jenniferhawke.com

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“Someday we’ll look back on this moment and plow into a parked car.”
~ Evan Davis

dearest Nevis,

this is my last letter to you. my last monthly update. my last few weeks on your little gem of an island. i’m swamped with the expected mixture of excitement about moving on and sadness at leaving you behind. i don’t doubt i will look back fondly on my time here. and will probably miss you more as the years roll by and my glasses become tinted with the rose-color of passing time. like a long-lost ex-boyfriend, i’ll easily forget the way you left your socks everywhere and spend my memories sighing over the times you surprised me with hand-picked flowers.

March came and went in the blink of an eye. i’ll believe you when you tell me that there were 31 days, but will probably look to a calendar for proof. April 1st feels like a Fool’s Day joke straight from Father Time. if i had a dime for each time i’ve commented on how fast the days are flying, i could probably pay off a significant portion of my student debt. i’m sure you’re sick of hearing it. i’m learning to hold on tight to the rollercoaster and enjoy it. because i really don’t think it’s going to slow down anytime soon.

and i’m okay with that.

my friend, Brigette came all the way from Vancouver to visit during the last week of February. it was positively wonderful to have her giddy laugh fill our little house for those 7 days. and let’s not forget the fact that more than half of her suitcase was filled with sugary Canadian goodies! she got a funny sunburn and an upset tummy from Pizza Beach, but i hope she found the rest and rejuvenation she needed. plus, she got to see monkeys and donkeys and goats and sheep and hummingbirds and cockroaches and sand and surf and the bottom of a white wine bottle. i certainly enjoyed her visit here as an excuse to take some time off myself.

Brandon made a new friend in late February. he named her Georgia and we enjoyed multiple daily visits from her for several weeks. she would crawl under the chain-link fence and come sit by our kitchen window in the morning and evenings. one night she even stopped by at 2am and ferociously guarded our house from some predator of the dark. we knew she was there because her incessant barking also protected us from soundly sleeping any more that night. Brandon toyed with the idea of taking her back home to Nebraska, but i think he decided in the end that it would be unfair to ask her to give up the free roam she has here on Nevis in exchange for even the biggest backyard.

we haven’t seen Georgia in a few days now and are hoping that doesn’t mean something bad has happened to her. maybe she just moved on to another kitchen window.

speaking of kitchens and food, i will miss the care packages full of sugary love. friends and family back home were wonderfully supportive with their diabetes-inducing boxes that took weeks and months to arrive. but i’ll trade those in any day for a grocery store with fresh organic produce that doesn’t cost as much as a month’s tuition. i won’t miss checking expiry dates and shopping in the frozen-canned-packaged food sections. i guess the day has finally arrived: i’m a little sick of Eggos.

the New Building on campus opened its’ doors to MED 5′s for our final few exams and classes are being held there as of March 25th. most of us that have been at MUA for any length of time (and those of you that have moved on to clinical rotations in the USA) can hardly believe it’s actually open. it feels like it has been under construction for-ever (since well before i got here in September 2007), but looks like it was well worth the wait. the new classrooms are gorgeous and the bathrooms are positively decadent.

the phases of the moon wax and wane. the tides roll in and out. i arrived on Nevis like a wave crashing onto the beach. and am about to be sucked back to the sea.

be sure to keep in touch. don’t be a stranger. take care of yourself.

all my love,
`Jennifer XO

okay, so i’m not really tired. i lied about that. or exaggerated in a “sick and tired of studying” kinda way. i know how important REM consolidation is and get a ton of sleep every night. thanks to Sydney and Brandon’s mom, i have more than enough coffee and Twizzlers to get me through these last 2 & 1/2 weeks.

and i’m not annoyed anymore. i’m thankful the little things pass quickly. and i’m especially thankful it’s all little things.

i still want to go home, but not SO much that i loathe the gorgeous sunrise i wake up to each day and the stunning sunset out our front window that entertains us over dinner each night.

life is great. i swear.

