jenniferhawke.com

a med school blog

Archive for November, 2008

[previous monthly letters: 14... 13... 12... 11... 10... 9... 8... 7... 6... 5... 4... 3... 2... 1]

“Mid pleasures and palaces though we may roam,
Be it ever so humble, there’s no place like home.”

~ John Howard Payne

dearest Nevis,

good morning! how are you? it’s 24°C and really windy out there these days. the short walk to the gym before the sun comes up is downright chilly, making me wonder how i’m ever going to survive 3 weeks of -15°C lows in Saskatchewan and Nebraska.

it’s been a great month in our new place with our new view and our new pool and my new roommate. i love not having to do laundry or put the dishes away or cook dinner or make my own coffee in the morning. in hindsight, i’m surprised i wasn’t more nervous about sharing such a small space with another person. but it has worked out perfectly so far. we fit. and it shows. i am enjoying our small sanctuary from the rest of the island and from school. some most days i want to just curl up on the daybed in front of the window or stretch out on a chair by the pool and watch the clouds roll by for hours.

the only thing that’s missing is Maddy. i keep saving the last bites of my toast crust… too many years of being trained not to eat the whole thing myself.

so how is the island? some things feel the same and some feel different. i know i’m not being treated any differently in town or at the hospital or in line at the grocery store, but some days the distinction of standing out as a tall blond woman really grates on my nerves. i am ready to go home and blend in again. i am ready to stroll the aisles of a grocery store without religiously checking expiry dates on everything i pick up. and wander through a mall without a purpose except to buy something that catches my eye. and to stock up on girly smelly make-up lotiony stuff at Shopper’s Drug Mart. and i would love to drive on the right-hand side of the road again.

and speaking of driving, of course i’ll probably go through the drive-thru at McDonald’s and Tim Horton’s at least half a dozen times while i’m home.

15 months. wow. Joyce came over the other night and couldn’t stop exclaiming how fast it’s going. how fast we’re outta here. how fast the next four months of MED 5 will fly. and then we will all fly our separate ways to our corners of the earth to study for the most important exam of our lives and live happily ever after the end.

one of our classmates asked Brandon what he will miss when we finally leave Nevis for good. right now i am hard-pressed to find an answer because home is looking so darn awesome. but ask me again in 8 months or a year. i’m sure i’ll have a list as long as your arm.


[block 1] [block 2] [block 3]

“A positive attitude may not solve all your problems, but it will annoy enough people to make it worth the effort.”
~ Herm Albright

inching along over here. Brandon and i are working hard to keep the other person smiling. we talk a lot about plans over the Christmas break and i think part of my brain wants to start enjoying it now because i know once we’re in the middle of it, the days will fly by quickly to January 5th and the start of MED 5.

but enough day-dreaming. here’s a concise list of the stuff we studied in block 4.

pathology
- congenital & acquired diseases of bone
- fractures
- osteonecrosis
- osteomyelitis
- bone tumors
- arthritis
- joint tumors and tumor-like lesions
- muscle atrophy
- muscular dystrophy
- myopathy
- diseases of neuromuscular junction
- skeletal muscle tumors
- fatty tumors
- fibrohistiocytic tumors
- smooth muscle tumors
- synovial sarcoma
- acute & chronic inflammatory dermatoses
- infectious dermatoses
- blistering (bullous) dermatoses
- skin tumors
- cerebrovascular diseases
- CNS trauma
- congenital malformations and perinatal brain injury
- infections of nervous system
- tumors of nervous system
- diseases of myelin
- acquired metabolic and toxic disturbances of nervous system
- degenerative diseases and dementias
- diseases of the PNS
- familial tumor syndromes

>> most interesting thing learned: we studied central nervous system trauma again this block which was a bit of a review from neuro last semester. i still really really love the brain. and i love how you can diagnose a lesion pretty much anywhere in the brain or spinal cord (or peripheral nerves) based on external symptoms alone. for example, if you have a stroke (a loss of blood supply to a certain part of your brain) in the front area, one of the things you will have a hard time doing is making decisions or having the desire to do anything (abulia). if the same stroke happens in the middle of your brain, you will lose the ability to speak or understand words (aphasia) and if it happens in the back of your brain you will lose the ability to read (alexia). it’s easy to see how strokes that affect an entire hemisphere can be particularly devastating.

pharmacology
- inhibitors of bacterial cell wall synthesis
- inhibitors of bacterial protein synthesis
- antifolate drugs
- fluoroquinolones & urinary tract antiseptics
- antimycobacterials
- antifungals
- antivirals
- immunosuppressants
- cancer chemotherapy

>> most interesting thing learned: i am so very thankful i haven’t had anyone close to me have to deal with the convoluted regimen of cancer chemotherapy. it seems that just as many drugs are given to relieve or prevent the side effects (nausea, vomiting, etc) than to actually shrink or kill the tumor. i do know someone that is on the rather stressful treatment for hepatitis C and don’t envy the colourful rainbow of hematologic toxicity, cardiac arrhythmias, changes in blood pressure, gastrointestinal distress, chills, fatigue, headache, myalgia (muscle pain), and severe neurological changes such as depression and hallucinations and schizophrenic-like symptoms that they have to deal with for the duration of the 12-month treatment.

physical diagnosis
- musculoskeletal
- neurological

>> most interesting thing learned: we spent most of this block with Dean T and his presentation of local patient cases. it was wonderful to have the Nevis patients visit our classroom and answer all of our questions. learning material directly from patients (on rounds in the hospital, during house calls, etc) is *so* much different than reading and regurgitating form a textbook. i am excited to get out of the classroom permanently and into the hospital hallways.

