jenniferhawke.com

[previous monthly letters: 9... 8... 7... 6... 5... 4... 3... 2... 1]

dear Nevis,

wow! exactly halfway!

i really really really wish i had time to write you a nice long letter this month, but pretty much all of my friends and family (hi, mom & dad!) are getting ignored lately. i’m sorry. i’ll write as soon as i can. hopefully shortly after i kill this next set of block exams over the weekend. in the meantime, you’ll have to believe me when i say no news is good news.

just. feeling. overwhelmed.

and like i would rather quit school and go back to getting a real paycheck while sitting at a desk all day playing with video games.

lotsa love,
`J XO

well, i received so many emails on this topic, i definitely had to write a post and open up the forum for your comments…

from the MUA Catalog:

The University has a zero tolerance policy on drug use (including distribution and possession) and excessive alcohol use while enrolled at Medical University of the Americas. Drug use is determined on-site by testing, random or otherwise, with a multi-drug screening kit. All students prior to coming to Nevis will be expected to sign a waiver allowing random drug testing. In the event of a specific complaint about a student, the test will not be random (Refer to the Student Handbook for policy details).

yes, every single person in the MED 3 class was filed into a bathroom with the door slightly ajar yesterday (girls separate from boys, obviously) and instructed to pee into a cup. 60 to 90 seconds later, we headed back to class and that was it. no big deal, right?

or is it?

drug testing is extremely common in Caribbean medical schools. Saba has an even more rigorous process than MUA where some students have the potential to be (randomly) chosen several times each semester. i have no idea if drug testing infringes on our rights or is unethical or immoral. i guess as someone that has “nothing to hide”, i never really gave it much thought.

does MUA have a professional responsibility to ensure that the students they are promoting into the field of medicine are “responsible” drug-free upstanding young citizens? is it a good idea that they are trying to avoid putting people with potentially dangerous addictive substance abuse problems in a profession so close to, well, more drugs? my sister is training to be a pilot, a field with ZERO drug tolerance. why should medicine be any different?

from “Drug abuse among medical students” in the Student BMJ:

Binge drinking and drug abuse in doctors and medical students have always been an occupational hazard, but drug abuse is undergoing a rapid renaissance. Medical students are exposed to the same illicit experiences as other students: exposure to amphetamines, cannabis, ecstasy, LSD, cocaine, and in some cases heroin – not to mention alcohol and tobacco. But medical students are future doctors. Maladaptive coping skills are hard to shake off, and at the moment there is a small, but ever increasing population of junior doctors who use cannabis, amphetamines, cocaine, alcohol, and tobacco recreationally, and as these doctors become more senior, this misuse could begin to present as a sizeable problem.

Dependence on alcohol and other drugs is a known problem among doctors – to what extent the professional competence and quality of care for patients will be affected is not known.

Several calls for the random drug testing of doctors have been made; it is possibly quite laughable that with such drug-wielding power no protocol for testing has been established. Pilots, train drivers, and many others undergo drug testing routinely; yet the “responsible irresponsible” have escaped. My personal concern is that drug abuse has become irreversibly intertwined with youth culture and that there will be a flooding of the medical profession with young doctors who are consistently misusing drugs. It can take one event to shatter the public trust in young doctors and shake the foundation of the entire profession.

what are your thoughts?

[not my office, but maybe someday - University of British Columbia]

i was going to reply to a comment on the previous post that was responding to a tweet in the sidebar, but then i realized it was all getting a little convoluted and just decided to start a whole new post.

plus, it combines two things i’m not doing much around here: writing and writing about med school.

yes, $645 is a lot for one semester of textbooks. there were a few review books and flashcard sets thrown in, along with some paper and miscellaneous school supplies, but MED 4 is probably the most expensive* semester here at MUA. giant tomes like Netter’s Neurology and Robbin’s Pathology aren’t cheap. add to that the fact that i’m stuck on a tiny island in the Caribbean without many reliable delivery options** and MUA’s University Bookstore Online has pretty much cornered the market. they know they can charge us whatever they darn well please because we really don’t have much choice if we want it to arrive in one piece and in a decent amount of time.

of note for any current or future students: used textbooks are often available from upper-level classmates if you are looking to save a bit of cash. because i like to keep my textbooks (see below) and because i am very much a from-the-book (as opposed to from-the-computer-screen) learner, i prefer to start out with a blank slate/page. plus, there really isn’t anything in the world like the smell of new textbook pages. yum.