————
photo: Brandon and i in the dirt-patch-trying-to-grow-grass in front of The New Building on Saturday.

for those of you not immersed in the system, Caribbean medical schools conduct their Basic Science courses (equivalent to the first 2 years of a North American medical school) on-island and offer clinical rotations (equivalent to the last 2 years of a North American medical school) through affiliations with teaching hospitals in the USA. while each student needs to complete 72 weeks of core and elective rotations, hospital affiliations vary widely across the country.

basically, you could end up in New York or Illinois or Georgia or Louisiana or North Carolina or Maryland. or a combination thereof.

rotations are 4 or 6 or 12 weeks long. some are cores (MUST do) and some are elective (often chosen based on your future residency aspirations). you don’t have to do all of your rotations in one city or at one hospital. in fact, it’s often impossible to do that even if you want to. you sort of have to go where there is space. or wait for space to open up.

have i mentioned it’s confusing? i’m getting flustered just trying to explain it. it definitely needs high-level coordination.

meeting with MUA’s Clinical Coordinator is a must for MED 5′s before we leave the island. today we had a nice chat with the lady that is in charge of juggling students from classrooms to hospital hallways. let me tell you, that is not a job i envy.

nothing is official yet, but it’s sort of looking like we might end up in Oklahoma City.

don’t worry, every preliminary apartment i’ve checked out in the area near the hospital is pet-friendly and there’s an awesome dog park just a 15-minute drive away. i hope Maddy’s ready for the buckle on the Bible Belt.

yeehaw!

————
*today’s photo is a snapshot of my desk (tiny, light-loving bug and all) and obviously has nothing to do with Bibles, or belts or Oklahoma.

[my previous shelf exams: Anatomy, Biochemistry, Behavioral Sciences, Physiology, Microbiology, Neurosciences, Pharmacology and Intro to Clinical Medicine]

How I Study for Shelf Exams

and the pre-written posts roll on in my month-long study-cram-exam session…

according to the NBME, this is another extremely comprehensive exam. it’s also our last exam before The Big One on April 13th. studying for one sort of felt like studying for the other because pathophysiology is so important.

i think the main thing that makes me nervous about this exam is the fact that the material spans 2 semesters. there is A Lot to remember. thankfully, this has been a strong course for me. if i had 2 semesters of biochem to recall today, i’d be in big trouble.

wish us luck!

————
photo: my giant cheek and Robbin’s small print, taken by Brandon.

as you can tell by this partial screenshot of my performance summary so far, Kaplan doesn’t think i’m ready* to write Step 1 yet. and neither do i.

here is what the NBME Self-Assessment Comprehensive Basic Science Form 6 thinks:

it’s basically a lot of mumbo jumbo. the scoring scale for Step 1 isn’t just a straight up this-many-right out of this-many-total percentage (ie: you got 30 wrong out of 100, so you get 70%), so graphic interpretations of your weak areas must be easier to understand than the crazy standard deviations and means the NBME uses to figure out who’s smarter than who.

still, the question remains: how do you know when you’re “ready” to write the biggest exam of your med school career? personally, i’m hoping to pull off a Slumdog Millionaire and am running on the assumption that everything in my life has led up to this point.

but seriously.

Brandon sometimes teases me about how much i read and how many different resources i use to study. since Step 1 is coming up** and is a timely topic, i figured i would give a quick run-down of the popular high-yield materials i have used and my concise opinion about each. as usual, this is just my personal opinion and not necessarily what all the cool kids are doing.

it’s short and sweet. cuz i’m too busy reading the stuff to be writing about it.

(in alphabetical order)

Exam Master
this question database is provided free to MUA students and i would only rate it a 6/10. the questions vary from insanely easy to ridiculously hard. some of the images are weird and it sort of lost credibility in my books when i had a question asking me about “Graham-positive” bacteria. hmm.

First Aid
i can’t count how many times i’ve heard “oh, i’ll just memorize First Aid and be fine for Step 1!” and rolled my eyes in response. don’t get me wrong, i really like the way First Aid is organized (and have since bought the Organ Systems and Basic Science versions as well), but i don’t think it should be your one and only resource. and depending on what edition you’re looking at, you may be memorizing errors. be sure to keep your Merck Manual handy.

Kaplan PLS
the online system is slowwww, the videos we have access to down here in the Caribbean are a little outdated, and the questions focus on detail recall rather than problem-solving. in short, i don’t really like it and will be giving away my review books for free as soon as i can find someone to take ‘em off my hands.

Kaplan QBank
i think the Facebook Daily QBank Challenge will be pretty cool once they work out the kinks and errors. and the online QBank totally kicks my butt. those questions are HARD. i will probably buy a subscription after i finish up with USMLE Rx (see below).

Merck Manual
not a high-yield review book by any means, but my bible. i use it to fact-check all other resources on my easter egg hunt for errors.

NBME Practice Exams
there are 6 of these available online for the Comprehensive Basic Science questions. i have heard they are good indicators of your progress and plan to write one on each of the next several Saturdays leading up to our comprehensive final.

