It's all in your head

one year later

2009-05-05T21:23:00.004-05:00

So here we go again. Another attempt at documenting my life, my career in medicine. A few updates... just graduated, G' turned 2, and we're packin' up the truck and moving to our new "southern" destination. Found a nice place, green as can be. In another month, I will be just about ready to start. Med-Psych. 5 years. Gonna be old when I finally get started. But it will be nice to finally get started. After all of this. Thanks to everyone who has followed along. I will try, but I may go into remission again.

"Time is priceless, yet it costs us nothing. You can do anything you want with it, but you cannot own it. You can spend it, but you can't keep it. And once you've lost it, there's no getting it back. It's just gone."

Stinky feet

2008-06-23T13:38:00.002-05:00

I did a consult yesterday on a guy with a dead foot. He was 70+ years old, had been apparently dealing with some podiatrist in Florida, and came here recently to spend time with his son. The thing I can never figure out is how a person's toes and foot turn black and pungent overnight. These people act like, bam!; all of the sudden, I woke up and my foot was dead. Perhaps it can happen that quickly, but when it does, be prepared, there is a vascular surgeon waiting for you, waiting to cut your foot off. There is really nothing else that can be done except amputation because the risk of systemic infection--which is usually well on its way--is a far bigger risk than trying to save a few toes or a foot. Anyway, this guys foot smelled so bad that I could barely stand there next to him. Sorry if you are completely grossed out.

Another lazy Sunday alone

2008-06-22T16:55:00.004-05:00

When I started this med school thing, writing seemed a perfect way to recollect all of the trials and tribulations. Turns out, all I have noticed lately are the trials and tribulations. I have had a very positive experience overall at this hospital learning surgery. Had it been in Orlando, or better yet, St Louis, perhaps Springfield, I would have truly enjoyed it. Half of my time has been spent actually actively participating in surgeries. Many of these are far to gruesome to mention out loud. But for those of you who have seen me, or at least spoken with me, you know the gory details. I have also gotten a bit lax. For instance, today, I am on-call. Normally, after morning rounds, I would try to be involved--either going into the OR or helping out on the floors. But, instead, I took a daytime nap in one of the call rooms, and now I am watching the Cards play the Red Sox. I think I was dissuaded by the fact that one of the potential cases today involved a patient who is HIV positive and another who is potentially (due to IV drug use). I just don't like taking chances. You might say it doesn't matter when you take the necessary precautions, but I am still green behind the ears, and with a baby, I don't want to take even the slightest risk. Less than 2 weeks left! Yahoo!

Roosting birds

2008-05-28T20:50:00.002-05:00

Being on-call is like when the birds go up into the trees for the night. As soon as there is a break, all of the med students and residents scurry to the call rooms on the 5th floor. Though the rooms are as small as any little walk-in closet, they are cozy and comfortable after 12-14 hours of surgery and floor work. As I write, I count the days til I am back in Orlando with Heidi and Gavin. Whew! I am counting this week over. 5 weeks to go!

Vascular and thoracic surgery

2008-05-26T15:43:00.002-05:00

Tomorrow begins a new 6 weeks. Fortunately, this is the 2nd half of my final 6 weeks of surgery. I will be doing general surgery from here on out. July 2nd cannot come soon enough. As of now, I have been doing vascular and thoracic surgery. Most of the thoracic surgeries were in the first 2 weeks and consisted of observing the chest wall being opened up and exposed. Inside the heart could be seen beating, and the lungs could be viewed slowly rising and falling. The vascular surgeries were where most of my stories originate. Some were surprisingly bloody. Others were surprisingly not. Carotid endarterectomies involve opening up the neck, finding the carotid artery, cutting it open, and removing the calcification. Vascular surgeons need to be very meticulous, as they are often exposing arteries and veins. I've also been involved in numerous femoral bypasses, vein procedures, and amputations. Take home point: do not smoke, control your glucose levels, and try to watch your fat/cholesterol intake. As you know, these all contribute significantly to damage to the inside layer of arteries and can lead to ischemia and eventual loss of a limb.

My dear grandma

2008-05-26T08:19:00.004-05:00

6 weeks down, 6 to go. Seems this surgery rotation goes on forever. I don't think it would feel so long if it were taking place in Orlando with Heidi and Gavin. Not being with them is definitely the most difficult part. Not knowing where I will live from day to day is a challenge as well.

I just returned to Worcester, Massachusetts, after being in St Louis since Thursday. My 92 year-old grandma died this past week, and because of that I got to see all of my family. She was a wonderful grandmother, and I will miss her dearly. She had aortic stenosis, and my dad made it possible for her to die at her home as she wished.

I have had a hard time so far dealing with her death. With this med school thing, I miss out on so much. That's what so regrettable about all of this. Although I talked to her often, I had not been able to see her very much recently due to the distance.

I used to go over to her house and watch the Cardinals while talking with her about life. Fortunately, I was able to see her on Skype a few days before she died. She was an instrumental part of my childhood, especially after she and my grandpa moved to St Louis from Michigan in 1978. We spent a lot of time together over the summers at their house. They used to take us to McDonald's and ShowBiz Pizza Place. We had so much fun. It will be strange once the realization sets in that she is not going to be present during holidays.

On to the next one

2008-04-10T12:54:00.002-05:00

As you may have noticed, I haven't been motivated to write in a while. Things started off well in Orlando, but now it is time to move on. Unfortunately, it is just me moving on. Cross off Internal Medicine, Pediatrics, Psychiatry, and now OB/GYN. Less than one year left in the first leg of this long process.

Heidi and Gavin will be staying in Orlando until my return in early July. Three long months begin this Saturday morning when I say my goodbyes and head back East. Fortunately, they will be coming to see me in just two weeks. Perhaps it will go by quickly--with hours from 5 AM to 10 PM, I think my time will at least be occupied by things other than sadness and worry.

It will be a challenge doing a surgical rotation under the Harvard residents in Worcester, Mass, but as Heidi has said, it will be a great experience. I found out today that I will be rotating with U-Mass med students, and my first portion will be cardiology, I think. Thanks to Marty, I will have a place to crash my first night, and I will get the grand tour of St. Vincent's Hospital bright and early Monday morning.

Of course, my worries are not with this new rotation, they are with Gavin and Heidi. I worry how my absence will impact the Gavinator. These are special days of development for him, and I know how important a father's role is in a boy's life. My eyes well up thinking about being gone, hardly the tears I will shed during the long drive this Saturday and Sunday. Hopefully, the surgery audiofiles will make me temporarily forget all that I am leaving behind, of course, only for the moment and out of necessity.

More to follow.

in a flash

2008-01-18T18:11:00.000-05:00

I'm on my last day of Peds. Perhaps it is time to go. When the frequent flyers start to recognize you, maybe it is time to move on. Much of the same all week, colds and the flu. I am proud to say that I can consistently diagnosis the influenza virus with just a few questions. Fortunately, I have been backed by the 15 minute rapid flu test. Monday I will begin to drive 37 miles each way to Orange City. I've spoken with the secretary of the psychiatrist with whom I will be working, and she seems very nice and enthusiastic--always nice to receive a warm welcome. Psych will be a good return to something that comes easy, something familiar, though I hope there is a chance to truly learn. From what I have heard, I think I will be in for a very positive experience.

Sick.

2008-01-12T08:35:00.000-05:00

I'm angry. I've managed to avoid getting sick for well over 3 months by taking the usual precautions--frequent hand washing and other simple measures--like not getting in the line of a coughing fire. I've seen numerous kids lately with strep, the flu, and a myriad of other viruses and bugs. I haven't had one symptom. Now, after waking with a sore throat and a rumbling stomach, I realize I have caught the bug from the stupid doctor who selfishly came to the clinic sick. And Heidi "doesn't feel right"; Gavin is irritable, restless, and showing signs of something too. Sick.