do i really need every textbook on the “required” list? probably not. i do draw a figurative line in the sand and don’t bother with the “recommended” list, but i LOVE textbooks. i kept all of my books from undergrad whether i thought i’d re-use them or not. yes, even that annoying calculus textbook that might as well have been written in Greek. it’s a guilty and indulgent and wasteful pleasure that proves to be slightly on the insane side every time i box stuff up to move. i don’t own a house or a car or a couch or a television. but i own books. lots and lots of books.

lastly, my 20 months here on this island is ultimately training me to write USMLE Step 1 sometime next spring/summer. the professor’s PowerPoint slides will probably prepare me enough to pass their class. but should i believe that they contain all of the information i am going to need to excel, both on the exam and on rotations and in the Real World?

or should i look at textbooks as another investment in my education and continue to read every thing i can get my greedy little hands on?

————
*you also need to drop a few hundred dollars on physical diagnosis supplies like those little thingers that let you look in ears and eyes. fun!

**at least 3 of my orders from Amazon.com have gone missing in the last 10 months. each time, the company was brilliantly fast at either sending another order (which often also went missing) or immediately refunding my money. i have no complaints with Amazon.com or their affiliates that will ship down here. i just can’t wait another 6 months to get my physical diagnosis manual.

well, it seems the rains have begun. just waiting for the mornings when our little dirt driveway is washed all the way into the main road and the wind is so strong, the pellets of rain whip horizontally. it’s HUMID. and starting to get green again. i wonder if Arthur is on his way anytime soon… and i wonder if my friend Arthur The Genius Math Guy (who can’t place a bet in a casino because his brain can figure out the exact odds too quickly and was always amazed when i won at roulette) knows the first storm of the year will be named after him? the rest of the names this year sound like the cast of a bad 80s movie.

and yes, it is this weather that makes renting a car so worthwhile. driving on the left is obviously no sweat by now, but there are two things that are still throwing me off:

1) i still shoulder-check over the right when backing up. my right shoulder obviously gives me a great clear view of… my seatbelt and a little of the side rearview mirror. i’m surprised i haven’t hit something yet. it just feels weird to look over the left shoulder to see through the back window.

2) i steer with my right hand. which usually leaves my left arm to rest on the door or open window. now i still steer with my right hand, but it leaves my left arm to rest on… well… nothing. my left hand just sits on my leg now with nothing to do. i could try steering with my left hand, but i don’t think the goats would appreciate it much.

so! congratulations to everyone in the northern hemisphere finally enjoying summer! hurricane season is rolling along nicely down here and i hope Kev’s visit in August (56 sleeps!) isn’t too stormy.

i was surprised to learn the other day that a fellow med student had never heard of scutmonkey’s 12 Types of Med Students. here they (we?) are in all their (our?) glory.

which one are you?

Topher is another medical student blogger that i have come to really enjoy over the years. he is infamous for his USMLE Step 1 study guide and is a bit of a Cinderella story because he (worked his butt off and) managed to transfer from a lowly Caribbean medical school back to the USA in his third year.

he hasn’t written anything in awhile. which, for a prolific blogger that loves to write, sorta seems like it should be a big deal. i guess a lot more happens in 3rd year than most of us expect.

Before, my shtick was looking around and sort of cataloging all the interesting things that were happening around me. Not a lot of introspection going on. Nothing to write about inside the barrel that is my hospital. Or there is, but that’s not the story.

The story is the fermenting. My classmates and I are taking on new flavors and textures. A few might be prematurely alcoholic. Others have lost their sweetness. Most rougher for the wear and rarely anyone smoother.

And it is incredible.

I put up a hell of a fight. A nine month spectacle of twisting, thrashing and spitting. On March 5th, 2008, I broke. Emotionally. Mentally. Broke. It was awful. I haven’t written about it because I’m unsure on these new, wobbly legs.

But for the first time I know what language is supposed to do. I know how people reward their physicians. I understand patience. I have experienced the risks and rewards of vulnerability. What is and is not important has been impossibly rearranged in my head. When I look at the decisions I am making now, I don’t recognize them as coming from my past. All of it seems to come from very different stuff.

But then you never could have told me, after I rolled one around in my mouth, that grapes could give way to wine.

