t Do My Rotations In Canada, But I Still Want To Get As Close As Possible”

so, i’m stuck in the beautiful US of A for 72 weeks. not so bad, right? which is the state closest to British Columbia? why, Washington! so, which is the teaching hospital that would be the super most awesome place for me to do clinical rotations? why, University of Washington School of Medicine!

does MUA have any clinical rotation affiliations with the University of Washington? unfortunately, no. otherwise my brain would be sound asleep as soon as the lights go out. most of MUA’s hospital affiliations are in/around New York. sticking with existing and current rotations, i think Colorado is about the closest i could get to Vancouver.

don’t get me wrong. i have nothing against Colorado or New York. in fact, i know some pretty fine folks from New York and can think of worse things than spending a little time closer to them. it just sucks that someone saw fit to make North America so stinking wide and separated the east and west coasts by so many zillions of miles.

which brings us back to my brain. it is keeping me up late at nights, storming around trying to figure out how i can get my foot in the door of either the Seattle or Spokane Visiting Student Program. i know i am a great student and a hard worker. i know i would be a brilliant addition to any teaching hospital clinical rotation program. i know i’m going to work my butt off wherever i end up. it just remains to be seen who i’m working my butt off for.

so, why not apply to Seattle’s Visiting Student Program? why not fire off an application into the pool and see how it works out?

turns out, i can’t even get past the first condition in the application overview procedure: i don’t have a sponsor. i don’t have a “pre-existing personal or professional relationship with a UW School of Medicine faculty member.”

there are other speed bumps, of course. but that roadblock is a giant red flashing sign with POLICE LINE DO NOT CROSS tape criss-crossing in every direction and electrocuting me any time i try to move forward.

it really is all about who you know.

and i’m not in the right circles. yet. thankfully, my brain is worrying about this early and i have some time.

by the looks of it, Spokane’s application is a little less stringent. it doesn’t look like i need a “pre-existing relationship” and could probably MacGyver my way into a 12-week rotation with a piece of bubblegum, some wire, and an empty pop can. from there, i might be able to meet someone that could help me get another 12 weeks in Seattle. as it is, i am currently at a bit of a dead end. does anyone know Dr. Tom E. Norris and want to put in a good word for a cool Canadian gal with a camera?

as the title indicates, this has just begun! i can’t give up until all of the doors are fully slammed in my face. i will keep you posted as this unfolds and if i have any success even getting my toe pinched in the door, i’ll be sure to share my tactics. because it will really be a magical Cinderella miracle.

and ginger snaps and mucopolysaccharidoses and respiratory alkalosis and Cheez Whiz.

i am a happy girl.

big thanks to Kev for the fancy purple calendar date icon thingers that match the rest of the purple-y site theme. and i was just considering changing everything to orange… ; )

… well, he was mostly dead, so not doing a very good job of it. and i ended up with clean towels anyway.

also, when he slowly sorta tried to move, i was reassured that my heart and sympathetic system are working just fine, thankyouverymuch.

ah, the joys of Caribbean living!

paradise definitely isn’t for everyone.

PS: for anyone thinking of coming to visit, this wasn’t actually in the house. my laundry room is an extension filled with bugs and lizards and fun stuff. enough stuff to make me afraid of washing at night. hah.

just spending some quality time with myself and my house and my flaws and my impeccable sense of humour and my camera and my kitchen. i have to admit i’m pretty darn good company. these days i am the happiest and most content i’ve been in 2008 thus far. and it just keeps getting better.

what’s changed?

not a single thing other than my perspective. i wish i could explain further, but i’m not a good enough writer. suffice it to say, it’s somehow sunk in that how we handle adversity (and pressure and stress and disappointment) is what makes us who we are. i know who i don’t want to be and am moving away from that.

i know who i do want to be and am moving toward that.

all the while eating lots and lots of cinnamon toast.

does listening to a radio book narration count as “Currently Reading”? probably not. but i’m pretty sure i get to make the rules around here.

a wonderful friend from across the pond, sent me the link to BBC Radio 4′s Book of the Week. Max Pemberton is “straight out of the medical school sausage machine. When he started work at a massive unnamed hospital he kept an honest diary about the transition from theory to practice.”

“Trust Me, I’m a (Junior) Doctor” (link only valid this week for 7 days after the broadcast)

[RealPlayer required]

thanks, Tim!