"You Make Me Sick"

2008-01-11T10:22:00.000-05:00

Why would a physician, who is obviously sick, continue to provide care to her patients? This is what I have had to deal with for the past two days: a sick doctor, wearing a mask, complaining continuously (with grave misperception), about nagging and off-base parents of child and adolescent patients. Not only is it unethical to continue to practice in a compromised state, it is also rude. Now, after spending two days under this lady's supervision, I have developed similar symptoms; and so has Heidi. (And therefore, so, too, soon will Gavin.) So, when you go to your doctor, take what you hear with a grain of salt. For some of what you may be told may be nothing more than nonsense masked by cold medication and a physician who shouldn't be working that day (or maybe any day) in the first place. More to follow.

The getaway

2008-01-10T11:57:00.000-05:00

I walked into the urgent care clinic yesterday, and the usually energetic doc was not as characteristically chipper. She barely said hello in a hoarse and fading voice. Now granted, I could quite easily tell she was not feeling well. But I am quite certain that this lady has Bipolar Disorder; without revealing too many details, (so as to not disclose personal info), I will leave out some of my reasoning as to my basis for the diagnosis. Regardless, my first objective was to provide her with a copy of the evaluation I need so that I can receive a grade for this rotation. I hesitated, then decided, while she is weak, her evaluation of me may be strong--probably out of feeling downtrodden. I handed her the form, explained what it was, and she immediately filled it out. I'm sure she doesn't always understand some of what I say--either out of language barrier issues or because she does not listen or because she does not understand. This leads me to the story I will now tell:

First patient to arrive was a one-month-old girl just now barely full-term and a mere 4 pounds. The parents were what some would call "rednecks", though they were not rednecks in the classic sense, but more so in a Floridian way. Both were short and petite, smelled of cigarette smoke, and neither likely had more than an 8th grade education. Dad was unshaven and unkempt, about 39 years-old, and his Southern drawl made it difficult to understand exactly what he was saying. Mom was short, 27 years of age, and obviously a few cards short of a deck. They were worried about their little preemie, who, after all, looked quite healthy to me. She had been vomiting four times per day, right away after each feeding. The formula had been changed recently, for some reason, and these two bits of info, in combination, made me immediately think that it was related to reflux. Plus, they were feeding her 3 ounces every two hours. That's way too much for a preemie with the stomach the size of an olive.

I walked in ahead of the doc and began to obtain a history. As usual, this doctor starting chasing zebras. I could see the gears in her head quickly shifting. After exminaing the "looks good to me" baby, the doc quickly said, "She needs to be hospitalized." She went on to confusingly explain that she suspected pyloric stenosis--a kink in the GI hose that causes projectile vomiting in newborns. Just to step back for a minute, the child had been gaining weight, she wasn't dehydrated; so to quickly think through this one, any old med student could rapidly conclude that this was not so much a malady as an educational opportunity.

The parents didn't understand. They became visibly anxious. The doctor walked out believing they had refused hospitalization. I would have refused hospitalization. But at this time, it was clear that this doc was amped on some sort of cold medicine--probably pseudophedrine--and she wasn't thinking very clearly. Of this, I was certain. So, for the moment, I listened to her complain that these parents were both "retarded" and on and on. So while she was preoccupied with something else, I went back in and explained, in plain English, the nature of pyloric stenosis. I also informed them that any hospitalization would be mainly to do a test and observe. any preemie who vomits a lot should theoretically get easily dehydrated. A simple urinalysis, which is routinely done at this urgent care clinic, could be done. I had no idea why I was telling them this knowing full well that the doctor would likely come in at some point and screw things up.

I made it out safely, smoothing things over. The parents understood, and they were at least willing to go along with this outlandish plan. I informed the doctor, and for some reason, she began babbling again about how the parents are retarded. I knew very well that they weren't the brightest of the flames, but it was obvious, they loved this child, and they were there to try to do right. Well, long story short, they grew increasingly anxious. the doctor left them hanging while another patient came in, and I tried to ease their worries in the mean time. After a long while, I, too, grew tired of waiting, and sort of hid out in another room, out of their sight. I couldn't only delay for so long, and then it was up to the doctor to explain her stance and the reason for the long wait.

In between the mess that this doctor created, I started to see a 17 year-old girl who had been sent by her primary care physician for "fluids". Apparently, this girl had been dragging for weeks, and she had tested positive for infectious mononucleosis. As I gathered the history, in full clear and lucid thought (and with good rapport with the mother and patient), the doctor walked in. Of course, she interrupted and confused the entire issue. Now, picture your doctor walking in during the middle of your time with a mask on and speaking softly with a raspy voice. This is what I was up against. It wasn't but a matter of minutes that my rapport had deteriorated to little more than complete confusion. As we walked out of the room, I heard all about how this mother was crazy. Again, I attributed this to paranoia and misperception secondary to cold medicine. But I was caught in the middle with no authority to try to make things right. Two separate sets of people, both looking for a solution, both ending up with a complex scenario having nothing to do with getting any better.

It wasn't long til I heard the back door slam shut. The parents of the preemie made a run for it. a call came in to the front desk from another employee who observed them leaving as she left the building. Soon it was Dr. Paranoia raising a stink, demanding the the Division of Children and Family services be called.

And on to the next victim

2008-01-03T08:05:00.000-05:00

I have 2 weeks of Peds remaining. Yes, it has gotten extremely boring. I hate making kids cry. That is what Pediatricians do every, single day. You work hard to get the kid's attention and trust only for long enough to take advantage of that same innocent desire to believe in what you have quickly sold them. Then in a flash, you're gone. The child is wailing. And on to the next naive victim.

Red from me?

2008-01-01T08:05:00.000-05:00

As I dug my way deeper through the thick wax filling this young girl's ear, (like the sun rising over the mountainside), the landmarks became fully clear. This was the most wax I had removed from a single child's ear, and I knew the left side would be a similar endeavor.

The 5 year-old girl was amazingly still through the entire procedure on the right, so I anticipated much of the same on the left. Normally, a kid, (especially the littler ones), starts out screaming from the time they hit the paper on the examining table. This girl was different, a pleasant surprise.

So I started to clear the left ear canal of cerumen. For some reason, it didn't come out as easily. In fact, it didn't come out at all.

I scraped, then looked inside with the otoscope. Nothing. "Hmmm...", I thought. "Try again." My second attempt. The girl abruptly twisted her head. "Oww!" The girl started crying. I apologized and took a look inside, as the ear canal was now likely clear.

Bright red, just as I thought. But I wondered, "Did I cause this?" I had no way of knowing if the eardrum was already inflamed before I dug may way in. It wasn't bleeding, so I didn't puncture the TM. And it couldn't have become erythematous in seconds just from irritation, or at least I had hoped. I felt bad. She was there to be fixed, not broken. This is how we "practice" medicine, I suppose.

chief complaints

2007-12-26T07:53:00.000-05:00

I saw an 8 year-old kid the other day whose chief complaint was an ear ache. Turns out he had a perforated tympanic membrane (TM). If you recall (or just simply know), this is referred to as the "ear drum". It tends to get popped when a stick enters the ear canal causing trauma to the TM. This kid found out the hard way when his friend decided to pierce his ear with a stick.

A 5 year-old complained of pain in his eye. Some fluorescein eye drops showed a 4-5 mm corneal abrasion. This tends to happen when another kindergartner pokes you in the eye.