USMLE Rx
from the makers of First Aid, the Step 1 Qmax test bank is extremely similar to USMLE World in question style, degree of difficulty, and user interface. but i’m impatient with the slowwwwness of test and result page loading and there definitely are a few bugs. the percentages and stats (you vs. everyone else vs. just you) don’t seem to be working properly. as a simple example, if i’ve used 1722 questions out of a possible 2802, that is definitely more than the “52% usage” reported on my overview screen. occasionally, you don’t get credit for selected answers and a little ‘i’ indicating ‘incomplete’ shows up instead.

as a sidenote, i also have a 1-month subscription to the Flash Fact flashcard deck and love it. if you really want to memorize First Aid cover-to-cover, you need the flashcards.

USMLE World
i loved this question bank when i first subscribed back in MED 1 in September 2007. then i exhausted all 2000+ of the questions and noticed that they were no longer updating old answers or adding new ones. which is really too bad. reputed to be some of the toughest questions out there, this database could be strong and invaluable if it was kept a little more current and expanded on a regular basis.

… and that’s it! feel free to share your experiences with particular resources or let me know if you highly recommend something not on my list. good luck with your studies!

————
*but at least i have a green light for the Pathology shelf exam on Monday.

**i don’t have enough money to take one of the fancy review courses in the USA after Basic Sciences finish here on Nevis. so i am studying for our Comprehensive Final the same way i would for Step 1 and using it as a sort of test run to gauge how much work i have left once i leave here.

“It is not the mountain we conquer but ourselves.”
~ Edmund Hillary

video by my mom earlier this week. sound not needed unless you require a reminder of how windy it really is on the wide open prairies.

PS: still AFK and OOF, but will BRB ASAP.

an old meme that was circulating about a month ago. i decided to save it for today.

What are your middle names?
mine starts with G and his has 12 letters. that’s all you stalkers get.

How long have you been together?
exactly one year today!

How long did you know each other before you started dating?
we met at the start of MED 1 in September, 2007. so, 6 months.

Who asked whom out?
i kissed him first. he never would have made the first move. but he technically asked me out on our first “date” (not including the time he invited himself over for a pretend biochemistry study session or the weekends we spent with cadavers at 6am).

How old are each of you?
i’m 31 and he’s 24. he’s my Ashton Kutcher.

Whose siblings do you see the most?
he has no siblings. so i guess i win.

Which situation is the hardest on you as a couple?
we live in a one-room basement suite on a tiny island and attend the same classes all day every day. when we’re not in class together, we are either sleeping or studying or eating. together. all day. every day. and we’re stressed out about school. it’s really tough to pick The Hardest from such a short list…

Did you go to the same school?
we do now.

Are you from the same home town?
we are from different countries, so no. ironically though, our home towns are pretty similar in population, isolation, prairie-ness, hardworking farmers, and traditionally conservative values.

Who is smarter?
he wins with numbers. i win with words. although, he is MUCH better with words than i am with numbers.

Who is the most sensitive?
as huge as his generous heart is and as much as he loves cute kids and baby goats, my emotional sensitivity is tough to beat because it can be annoyingly off-the-charts some days.

Where do you eat out most as a couple?
our post-block exam tradition is to get take-out from Teahouse, a Chinese food restaurant in Charlestown. in the USA (and Toronto!), we like Chipotle.

Where is the furthest you two have traveled together as a couple?
the furthest from Nevis? Moose Jaw. the furthest from our homes? Nevis.

Who has the craziest exes?
we seem to live in a bubble relatively devoid of exes. it’s like they never existed. i guess that means they aren’t crazy, right?

Who has the worst temper?
my sensitivity with his temper can make for interesting arguments discussions.

Who does the cooking?
Brandon loves to cook and i am more than happy to let him feed me because he’s good at it. i do the dishes.

Who is the neat-freak?
he hates strands of hair anywhere and i hate toaster crumbs. i’d say we’re pretty even.

Who is more stubborn?
we’re both still here in med school on Nevis despite all of the trials and tribulations we’ve been through in the past year and a half. i’d say we’re pretty even with the stubborn gene. see arguments “discussions” above for further reference.

Who hogs the bed?
definitely me. i also hog the sheets or blankets. but he’s usually so hot that it doesn’t matter. although, there has been the occasional elbow (his) in the head (mine) that i haven’t reciprocated yet.

Who wakes up earlier?
i like to think i’m the early bird, but i don’t know how to fumble with turning off his alarm clock in the wee hours of the dark morning, so he is usually the one OUT of bed first. and then usually comes back to bed when the annoying buzzing-beeping has stopped.