[block 1 re-cap]

yikes. what a brutal block. physically, mentally, and emotionally this has been the toughest block yet. and i’m not delusional enough to hope it’s going to get better any time soon.

physiology
- cardiac pressure-volume loops
- cardiac cycle: Wigger’s diagram
- cardiac output and vascular function curves
- regulation of blood pressure
- renin-angiotensi-aldosterone system
- microcirculation
- Starling forces
- myocardial infarction, congestive heart failure, valvular disease
- lung volumes and capacities
- mechanics of breathing
- breathing cycle
- gas exchange & partial pressures

>> most interesting thing learned: fever is produced by pyrogens that alter the brain into thinking the normal temperature of 37.5oC is too low. the body compensates with heat producing mechanisms to bring it up to a new (too high!) set-point that it thinks is correct. aspirin works to reduce fever by inhibiting the cyclooxygenase enzyme necessary to produce the prostaglandins that raise the set-point.

the difference between heat exhaustion and heat stroke: heat exhaustion occurs when you’re in the hot sun too long and your body works overtime dissipating the heat (ie: too much sweating). heat stroke occurs when you’re in the hot sun too long, but there is something faulty with your body’s heat dissipating mechanisms (ie: you can’t sweat at all).

biochemistry
- classification of carbohydrates
- isomers, epimers, diastereomers, enantiomers, etc
- monosaccharides & their bonds
- digestion of carbohydrates
- deficiencies and abnormalities of carb digestion
- glycolysis (reactions, regulation, & enzyme deficiencies)
- tricarboxylic acid cycle (reactions, regulation, & enzyme deficiencies)
- gluconeogenesis (reactions, regulation, & enzyme deficiencies)
- glycogenolysis (reactions, regulation, & enzyme deficiencies)
- glycogenesis (reactions, regulation, & enzyme deficiencies)
- fructose metabolism (reactions, regulation, & enzyme deficiencies)
- galactose metabolism (reactions, regulation, & enzyme deficiencies)
- lactose synthesis
- hexose monophosphate pathway (reactions, regulation, & enzyme deficiencies)
- uses of NADPH

>> most interesting thing learned: i could never really understand how high sugar diets can make you get fat. i mean, doesn’t eating fat make you get fat? and yet, after the liver and muscles get what they need, high sugar consumption (glucose, fructose, etc) shuttles the products of their breakdown almost directly into fat production! so just because some Hershey’s products are fat free doesn’t mean they won’t make you fat!

of note, this biochemistry class is geared to medical students. we did not have to memorize structures and electron movement and bond breaking and all of that fun chemistry stuff. whew.

psychology
- anxiety disorders
- panic disorder
- specific phobias
- obsessive-compulsive disorder
- pharmacology of everything mentioned above
- systematic desensitization
- classical conditioning
- operant conditioning
- death & dying
- human sexuality
- sexual disorders
- paraphilias
- child sexual abuse

>> most interesting thing learned: a man who thinks he’s a man and wants to have sex with men does not have a disorder*, but a man who thinks he’s a woman and wants to have sex with men does.

also (and i already knew this from training Maddy), the best way to get someone to keep performing a learned behaviour is to reward them randomly. so if you want that guy to keep calling and asking you out on a date, don’t say “yes” every time. i suppose we know this as playing “hard to get”. slot machines do it too. and Maddy will sit every time i ask her to because she isn’t sure if this is the time she gets a treat or not.

alternatively, the best way to extinguish a learned behaviour is to reward it every time and then suddenly stop. so if you want that guy to STOP calling you because you’ve decided he’s annoying, start saying “yes” every time for at least a few weeks in a row. then stop saying “yes” and he’ll get the picture much faster. you won’t have to resort to that restraining order after all.

medical ethics
- advanced care planning
- informed consent

>> most interesting thing learned: Dr. Anna Pou still faces civil charges for the three people she administered lethal doses of painkillers to three days after Hurricane Katrina. to put it another way: one of the very few doctors that stayed behind after the shockingly tragic events of Katrina, is being persecuted by families for ensuring their critically ill loved ones were comfortable when she found out they would not be evacuated and no other help was coming.

if the courts could not find evidence of murder (mercy or not, ethical or not), i am saddened that these civil suit families are undermining this woman’s courageous attempt to help in such a terrible situation. i mean, what doctor in their right mind is going to stay behind after the next disaster?

————
looking for MED 1?

*in this particular instance, it’s Gender Identity Disorder and whether or not you may agree that it’s a “disorder” (as in, something “wrong” with the person) is a completely different discussion.