I saw another 2 year-old kid whose chief complaint (as written by her mother) was simply, "smelly nose". Upon further and close examination, it was revealed to me that her smelly nose was due to a 3-5 day course of wadded tissue paper carefully placed inside her nasal cavity. Of course, her mom tried to feel the child's nose, but she guarded it successfully every time. A light and a pair of tweezers combined with an easy pull (and some minor screaming) and the rancid odor soon became a bad memory.

Another 4 year-old kid's chief complaint (as written by his father) was "knee hurts. He has sick cell". Enough said.

The usual complaints of kids

2007-12-19T09:26:00.000-05:00

Tonsillitis, conjunctivitis, pharyngitis, allergic rhinitis, bronchiolitis... It's all about the eyes, ears, nose, and throat with these kids. It's good that I am now getting to really use the otoscope and see how normal and abnormal ears (read: tympanic membranes, TM) look. So far, 8 times out of 10, there's so much wax in the ear canal that the TM is obstructed. Combine that with a screaming, crying little kid, and you've got yourself a little problem. Because your boss (read: the doc you're working under) wants to know the source of the infection. It's only when there is evidence of infection, such as a higher fever, and no source, (such as a red, swollen throat or red ears), that the situation becomes more severe. If there is no source, septicemia (an infection of the blood) has to be ruled out. This means blood has to be drawn and sent off for culture to see what microscopic bug grows. This takes a few days, and the management of a blood infection requires high-dose antibiotics and usually hospitalization.

Spare change

2007-12-18T10:03:00.000-05:00

A kid came in this past Thursday night with a set of x-rays showing a perfectly round, clear object in his belly. Apparently, he was low on nickel. Not anymore. His mother almost glowed while she emphasized how she has sifted through all of his poop for the last several days looking for this now valuable coin. No such luck. A repeat x-ray showed it had likely passed while the kid was at his father's house. Of course, the dad told the mom he had been checking the poop too.

Jacked in South Miami

2007-12-16T12:24:00.001-05:00

Dare go to Miami. The drive down was a nightmare. I sat with the engine and lights off, in the dark, in the rain, for over an hour due to an accident. Never did see it. But I saw about 9 others instead. The roads are all under construction. I drove around for an extra hour even with my Garmin GPS. Next day, after the exam, I walked out to the parking garage and could not get in. The sign said to go to Level 2 and go across the skypass. As I finally made my way to my car, I noticed I left the window open. A closer look revealed that it was not just open; it was smashed open and now in a million pieces all over the inside of the car and on the parking lot floor. As I took a closer look, I knew my beloved Garmin was gone. I just hoped my laptop was still safely hidden under the large duffle bag in the trunk. Needless to say, all of my photos and videos of Gavin and my med school resources--gone. In a flash. I would only begin to add up the loss in the moments of panic that ensued. Grand total (with the aforementioned and my external hard drive minus the sentimental and priceless objects): well over $5K. I can deal with the loss of material objects. I even password protected my laptop. What I have a hard time parting with is all of the photos that I have compiled over the years in Grand Cayman and Portland and of Gavin and family and friends and all of the photos that I had hoped to portfolio one day. And although my laptop had been replaced in the past year (due to Dell's warranty), if you may recall, it was a gift from my brother, Dennis, for starting med school. So to all of you thieves out there, as Heidi's dad said so well, may you experience "severe chest pains all night compounded by an acute case of athletes foot and other fungal infections to all parts of their body".

Numero Dos

2007-12-12T21:01:00.000-05:00

Day # 2, pediatrics. Ear aches, sniffly noses, crying, cranky babies. For some reason, it's not as much fun to see the little ones in agony. Adults, yes. Perhaps it's just unconscious revenge. Or maybe it's because the older ones can modulate and hide the pain, and this makes them bearable.

If we were to be real, fully real, we, too, would cry out loud. We would twist away from noxious smells, sounds, people. We would tell it like it is. Sometimes I think it would be nice to give words to little bitty kids so that they could give this politically correct nonsense an about-face.

As for the routine, so far, it has been great. In at 1:30 PM or so, and back by 8PM-ish. Yeah, I might not learn Peds very well, but I have the necessary resources to pass the USMLE. So the story goes.

Flipper

2007-12-11T20:55:00.000-05:00

Heidi has helped me realize the importance of being early. So I arrived at the Pediatric clinic today about 30 minutes early. As I walked in, I walked past a family of three: a typical husband and wife with baby waiting for the clinic to open. First patient, a very small baby with a big head, flippers for legs, and doll's eyes lying on her back on the examining table, barely moving, the kind of thing you see in a medical text as the worst-case scenario example.

No matter what anyone says, the things you do in life are taken in, swirled around and processed, and then are somehow, perhaps unconsciously, applied to oneself or one's situation. I could never imagine having to take on the enormous responsibility of 24/7 care of a crippled child.

Call my terminology politically incorrect, but it becomes real when you fail to sugar-coat some sad realities of life. Perhaps our overly selective choice of words helps to depersonalize the humanity in one another. Does this make it easier to avoid having to face that which is what it is?

Anyway, this little girl, barely 3 and 1/2 pounds, has a ventriculoperitoneal shunt relieving the pressure on her brain, significant hearing loss, spina bifida in one the worst forms (meningomyelocele), failure to thrive, bilateral hip dislocation, and (as if she needed anything else wrong), 2 ureters coming off one of her kidneys resulting in a neurogenic bladder.

Of course, my thoughts were immediately of Gavin: his ten fingers and ten toes and almost always happy disposition. How are these blessings and curses handed out? What does one need to do to get it so wrong that this type of lesson needs to be learned? I mean, you could write off a God with something like that; or you could try to morph it into a rational and positivistic mold and apply it to your situation, but let's face it, there's no right way to interpret a total disaster. Gavin's the exact opposite. Have I done a whole lot of things right? Or are my life's lessons going to be learned in some other arena. God, I hope so.

Butterflies

2007-12-11T08:03:00.000-05:00

After a while of doing this medicine stuff, you start to lose the pre-game butterflies. Each rotation is like starting a new job. Imagine having a job where every 6 weeks or so you moved on to a new location, with new people, a new boss, a new system... The learning curve is steep, but you learn to learn learning curves. In a way, it keeps it fresh and new. But remember, the grass is always greener.

These rotations are simply about numbers: seeing as many patients (read: people) as possible in 2 years so that when you get out (sort of) on your own, you have a clue as to what to do. Things that might have baffled me prior to IM, such as how to manage a diabetic ketoacidosis or hyperglycemic hyperosmolar non-ketotic acidosis, become fairly routine (or at least you understand what you are doing and why). But walking into the clinic today, I bet those butterflies will start to swirl in my belly.

First day of Peds

2007-12-10T13:20:00.000-05:00

My first day of pediatrics, and I am off! Nope, not as in leaving to go to a new place, but as off as in not going in. I had to take some paperwork to my school, and I waited for calls back, but none ever came. Finally, I got the call, and I found out that I will be doing Peds in the office for now. 2PM til midnight. Quite a change from up and to sleep early.

IM & Peds

2007-12-09T13:27:00.000-05:00

After 12 weeks, I have finished the actual Internal Medicine rotation. I still have to do the logs, turn in a survey, and drive to Miami for the final shelf exam. I think Heidi, me, and Gavin will be heading further south this coming Friday. I was supposed to start Pediatrics tomorrow, but because of paperwork, I'll begin on Tuesday. I could use another day to study. I sort of wish I would have documented more of my first rotation, but I didn't. I can tell you that I learned a lot, and I was given a lot of freedom to learn medicine. Maybe more during this one...

4 mos and counting...