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looking for MED 1? or MED 2? or MED 3?

go check it out!

these are the days i’d like to lay in bed and watch cartoons all day. i almost did when i woke up this morning with waves of debilitating abdominal pain radiating from my — to use the technical term — stomach. sad to think that it might have been the fault of Teahouse, our fave Chinese food restaurant on the island.

16 sleeps till our last exam. keeping up the caffeine and counting the minutes.

one month till Christmas! can you believe it??

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photo: sunset off a pier in Charlestown, Nevis.

meet Betsy. our new temporary neighbour set out to graze in the field next door and Brandon’s new friend. she’s pretty quiet and really likes the green leafy stuff on our side of the fence.

we like her. in fact, we’ve been sort of entertained by her all day.

what can i say? it’s block weekend and i’m distracted easily. which is why i have to say goodbye to the internet for the next couple of days. see you on Monday! wish us luck!

this is a view of Nevis from the window of an American Airlines plane. in order to be able to relish this view as you head back to North America for the next chapter of your academic medical career, you have to pass one final big exam.

you have to complete a comprehensive (on every subject from MED1-5) Basic Science shelf exam from the National Board of Medical Examiners with a grade that is equivalent to 185 on the USMLE Step 1.

the logic behind this is that 185 is a passing grade for Step 1* and our administration wants to increase our first-time pass-rate to upwards of 90%. this criteria is important for state-side and international accreditation. in order to prove we are a medical school with an education equivalent to our counterparts in North America and graduates worthy to work across the USA and around the world, we have to meet certain standards.

according to Iserson, the first-time pass rate for foreign medical students is 67%. i don’t know MUA’s current status, but i figure it’s pretty close and is definitely well below students in the USA for several reasons that are beyond the scope of this post — including the caliber of students that come to Caribbean med schools, the fact that we write Step 1 before clinical rotations instead of after (like most North American Canadian schools), whether or not English is your first language, and the general quality of curriculum scope and education.

the current first-time pass rate for American medical schools is upwards of 93%.

if we can’t produce numbers similar to the USA, why would MUA expect their students to be treated the same as American medical school grads? alternatively, if our pass rate is similar to North American schools, why shouldn’t we be able to be licensed to work anywhere in the USA or Canada? why shouldn’t our diploma be looked upon as just as valuable if we can prove we learned the same amount of material in a shorter amount of time?

to get an idea of where MUA is currently at, let’s quickly look at the class that completed their Basic Sciences (finished 5 semesters of classes on island) in August 2008…

approximately 40+ students wrote the “exit exam” and only half passed. the penalty for failing is that you have to return to the island in three months and re-take the exam. in the interest of exam hygiene (keeping it clean and honest), MUA does not yet (and may never) offer state-side retakes.

the re-takers recently returned to Nevis and rewrote in the middle of the November. results came in this week: only 3 more students passed. 18 failed for a second time.

in a “three strikes you’re out” kinda way, the re-re-takers have one last chance to pass the final exam. if they fail again, they will be dismissed from MUA and their only option to continue a career in medicine will be to transfer to another school.

is this a good thing or a bad thing?

for the 18 students that have to re-re-take the exam, it’s obviously very stressful financially (flying back and forth) and academically (all that studying with no end in sight) and emotionally (what on earth am i doing with my life??). i feel bad for them and empathize with their frustration. people end up in Caribbean medical schools for a variety of reasons, and i don’t doubt that troubles with traditional academic settings is one of them. plus, if you have any sort of debilitating test anxiety, you’re sort of screwed if you want to become a doctor.

i know academic standards have shifted a bit even in the time i have been at MUA with more stringent pass requirements, less curving, and more shelf exams for each semester. MUA has recently moved to instating NBME shelf exams as the sole final exam worth 25% of your class grade. which essentially means you have to learn the material to the level of the North American Medical Board of Examiners before you are able to move on to the next semester. this probably means that my class (and all of the classes behind us) are better prepared for the comprehensive final and Step 1. it probably means the classes before us weren’t as well-prepared for the exit exam because they didn’t take nearly as many semester shelf exams and are paying for it by having to do even more work now. which sucks.