Where was your first date?
our first real DATE Date where we went out for nice food and had romantic conversation was to Bananas restaurant, here on Nevis. later that night we went to the beach and watched the moon while talking about what we thought our future(s) might look like.

Who is more jealous?
i think he wishes i was more jealous. little does he know i would go Chris Brown on any Rihanna that looked twice at him.

How long did it take to get serious?
time is distorted on this tiny island, so i don’t know if i can answer this accurately. i know we started dating in March and by April break when i went back home to Saskatchewan, i really really missed him. like teenagers, we talked on the phone every night and sent text messages all day.

Who eats more?
he does. but he always teases me about eating between meals. so we might actually be pretty equal over the course of a whole day.

Who does the laundry?
i am not allowed to touch the washer or dryer. this is a good thing because i am deathly allergic to laundry.

Who’s better with the computer?
me. but i still can’t fix half of his Windows PC problems.

Who drives when you are together?
we take turns and are about even. but my island pothole-swerving or parking lot meandering usually gives him a literal and figurative headache.

[my previous shelf exams: Anatomy, Biochemistry, Behavioral Sciences, Physiology, Microbiology, Neurosciences and Pharmacology]

How I Study for Shelf Exams

at 1pm today (in the new building) we take* the Introduction to Clinical Diagnosis Subject Examination. our antepenultimate exam at MUA.

according to the NBME, we can expect to see just about anything on this exam related to our class that was intended to introduce us to clinical medicine and the art of diagnosis-ing. almost every disease, disorder, genetic abnormality, step of embryonic development, psychologic factor, facet of ethics and patient interaction is fair game.

yikes.

if you measured, i think my EKG would be off the charts right now.

————
*i still struggle with “take” vs. “write” an exam. Brandon thinks it’s weird to say “write” because we aren’t actually writing the questions. i think “take” sounds off because, um, where are we taking it? it stays on that little desk under your pencil.

break the tie: which do you use??

today we dress up like 3rd year medical students in our short white coats with nametags clearly displayed, clipboard in arm, a bag of tools at our side and stethoscopes casually-but-carefully slung ’round our necks. our task is to meet a pretend patient (aka: MED 3 student) and run through the entire history and physical exam to figure out what their pretend symptoms mean. in 20 minutes.

20 minutes might not seem like a lot of time, but i can’t remember the last time my doctor spent 20 whole uninterrupted minutes with me.

at the end of our exam, we present our findings to a pretend attending (an MUA professor), outline differential diagnoses, and list further tests we want to run or what we might to do help fix them. they ask us questions, point out what we missed and give us a grade toward our final Intro to Clinical Medicine class mark.

here is a list of the diseases and disorders and things gone bad we might see today:

Acoustic Neuroma
Acute Infectious Diarrhea
Acute MI
Alcoholic Liver disease
Anemia
Aortic Dissection
Aortic Stenosis
Appendicitis
Asthma
Bell’s Palsy
Benign Prostatic Hyperplasia
Carcinoma Bronchogenic
Carcinoma Prostate
Carcinoma Breast
Carcinoma Colon
Carcinoma Stomach
Carpal Tunnel Syndrome
CHF
Cholecystitis
Complete Heart Block
COPD
Costochondritis
Domestic Violence
Drug Induced Cough
Ectopic Pregnancy
Esophageal Spasm
Fibromyalgia
GERD
Gout
Low Back pain
Meniere’s Disease
Menopause
Migraine
MS
Osteoarthritis
Osteomyelitis
Pancreatitis
Panic Attack
Parkinson’s Disease
Pelvic Inflammatory Disease
Peptic Ulcer Disease
Pericarditis
Pneumonia
Pneumothorax
Polmyalgia Rheumatica
Prostatitis
Pseudotumour Cerebri
Pulmonary Embolism
Pyelonephritis
Renal Colic
Rheumatoid Arthritis
Ruptured Abdominal Aortic Aneurysm
Seizure Disorder
Sexually-transmitted Infection
Sports injury
Stable Angina/ Unstable Angina
Stress Incontinence
Subarachnoid Hemorrhage
Subdural Hematoma
TB
Temporal Arteritis
Testicular Ca
Thrombotic Stroke
Torsion Testicle
Trigeminal Neuralgia
Vasovagal Syncope

it all sounds awfully similar to the Physical Diagnosis practical exam in MED 4, but just a little worse. those patients weren’t actually patients because nothing was wrong with them. this is one step closer to what we will be doing for the rest of our careers.

i’m nervous. thankfully it’ll all be over in 20 minutes.