2007-08-23T11:26:00.000-05:00

3 mos later

2007-08-19T23:34:00.002-05:00

Three months ago, I decided that I would learn how to relax again. I feel confident that I have done just that. I’ve watched G grow from a little peanut into his big shell. He has doubled his weight and added several inches. He smiles and squeals and cries to be held. He likes to be carried when he is upset. He has changed our lives forever, as well as the direction that we might have otherwise taken. It’s time to get back on track. It’s time to end this summer’s abeyance. Soon we will begin another journey.

Step 2 CK

2007-05-17T12:41:00.001-05:00

I just registered for a “field trial” for Step 2CK. Apparently, the National Board of Medical Examiners is testing new software, and I was chosen to try out the new software/interface. This will give me the chance to test drive Step 2. If all goes well with the software, I will get results. Maybe this will help me do well on Step 2 Clinical Knowledge. So I plan to study for this exam during July and sit for it on August 4th, in Creve Coeur.

Still sinking in

2007-05-09T23:13:00.000-05:00

Like sky-diving... if everyone could be so lucky to experience this... Dive if you can. Live when you can.

Who are you?

2007-05-03T20:47:00.001-05:00

Like catching a fish: the most important detail to pass along—the weight and size. 7 pounds, 4.2 ounces. 20 and ½ inches. Two little, bitty eyes looking at me as if to say, “Who are you?”—just like the fish. Only this one cannot be thrown back. This one is a keeper. Medicine can wait—at least til September.

Meet Gavin.

2007-05-03T20:47:00.000-05:00

The other side

2007-03-06T21:45:00.000-05:00

I've been doing a lot of thinking, and I've decided to suspend my life like a puppet on a shelf hanging from its strings. No phone. No email. No internet.

Heidi suggested that I take a hiatus from the world until this exam is behind me. I couldn't agree more. So if I do not call or write, rest assured, I will do so as soon as I take Step 1. I have not posted because I have been studying non-stop, plus a few days missed being sick this past week; but I have a lot to say, much of which has accumulated over the past month or so of not posting. Much more to come... Please keep me in your prayers. Also, please pray for Heidi's father who broke his calcaneus (heel) and a vertebrae in a fall yesterday. I will see you all on the other side... of Step 1, that is. Thanks again for all of your support: family, friends... all of the important people who have made this journey possible for me. It's all soon coming down to 350 questions. May I know at least enough to hit the mark.

This quiet place

2007-02-06T10:40:00.000-05:00

There aren’t too many places in the world where one can find solitude: a place where there is absence of human activity. This is the reason many hunters and fishers go out into the wilderness, even when it is 10 degrees outside.

Because my free time lately is limited, I look for a taste of solitude in Churches and in libraries. When it gets so quiet you can hear yourself breathing, you know that God is all around. That is why I am reminded to say thanks during the many hours spent at the library. Daily, now, I spend countless hours staring at pages, wondering if this journey will be worth it.

Sitting at a table overlooking some large expanse of (now frozen) water and the downtown of Maine, I dwell on medicine and life. Never do I find I make much progress on either.

Toward the end of the night, the silence fills the room. It is amazing how quickly time goes by as I read and read until the buzzer sounds reminding me that I must soon leave this quiet place.

The real deal

2007-01-22T17:05:00.000-05:00

Today I scheduled to sit for Step 1 on Thursday, March 8th, (which is also my dad’s birthday). As I move closer to this date, I will continue studying for at least 12 hours per day (including review time, of course). It has gotten easier to study for longer periods of time as I have progressed. As well, I have started to gain confidence in my knowledge base, and I know I still have a lot of work to do. It’s all about reading and then seeing a lot of questions. So far, I have done half of Kaplan QBank—an exam bank of 2100 questions. I have a long way to go if I want to get through each of these questions twice before the real deal.

Grinding

2007-01-20T17:44:00.000-05:00

I just received confirmation of my scheduling permit to sit for Step 1. This means my only next step is to actually schedule the exact date of the exam. I have between March 1st and May 31st to take this exam, and I am getting more and more eager to do so as the review days move forward. It is not nearly as intimidating as I had expected it to be. I still have a tremendous amount of work to do, but I am gaining confidence as the days pass. Also, I am reassured that I can reschedule the date as necessary within 5 days of the date I set. A passing score on the final comprehensive exam certifies that I am ready to sit for Step 1. That will take place in quite a while, so until then... I will keep grinding away.

Stepping it up

2007-01-10T23:18:00.000-05:00

First official day of review for Step 1. The material is covering molecular biology, genetics, and biochemistry. The professor, Dr. Reichenbecher is excellent. He is a professor at Marshall University School of Medicine in Huntington, West Virginia. Even after having taught this stuff for 25 years, he is very much enthused and seems very eager to ensure that every student learns as much of what he knows as possible. This has really encouraged me to learn some of the stuff that I really glossed over in the past and didn’t feel too interested in. Great teachers always have a way of igniting a spark in students. I have seen so many professors in my short, but involved, medical education that it quickly becomes obvious as to the quality of one’s instructor.

After a brief orientation and look over the schedule for the next six weeks, I have quickly realized that this ride is going to be a fast one. Six weeks of really long days with little time to go home and review. We spent only 4 hours in lecture today, but tomorrow will begin the real deal when we swallow 8 and ½ hours of lecture whole. This means, after sitting for all that time, I will have to go home and review it all again before going back for much of the same the next day. That poor professor has to stand for the entire time. I do feel bad for him, but when someone mentioned that to him, he replied by saying, “I feel sorry for you guys who have to sit for that long.”

I think I will post the general schedule here so that some of you who may wonder know where I am during these days. I do have Saturday off this week to study on our own. Next week, I will begin a review of Anatomy. This really covers histology, embryology, and gross anatomy. That will go from Sunday until Wednesday concluding with an assessment. Right after the assessment, I will have a 4 hour exam to see where I stand.

I then get three more 8 hour days of Behavioral Sciences concluding also with an assessment. The following Monday—01/22/07, I have the day off to study. But then I get ride back to it with Microbiology and Immunology on Tuesday. This last til Saturday the 27th. Sunday the 28th is another day off. The following Monday is the first 8 hour exam, and Tuesday gives me a day of rest/study/catch-up. I will post more as we move along. For now, that seems confusing enough.

If today sets the tone for the entire review, I will be extremely pleased. So far, it is long, but excellent.

Ad infinitum

2007-01-07T19:39:00.000-05:00

So much to study, so little time. I am trying to get all of my study materials in order. I have so many books that the only thing I look forward to is passing this stupid exam so that I can sell them on Ebay.

I have been going through a book I bought from a Christmas present from my friends—Nathan and Eileen. They gave me and Heidi a Borders’ gift card, and since Heidi thought I would benefit more from using it, I chose to get a USMLE review book. It’s called Deja Review. It is organized in an organ systems format, and it provides high-yield facts for memorization.

One half of each page has questions or cases, and the other half provides the answers. When I arrived in Portland, and I began to get organized for 6 solid weeks of study, I broke this book out and folded over each page. I like the size of it because it is not too heavy and can be held like a larger novel. It contains about 350 pages of really great information. I also have a new set of Biochem and Micro flash cards. I am definitely weak in Biochem, and these are helping to inspire me to learn this necessary info.

I realized that I don’t have to go to school til Tuesday, so I have tomorrow to continue to get organized and study. I think Wednesday marks the beginning of my 6-week review course. This course apparently goes from 8 A.M. to 5 P.M. five days per week. I have heard that, depending on the instructors’ schedules, it may include weekends as well. I also am taking two Master’s classes this semester, but I do not plan to devote much time to these. Likely, I will study during these two 3-hour once-per-week classes. Fortunately, I had friends who took these classes last semester, and they gave me really good insight into the easiest professors. From what I have learned, the professor who is teaching both of my classes lets class out early on a consistent basis. As well, I am pleased to recall that I can miss two of these classes, and I will plan to do so the 2 weeks prior to taking Step 1. I am going to make my way to the SJCME campus tomorrow to try to get the classes finalized.