but from MUA’s point of view, they are improving the caliber of the school by “weeding out”** graduates that may or may not pass Step 1. so far, every August 2008 student that passed the comprehensive shelf has passed Step 1. there are always stories here and there of people who got Cs in every class, did poorly on the exit exam and totally rocked Step 1, but in general this supports the administration’s theory that the comprehensive final is a good gauge of how prepared you are to write Step 1.

and the most efficient way to improve your school’s first-time pass rate is to prevent people you think are going to fail from taking Step 1.

as a future MUA grad that is going to take the name of this school on my diploma and into every hospital and emergency room and doctor’s office that i go to once i leave Nevis, i am thankful for a school administration that is interested in improving the caliber of our graduates. i don’t deny this whole exit exam thing is scary as hell, but working my butt off to get off this island and move forward will be well worth it. i look forward to meeting fellow MUA students again on rounds and being proud of how well we will be able to answer questions from residents and attendings. i am excited to show up our American counterparts and improve the name and negative stigma of Caribbean medical schools within North America. we are smart! we will make amazing doctors someday! just wait and see.

i love Nevis, but once i say goodbye after MED 5, i really hope the only time i return will be on holiday to the Four Seasons.

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*as a quick reminder to non-med non-Caribbean student readers, we need to pass Step 1 before we can start our clinical rotations.

**horrible phrase, i know — apologies to the 18 re-re-takers.

“Home is a place you grow up wanting to leave, and grow old wanting to get back to”
~ John Ed Pearce

getting chilly in Moose Jaw and i am hoping for snow on the ground when i get there. not too much snow, of course. still want planes to be able to land and take off okay and for the 45 min drive to and from the airport in Regina not to be too dangerous. my mom drove me to the airport after Christmas once some years back and we counted over 30 cars in the ditch just in that short stretch.

but some snow would be nice. i know my mom will greet me at the airport with appropriate outer wear because i’ll show up in shorts and flip flops – ha.

she’ll probably also have the heat cranked up in the house. because as much as i say i like snow and can’t wait for the cold, i’m still a giant wimp and will be FREEZING when i finally get there. socks and sweaters indoors all day, everyday.

it’s even getting cold in Scottsbluff. Brandon saw the temperature over my shoulder and asked what it was in Fahrenheit. of note, i’m trying to learn shortcuts for the F to C and C to F conversions and figure flipping back and forth in a widget is a start. the extreme minuses in Celsius always sound more impressive.

3 weeks from today, i will be on my way home. unfortunately, there are still a few pesky speedbump exams between here and there, so it’s back to antiviral drugs (and coffee) this morning.

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photo: screenshot of my widgets. top left is a CFL score widget and top right is the sky stars at this lat/longitude. Saskatchewan doesn’t observe daylight savings time either, so we are always two hours apart.

“If you’re here for four more years or four more weeks, you’re here right now. I think when you’re somewhere, you ought to be there. It’s not about how long you stay in a place, it’s about what you do while you’re there, and when you go, is that place any better for your having been there?”

~ Chris from Northern Exposure

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photo: St. Maarten Maho beach.

“Love is, above all else, the gift of oneself.”
~ Jean Anouilh

i’m sitting here trying to think of what to type for our 8 month-iversary and the only thought rolling over and over in my head is that it feels like a lifetime and a brand new beginning all rolled up into one. i just can’t decide whether i should be happy about what we have found together or excited about all of the wonderful things still to come.

tough decision, huh?

either way, i know i couldn’t go another day without him by my side.

and not just because he cooks and cleans, puts up with my PMS mood swings and comments on every single one of my blog posts. ; ))

“Nobody trips over mountains. It is the small pebble that causes you to stumble. Pass all the pebbles in your path and you will find you have crossed the mountain.”
~ Author Unknown

“If we are facing in the right direction, all we have to do is keep on walking.”
~ Buddhist Proverb

Joyce ran into Brandon and i outside the cafeteria last week and moderately chastised me for doing a bit of a disappearing act this semester. Sarah commented the other day that i’m writing on here less. emails to dear friends are growing fewer and farther between. i swear it’s not Brandon’s fault and i swear i haven’t turned into one of those girls that ditches all of her friends when she starts dating a new fabulous awesome wonderful guy.

i’m just mentally exhausted and trying to conserve my energy.

we have 7 exams and 1 quiz left in the next 4 weeks worth 25% (path) + 25% (pharm) + 55% (physical diagnosis) of our final grade.

and i’m concentrating wholeheartedly on tightening the reins and harnessing my brain from running away on holiday a month early. physically i feel fine — great, even. i am getting my beauty rest each night and eating the best i have on the island now that Brandon is doing the cooking. i’m taking my daily vitamins. i’m not drinking too much coffee. i’m going to the gym 5 mornings a week. my body feels good.

my brain can hardly put a few words together to form this sentence.

so yah. keeping on keeping on. eating my 5 pancakes a day. fighting the good fight. realizing the rest of my life is set up to unfold in a similar manner, which is great, but entitles me to a little corner-cutting here and there. i’m sorry if you’re one of those corners.

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photo: Maddy and i snowshoeing at Hubble Homestead in British Columbia – January 2007.