~ from Topher’s “Grapes and Wine”

commencement is still pretty far off for most of us, but it’s going to come faster than we think. i have been following Graham’s blog for years now and think he is a wonderfully brilliant writer with a mean streak for American health care reform. i wish him success and happiness in Emergency Medicine and i hope he keeps writing. because we can all* learn from values such as these:

Number one: I will continue to use objectivity, without forgetting the subjective.

Medicine is an art grounded in science. I’ll do my best to know the studies, the data, and the pathophysiology, and try to apply them objectively.
But I won’t forget the patient. I’ll listen. I’ll be compassionate. I’ll try to keep social context, “chief concern,” and patient perspective in mind.

And number two: I promise to ask questions, and on occasion dare to admit: “I don’t know.” And thank you to Stanford for encouraging this—in Gil Chu’s class, where we weren’t allowed to leave until we had collectively asked him 10 questions; with Dr. Wolfe, who teaches students to admit their own “Areas of Ignorance.” We are a generation of physicians who are unfortunately (or fortunately) still human. We are not gods. We still make mistakes, and we still don’t have all the answers. But, hopefully, we’ll know where to find them.

Number three: Don’t mess with the pancreas. Or, in the famous words of master pancreatic surgeon Dr. Norton, “I’m tellin’ you, don’t mess with the pancreas! You gotta believe me!”

And number four: I promise to be involved. Whether it’s researching, teaching, advocating, or volunteering, I will remember that health and medicine are often advanced and affected more by time spent outside a hospital than within one.

While passing clerkships and boards and memorizing facts may make us doctors today, it’s our values that will drive us to become great doctors, like the many we have met here at Stanford. Because the great physician is dedicated to the truth, but also to patient. She is a scientist, but also a healer. He tempers prognosis with hope. I think Kurt Vonnegut sums up medicine’s curiosity and compassion better than I ever could: “We are here to help each other get through this thing, whatever it is.”

~ from Graham Walker’s Commencement Address to the 2008 graduating class of the Stanford University School of Medicine

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*okay, maybe we all can’t learn from “don’t mess with the pancreas”…

[Save-On-Foods - Prince George, BC]

while laundry is my least favourite chore, grocery shopping is probably at the top of my MOST favourite list. i always set aside lots of time because i like go slow and not forget anything. i love pushing the cart through the big wide aisles and reading packages to decide between dozens of brands and flavours. i love the smell of the bakery section and wide variety at the deli. i love the fact that the produce section often takes up almost half the store and is filled with bright greens and reds and yellows and purples and oranges. i love the efficient and fast barcode-scanning checkout with the cheery staff efficiently scanning and bagging and swiping your debit card all at the same time.

it’s a wonderful way to spend a weekday morning (because why go on the weekend when everyone else does?) and something i haven’t done in almost 10 months…

grocery stores here are so much different. my favourite store on Nevis is the Best Buy in Gingerland. it is usually very dim, with aisles almost big enough for two people to pass (but not if you have a basket on your arm). it has a HUGE cereal selection disproportionate to the size of the rest of the store and recently added a fresh slice deli. the selection is pretty good, meaning that you can probably find the particular food you’re looking for, but definitely won’t have much selection between brands or flavours. the staff are generally friendly, but seem to sincerely believe that since they aren’t going anywhere in a hurry, why should you?

all of that aside, the biggest thing i hate about grocery shopping on Nevis is the fact that i leave the store with way too many boxes and cans and jars and bottles and frozen stuffs. and i miss organics.

of local interest, the Nevis Supply recently announced that they are going to stop importing dog food. this has obviously caused a huge uproar with dog owners and i’m still scratching my head and wondering what the logic of their reasoning could possibly be.

or six.

don’t worry. i’m setting aside tomorrow night for some decompression. and i spent the last couple of nights (finally!) watching the tail end of “Grey’s Anatomy” and almost caught up with the “House, M.D.” season finale.

in some ways, i wish i could kick up my heels and celebrate TGIF the old-fashioned way. sometimes i wish i could have more of the weekend to myself.

but then i realize i DO have the weekend to myself. and i’m celebrating it exactly the way i want.

[photo from somewhere outside Vegas - June 2006]

“Happiness is nothing more than good health and a bad memory.”
~ Albert Schweitzer

ever feel like your life is running so swimmingly it seems like you’re looking back from the future, watching it unfold, and nodding your head saying “yup, that’s the way it’s supposed to go” ??

yeah. it’s a good place.

happy Friday! have a good one. and keep smiling.