Beyond the safety of youth's freedom

2007-01-06T09:00:00.000-05:00

Saturday night. Not a soul that I know in these parts. The free internet is now gone. So I am forced to study and wait for someone familiar to call.

I woke up around 10:45 A.M. a bit confused and disoriented. I knew my body was tired from traveling, and my heart is heavy with the sadness of leaving Heidi and my family behind. I feel a bit of guilt, but I suppose that is normal considering the circumstances. I have to get my head in the game so that I can be successful in this mission. It is a mission. I must succeed in my mission.

I think my mom said it best when she told me today that it is normal to be feeling what I am feeling—considering the difficult task that lies ahead. I truly don’t think I would be able to study back home. At the same time, I just worry about back home. Premonition and intuition create an undue anxiety that only can be relieved in due time.

For now, I must focus on my mission. It seems that time moves so quickly, and I just wish I would have committed to this journey earlier in life. Time can be both a friend and enemy. While I sit and wish for time to go by, I simultaneously wish for additional time to study.

It’s not that I feel too old; I am just beyond the safety of youth’s freedom. Whereas some would say, “What do you have to lose?” –I would suggest that time is more important now than in the past. Every move I make requires careful consideration, much similar to the moves made in a chess match. Could it be that what I have to lose is more important than what I have to gain? Or could it be that the potential regret I may gain is far more costly than any loss I could realize? A dilemma perhaps, but only one that will make itself known in due time.

4:21 A.M.

2007-01-04T09:00:00.000-05:00

Driving back to Maine in a lot of rain… Spent the evening Thursday night with my great Uncle Frank in Akron, Ohio, ten hours into a 2-day drive to Maine. We met at the bowling alley where he bowled a few games, then we went to a late dinner. My Uncle Frank never ceases to amaze me. At over 80 years of age, he bowled 3 games—and he not only kept his 174 average, he did so after playing softball earlier in the day.

We arrived at his house around 11 P.M. We sat and talked, and then I gave him the gift my brother, Dennis, had sent. As he opened the package, I took a few photos of him. He was very pleased to receive the micro-helicopter. As he made his first flight around the living room, I took photos. We talked til about 1 A.M. before calling it a night.

When I awoke, Uncle Frank was already up reading the news paper at the kitchen table. He invited me to breakfast, but I graciously declined, as I was still full from the late dinner the night before. We again sat and talked for a while before I began the long journey back to the Northeast. Since he is going to Maui on the 14th, I was excited to tell him about Heidi and my trip there the April before last on our honeymoon. Recollecting the helicopter trip we took all around Maui, I wished myself back there with her for only a moment.

My drive was difficult, but it was made much easier by the new navigational device I received for Christmas from Heidi’s parents. I am still amazed at the caliber of this tool. Not only does it provide the path of least resistance, it also gives directions to fuel, food, and lodging; and it breaks down your travel into MPH, miles to go, average speed, total time traveled, and other really cool things. I had to make several calls to my dad, Heidi, Nathan, and some friends, as the loneliness of the drive set in early. The most difficult call was to my dad. I felt the tears welling up in my eyes as we talked. Heidi cheered me up a bit, and then I just took the dry time to study flash cards and kept my wandering thoughts off of those things I had to leave behind.

Since it rained from Ohio to New York, then stopped for a short time before continuing all the way to Maine, I had little opportunity to study flash cards. And since I couldn’t sync the Goljan files to my Zen the morning before, I was forced to listen to music and focus on the road. Fortunately, I had Mat Kearney with me. He kept me company for several hundred miles. Eventually I was singing along with him.

Although I could have set the parameters of the GPS to avoid tolls, I did not, fearing my travels would take several days. I swear, the tolls are the work of socialists. I spent approximately $20 getting from New York to Portland. I started counting the only-option McDonald’s along the way, but I lost track somewhere after 25 of these. I cannot believe how different the East Coast states rely on these inferior services. Just to get off of those tolls takes far too much time. They are built to keep you away from anything except McDonald’s and their own over-priced gas stations.

Much to my dismay, I arrived in Portland a bit over schedule around 10 P.M. on Saturday night. The weather was unseasonably warm—approximately 60 degrees—apparently a record high for this place. There was a heavy fog filled with premonition. The apartment was as I had left it with a bit of cleaning to do in the bathroom. As Heidi likes to do, I brought some of my belongings in right away and unpacked. I had a difficult time falling asleep, but I finally last recall seeing the time around 4:21 A.M. This time away from Heidi and my family will be most difficult, but without the usual distractions, I may have a shot at taking Step 1 during the first 2 weeks of March.

On a whim and a prayer

2007-01-03T09:00:00.000-05:00

Wednesday night. Late into the night, I cannot sleep. My mind is wandering all over the place, and some of the thoughts I have make me wonder if this is the right time. Should I stay? Or should I go? I get up to try to utilize this otherwise useless energy. I consider the anticipated road ahead and remember that I must use all of my time efficiently. So I first delete the unorganized Goljan Path MP3 files, then try to sync the more organized ones to my Zen. No matter what I try, nothing seems to be working. I am discouraged so I try to go back to bed.

My mouth is dry from the last supper at Chevy’s. Although there was little said, I truly enjoyed this time with family. I am going to miss this place—not just Chevy’s—and these people as I try unsuccessfully to depersonalize my loved ones. It doesn’t work. It is late. So I go downstairs to get a drink of water. I know I have to get to sleep, as the drive tomorrow will require a solid 9 hours.

Although I am trying to be a soldier, my mind reminds me that I am not heading to war. I make believe that I am on a mission—one that was maybe of more importance in my past. Maybe I can find satisfaction in what I had been doing. Maybe I can make enough money to make it. Maybe I should consider calling it quits, as I believe I have proven to myself that I can be successful.

Have my goals shifted so much that I could walk away right now? I wonder for a moment before I drift to sleep.

Morning comes too early. I am irritable and anxious. I take it out on Heidi subconsciously realizing that I am trying to make it an easier break. It does not work. I watch as Heidi leaves for Springfield. My eyes well up with tears. I end up leaving in a hurry, although I am already an hour behind. Still the files would not transfer, and the rain has begun to fall. I try to begin the long drive. I remember I had another bag with important belongings. I call Heidi to tell her that this bag is in her car. She agrees to meet in Collinsville. This forces her to remain behind as I travel the necessary 20 miles. We meet again at McDonald’s as a matter of convenience. I get the bag as we both watch smoke rising from the hood of my car. Could this be a forewarning of things to come? I think too much about what might be.

As Heidi pulls away, I force myself to be brave and focus on the task at hand. I realize now, it is just me and the road. As I gas up the gas-guzzling SUV, I, too, pull away and open up wide the engine. I get out the St. Jude prayer card and place it on the center console. Realizing those things that lie ahead, it is only me left to console.

Registering for Step 1

2006-12-15T11:56:00.000-05:00

Minus paying the application fee, I registered online to take Step 1.

Amazing.

I have watched others not make it this far, this fast, and for my accomplishments, I am proud. I will have a window of three months from which to schedule an actual date to sit for Step 1. For now, I am approximately three months out. I have a lot of work to do before March, April, or May. It is going to boil down to knowing as many of 350 questions to earn a passing score. This will be my ticket into the world of clinicals.

Time is my enemy now.

Heartless?

2006-12-04T15:10:00.000-05:00

On just a few hours of sleep, I am sliding by:

Path Exam 7—check.
Patient-Doctor Relations Final—check.
Patient-Doc Full Physical Exam—check.
Pharm Shelf exam—check.

I still have the Path (shelf) tomorrow, the Genetics Final on Wednesday, and the last Pharmacology exam on Thursday. Long week ahead, but soon I will breathe easier. A little sacrifice goes a long way in the home stretch.

I am trying not to look beyond these critical, make-or-break exams. I have sealed up one acceptable grade (Patient-Doctor Relations), even though the physical exam didn’t go as planned.

My patient and I arrived at school around 715 A.M., sleepless, yet unafraid. The Professor had not even arrived yet. We made our way into the clinical skills lab, and my examiner proceeded to complete his exam on me. He moved to the end, entirely forgetting to examine my heart. He stood there for a moment before he was about to throw the towel in. The professor looked at me and said, “You’re missing something big.” The professor was looking at me when he said this, and out of a knee-jerk reaction, I placed finger over my heart. This was not intended to be a prompt for my examiner; it was more of a response to the professor. Needless to say, he did not take it as such, and he became angry. “No clues! Now I am going to grade you much harder for your exam.” My examiner stood there for a moment running through the thoughts in his head. Finally, he remembered what he was to do. He had skipped several things, but he pulled it through in the end.

Feeling small and trying to reconcile the thoughts of insinuation of cheating, I tried to recover. My voice quivered as I began my exam. My concentration was off. I had done this exam a million times before, but now, feeling belittled, slowly I worked my way toward confidence. I finished the exam without too much difficulty.

As the professor began to critique us, he chose to start with me. Right away, he informed me again that my grade was lower because I had provided my examiner with a clue. Again, I said nothing in dispute, but afterwards, after a lot of thinking, I could have had so many things to say. But I chose not to at the time. “I am giving you a B”, said my professor. I stood tall, remaining silent, knowing that his thoughts were that I had cheated. I knew I had no intention as such. For my examiner, the professor gave him a high B/low A. I was crushed. At that point, I knew my chances for an A in the class had likely slipped away. No final grades are given until all of the students are graded, but my professor had made up his mind.

Heidi suggested that I try to speak with him, but I have chosen to let it go. It is really not that important, but knowing I did work hard for a good grade, I am a bit displeased. A large part of my Thanksgiving break was spent preparing, and I knew I had prepared well. Perception is what one perceives. If another tries to dispute one’s perception, the other will certainly deny the other’s perception. So, for now, I will go back to Pathology, then Genetics, and finally Pharmacology. Hopefully, by Thursday afternoon, I can get some sleep before I leave for my great uncle’s in Akron, Ohio,

555-555-5000

2006-11-28T20:43:00.000-05:00

Another exam complete. One down, six to go. With my new prayer card from my Grandma Paruch burning a hole in my pocket, and all my family’s prayers floating in on the jet stream, I survived the Patient Doctor Relations final exam. The pressure is always on when these final exams carry such weight. It feels good to have another down, but to arrive at this point simply means there’s another one looming right around the corner. Move to tonight:

As I attempted to duck for cover, (amidst the heat of a 7th Path exam this coming Thursday), I felt a buzz from under the covers. I searched for a moment for my phone, and much to my surprise, I saw a very familiar number. It’s one of those numbers one could never forget. Although I’ll keep the exact number discrete, I’ll just say it’s something like 555-555-5000. I hurried to answer it since I knew the several reverberations were soon coming to an end, and the call would go into voice mail.

“Hi Uncle Frank!”
“How did you know it was me?” “I saw your number.”

I had reminded myself earlier today to call my uncle, but like most of this medical stuff I try to freeze into my head, it had already faded like one of those long summer nights.
Apparently, my mom had recently informed him by voice message of my desire (or shall we say, non-pre-approved plan) to stop by and see him on my travel home. He had just returned from a trip to visit his son, grandson, and family in Oklahoma. Rather than call my mom back, he decided to call me.

“When are you coming?”“December 8th, if that’s all right with you.”
“How many beds should I have made up?”

We talked for a while about his trip to Oklahoma, as well as his summer softball tournament in Las Vegas. Unfortunately, his team belly-flopped in Vegas during their most recent tournament. Had he not played with the young guys—the 70-somethings—he would be proudly displaying another championship ring on his finger. I look forward to my time in Akron, but for now, I will get back on the path.

In your own special way

2006-11-27T00:54:00.000-05:00

Anxiety is beginning to set in…for a few things: (1) all of these upcoming exams, (2) the long drive home, and (3) the challenge of putting together a comprehensive Step 1 study plan. Another semester has come full swing. From the humble beginnings in Grand Cayman to the intense finish in Maine. They say nothing comes easy… but if it did, I wonder, would it be truly worth it?

I have a Final Comprehensive exam in Patient Doctor Relations on Tuesday. Thursday morning, I will be graded in the same class on a full physical examination. The pressure will be on me as I am critiqued by one of two superb physicians. Later that day, I will take my 7th Pathology exam of the semester under the guise of General Wilhoite. Another Path exam will follow in the form of a standardized and comprehensive “shelf” exam which will take place the following week. As well, during the last week, which happens to be next week, I will have my fourth Pharm exam. Unfortunately, this is scheduled to occur after the comprehensive Pharmacology shelf exam. To finish it off, I will take the final Genetics exam—which counts for 40% of the final grade.

In total, I have well over 100% of my final grades remaining in these last two weeks. The pressure is on to study well, to remain healthy, and to finish strong so that I can joyfully make the homecoming complete.

Although I am trying not to look too far ahead, I have already mapped out two paths for the travel home. Both of them include a night over visiting my great Uncle in Akron, Ohio. I plan to leave, ideally, on December 8th, at an early 4 o’clock before the roosters even begin to consider their ritualistic morning crow. (Now Heidi knows full well that those roosters have no set pattern to their “morning” cries. We heard them all day and night during our time, not so long ago, in Grand Cayman.)

I think that’s as far ahead as I should think right now. There are many other things I have on my mind right now, and to keep it simple makes it possible. I have neatly organized all of my belongings for the week ahead so that I can successfully limit the natural obstacles that will inevitably cross my path. I have even loaded up an extra Snickers in my bag for an energy boost—thanks to Mom D.—just in case—and so, as Heidi would say, I can avoid that ravenous look in my eyes (when I forget to eat).

As I look back at time—the time that has passed so quickly—I am reminded of the prayers—so many—that you have all said on my behalf. One day, I strive to find those things that can begin to move me closer to feeling a sense of repayment. Never will I be able to repay all of you for all of the support you have provided, but I will try.

Some things I am thankful for include many of those things—from the many cards and gifts, as well as the prayers and words of encouragement. One of my dearest friends that I met along the way—Promise—reminded me recently of all the times I said I wanted to quit. Although he may not have known, his example pushed me further than I might have otherwise traveled. He’s an impressive kid—wise beyond his years—though he may not realize it right now. For the sacrifices made by everyone—Heidi and her family, my dad and mom, my brothers and sisters, and my friends, I am thankful to each of you in your own special way.

A different Path

2006-11-22T16:25:00.000-05:00

This is what a last minute review of Path looks like the night before the exam. Dry erase boards are incredible tools for organizing thoughts and connecting concepts in med school. Even though this might look like a mess of words, this sort of tool helps get me through the tests that matter most. I plan to go through a lot of markers in the next several months.

My dear friend

2006-11-18T13:50:00.000-05:00

Another weekend spent hanging out with my good friend, Pathology. Exam # 6 is on Monday morning. Still in the game in all classes… Some who have otherwise made it safely in succession to this semester have already fallen; others are still playing, but in denial.

Is Maine more difficult than the campus in Grand Cayman? I would have to say yes. More challenging at least. There are no curves, no extra points, and little to no room for error. There are more exams and far less time for Step 1 preparation.

As the semester draws to a close, I am reminded daily of the challenge that lies directly ahead—Step 1. As of now, I am excited to be arriving at this point the course, but a bit reticent about my ability to pass this exam. I have a lot of work to do, and time is now no longer the friend I once had. I will have to register to take this exam in the very near future. $695 required to do so.

The National Board of Medical Examiners (NBME) provides you with a window of a test date—January through March, February through May, March through June, et cetera—and in order to make it safely to the start of clinicals for the 6th semester in June or July, I will need a passing score of 182/75 six weeks prior to that time. The NBME provides results in four (4) weeks, however, there is a trick (Oasis) in which one can try to re-register for Step 1 just a few weeks after taking the exam, and if it refuses to let you register, you have passed the exam. Many who have walked before me have had shaky hands as they attempted to make that last registering click. Some have had tremendous disappointment; while others have jumped for joy. Ultimately, it all boils down to those 350 questions. The school requires six (6) weeks for clinical placement. Let me not get to far ahead…

As soon as the semester ends, I will pack up the trolley and head west for a few weeks. Finally, I will get to see Heidi and my family and friends. Right before doing so, I have to devise a sold plan for study. I had initially hoped to take the first of four NBME exams to establish a baseline of where I currently stand. I have decided to revise this plan in lieu of study so that at the end of the break, sometime in early January, I will take the initial NBME exam. This will tell me those subject areas in which I need the most work. I can already anticipate deficits in Physiology and Biochemistry. I will emphasize these areas during my study over break.

This study plan will break down the areas of concentration in a systems-based approach. I will attempt to integrate much of the basic science material as I progress through the endocrine, renal, digestive, and all other bodily systems. Daily, I plan to spend 6-8 hours in study. I will reserve weekends for working on questions. I have compiled numerous books and resources for the questions and study. Fortunately, through school, I also have access to Exam-Master and Kaplan’s QBank of questions. This will ideally provide cumulative scores to further guide my preparation.

As well, I may spend a few days shadowing Dr. Noguera in hopes of honing the clinical skills I have discovered here in Maine. During my last round with Dr. Noguera, he informed me that he would like me to take more of a hands-on approach when I returned. Whereas it might be nice to dazzle him with my skills, I truly hope that he can provide some much-needed constructive criticism, as well as some “pearls of wisdom” for making my exams more concise.

He has told my dad that he has noticed an improvement in my knowledge base over the several semesters I have shadowed him. I will be more than happy to practice on any and all of my family members when I return. This will only help me improve.

When I return to Maine in early January, Semester 5 will rear its ugly head. SMU SOM now requires a successful passing score on a “practice exam” prior to actually sitting for the real deal. I will spend the initial six (6) weeks in the Kaplan review with several chances of passing along the way. This is as far as my mind can truly wander at this point in time. If I get too far ahead of myself, I either start day-dreaming of a passing score and the progression to clinicals, or I start to think about the after-effects of re-configuring a plan to re-test Step 1. Neither one of those ideas is too appealing or helpful now. So I keep going back to the present, as my dear friend, Pathology, calls my name…

A competent one

2006-11-02T23:52:00.000-05:00

The most frequent question that I am now asked by anyone who knows anything about me is, “What kind of doctor do you want to be?” After thinking about it for a few quick seconds, I always debate as to whether or not I should reveal that I truly have no idea. My biggest worry right now is surviving this semester, and then seeing how well I can do on a “practice” Step 1 exam called the NBME (National Board of Medical Examiners) before the next semester starts. Do I tell them this? Do I talk about what inspired me to take this route—(a broken arm in 2nd grade and a fractured foot in 7th grade and the orthopedic surgeon that treated these injuries)? Do I tell them the awesome experiences I had while interning in the ER at St. Louis University Hospital in college? That was years ago. Do I mention how I worked in psych for over six years and how this would be the easiest and most logical route to take? Do I try to impress them with the fact that my parent’s good friend—a family medicine physician who graciously takes me under his wing while I am on break—keeps talking to my parents about how he wants me to join his practice right after graduation? Do I tell them I truly no idea? Do I remind them (or inform them) that the 1st two years of medical school are spent memorizing a bunch of facts that are likely forgotten days after an exam? My usual answer now, when I am asked, “What kind of a doctor do you want to be?”, is, a competent one.

Counting the days

2006-11-01T12:49:00.000-05:00

Why is it that we always want what we cannot have? Right now, I am craving Cecil Whitaker’s pizza. Is it truly the object that is of my desire? Or is it those things that I acquaint with the object that I desire? In this case, I think it may be a bit of both. I long for the days of the past when I was able to just sit and relax. My brother and I would devour the awesome provel-cheese, thin-crust, St. Louis style pizza and talk about whatever it was that we talked about—however trivial those things may have been at the time. I can’t really recall any of our conversations, but that is not what is important anyway. Heidi eventually joined in our new-found tradition, ultimately replacing my spot at the roundtable with Dennis, and she actually admitted to liking Cecil Whitaker’s pizza too. Amazing how life turns you around and turns you into whatever it chooses. Some things are unavoidable, I suppose. Last year while in Grand Cayman, Heidi and I were wishing we could just go to the grocery store and buy a Tombstone pizza. Now as I break from studying, I lackadaisically dine on a Tombstone pizza while thinking of what it will be like to share the love of a Cecil Whitaker’s pizza over Christmas break. Am I counting the days? Almost.

Does anyone recognize these people?

2006-11-01T10:10:00.000-05:00

Life is what happens...

2006-10-29T23:39:00.000-05:00

After more than a few inches of rain falling this weekend, all that remains is the whistling wind. Since I have spent the majority of the weekend studying, I have sat in the quiet, listening at times, intently, to the noises outside. The wind is incredibly relaxing. I have even opened the sliding glass door for its soothing quality. It gets lonely here on the weekends, and it is nice to drift off into my thoughts and daydream. Although Heidi might not believe me, this place is far more quiet than the library, especially when the door-slammers are gone for the weekend. Of course, it is obvious when they are not home. I am sure I will hear their arrival at 12:30 A.M.

Not a lot to report, other than a lot more studying for Pathology. I am working ahead right now, and there is no better feeling than this.

Each morning, the Pathology professor, who likely has 50 years of experience, has what he has termed, “The Socratic Inquisition”. During this portion of the beginning of class, he randomly calls out people’s names asking them specific questions about specific pathologies. Fortunately, I tend to know a lot of the answers, but sometimes, when your name is called, the question involves a something with which you know absolutely nothing. If he gave a moment to think through his question, I may find the answer by making conceptual connections. But more often than not, he expects a “snap-snap” response. Tomorrow I expect to dazzle him with my knowledge while the others who decided to go out of town or play for the weekend will not.

Since this next Path exam—on November 8th—is reportedly a challenging one, I plan to prepare as if it were this week so that when the day before the exam arrives, I can relax and review. As Heidi’s mom might remind me, “Life is what happens when you are busy making plans”. Likely, I will plan to do this and actually do what I normally do—which is have to kick it into high gear the night before the exam. Old habits die hard, I suppose.

With just 5 weeks remaining, I keep asking myself, “Is winter on its way?” Had a cold front rolled through this weekend, this place would be buried in snow. I have a lot of work ahead of me. I am ready to move forward.

It's a good start

2006-10-28T15:50:00.000-05:00

Well, there’s a lesson hidden in there somewhere, now, I am sure… a line I’ve heard from many, many times before. Maybe it wasn’t in reference to me specifically, but I’ve always tried to sneak a peak and find the lesson too. In watching the Cardinals win the World Series, I learned many a lesson:

The work of many for a goal of one team.
Overcoming obstacles.
Accepting defeat.
Seeing the good in bad.
Knowing when to dig deeper.
Celebrating the victory.
Celebrating one’s self.
Sharing.
Not saying too much, but saying enough.
Passing along lessons to those who strive to wear your shoes.

As I watched the Cardinals pull off what many would claim to be a major upset, I thought for a moment, “What is it that motivates me to participate in someone else’s victory?” Truly, I feel a tremendous sense of belonging to the winning that became the World Champion St. Louis Cardinals. Why, you might ask. Because of the time and energy that I’ve devoted to watching them—through the wins and the losses alike? Maybe. Onlooker play—as some psychologists might say? Maybe.

Regardless of why, when they failed, I felt defeated. When they won, I felt a sense of victory. Connected in ways that make me look back on a long season and reflect upon all the personal victories that I have had in life as well. For the past year and a little more, I have traveled through some truly difficult roads. Heidi and I have had our fair share of challenges along the way. We have endured, as the Cardinals have endured—victoriously.

This is what motivates me to stay involved in something I have truly no real, formal connection. Seeing how others persevere helps me learn, or sometimes even reminds me—to persevere. Some say winning isn’t everything. My response to them: it’s a good start.

Win! Win!

2006-10-24T18:20:00.000-05:00

Studying during the World Series is usually no problem—that’s when you’re in a foreign land with those damn Yankees playing. Who cares about the Yankees, right? But, when you’re in the great ol’ US of A, and your home team (the Cards) is playing against the team your dad grew up loving (the Tigers), it becomes a major distraction, especially the night before a major exam.

As I was studying Pathology tonight, I took a break for dinner and a minute to catch the national news. Of course, there was talk of Kenny Rogers cheating, which, by all means, is old news. From what I have read, using pine tar, suntan lotion, and shaving cream is a common pitching practice utilized by pitchers in the MLB.

The story took a little twist that peaked my interest: a young guy who goes from stadium to stadium “shagging” fly balls. No, he doesn’t really get onto the field and catch fly balls. He remains in the stands going from seat to seat trying to obtain as many baseballs as possible. His technique inspired me: As the home team is playing, he wears a home team ball cap. He quickly switches as needed to the away team’s hat. He even uses language to benefit his end-goal—he can ask for a baseball in several different languages (which usually gets the foreign-speaking baseball player’s attention). To take it to a bit of extreme, he has even devised a glove with a pen in the mitt and a rubber band around it used with a string to drop down onto the field and obtain those hard-to-reach balls that no one else can grab.

Maybe anything is better than studying, but it sure makes it difficult to study when the Cards are playing the Tigers in game 3 of the World Series (now in St. Louis). What I would give to be back home right now feeling the energy of the town…Go Cards! Go Tigers! Win! Win! I expect my phone will ring if things go well. I look forward to that call.

A steady stream of inhibition

2006-10-23T15:21:00.000-05:00

I finally got out and “tried” to fly-fish on Saturday. I felt so rusty. I think I spent more time untangling line and re-tying on new line than anything else. The 2-pound test seems so small after the line I used in Grand Cayman. Combined with the small, hard-to-see line, my cold hands had a difficult time tying knots and threading the eye of the small hooks. Wind and not much back-casting room made it difficult to cast and not get caught in the trees.

The stream is beautiful, but I find it strange that, in Maine, (one of the better places to fish for trout), that it is as artificial as it is. The river is just a small stream, man-made by a series of dams that intermittently control the flow of the lake a ways upstream. I waded downstream only a short way to find an area of expansion—a pond perhaps—but this only made me think back to the places in Missouri.

Sometimes, it’s only by seeing what else is out there that I realize Missouri has a lot to offer. I wanted so bad to catch (or at least see) one of the Brook trout that prefer the colder waters here (even if they are just stocked like most places in the Ozarks back home). Not one. The only thing I witnessed was a decent rise in the flow-in area of the pond as I haphazardly threw my scud-fly into the riffles that lead into the pond. It did ignite a flutter in my hart, but no real adrenaline rush like the torrent of a tarpon tearing the drag across the ocean (just before he launched himself out of the water and onto the shore).

I suppose I will have to brave the cold again just to get a glimpse of the elusive brook trout. Back to Path.

Alone in the snow

2006-10-18T22:38:00.000-05:00

October 18th, 2006…and it’s 70 degrees in Portland, Maine, today! I am still waiting for the cold and snow, but I am patient and in no hurry. I am sure it will soon be on its way. Heidi leaves Friday morning, and from there on out, it’s going to be just me and all these books until I make the long drive home in December. Loneliness will be replaced with increased informational input.

I have the 2nd Pharm exam this Friday, and as soon as it is over, I will be working on Path. We just finished the CNS/PNS today, and I am almost all caught up with the reading. I plan to re-read what I have already read before I start to memorize the minutia. I often wonder where this info goes after-the-fact. I know it has to be in there somewhere; retrieval is always the most difficult part. How to link it together and how to figure out what was filed where is always the true challenge.

350 questions

2006-10-18T13:45:00.000-05:00

I don’t think I realized what I was getting myself into when I started this journey. I think I, like many others who have gone before me, as well as those who travel with me now, just thought that you take classes, learn about medicine, and then like magic, you’re a physician. Not so easy. There’s a tremendous amount of synthesis of information that needs to occur—both in the academic, as well as in the clinical, setting.

Soon it will all boil down to knowing the right answers to as many of 350 questions as possible. The Dean spoke with us yesterday, and he informed us that for those who have maintained a 3.0 or higher throughout basic sciences, their pass rate on Step 1 has been 100%. So it would seem that I am in good shape.

After this semester, I will have to tie together all of the material I have learned so far so that concepts become as clear as possible. Test-taking strategies will be an important part of this exam, as well as developing enough stamina to make it through the 8 hour exam. First things first… this semester is going to continue to be challenging enough.

and soon you are all by yourself

2006-10-13T06:14:00.000-05:00

Sometimes I just want my life back. This pursuit for knowledge has led me down a dead-end of deceitfulness. It’s a drug. The more you learn, the more you realize how much more there is to learn. You try to take it in. But there’s too much, and you know it. So you just set life aside and hope that somehow your mind will adapt. And it does. What used to take a while to memorize now can be broken down and stored in short-term fairly quickly. So you do this on a daily basis. No, an hourly basis. You break down the day in increments to try to optimize learning. Learning and studying become code words for memorization. You tell your wife you’re going to the library to study. You know the real reason—the pursuit of information. You walk in. You know the library has four walls and comfortably holds all of this knowledge. But you know there’s so much more than what’s just in these four walls. It’s not finite. There’s the internet—endless information. You extract information and program your mind. Now you’re a machine. You are startled by the alarm of closing time. You’ve been here for hours diligently inputting bits and pieces of information, filing it away for a later time. You’re back here everyday doing the same thing. Life passes by—and the pursuit of knowledge continues. You wake up to review flash cards. You’re consumed. You realize it’s way before anyone else has considered getting up. And you know you went to bed late into the morning. You realize you are addicted. You tell yourself it is because you have to be (knowing that this is not the truth). You pull away hesitantly to get a drink, to take a shower. You feel it’s just wasted time. If you could skip these things you could take in more information. You review the input from this morning while reviewing flash cards on the toilet while you are in the shower. You know you have to go back to a certain flash card when you finish. You can see the words in your mind. The pursuit is endless. And soon you are all by yourself.

Wading on...Genetics?

2006-10-11T21:40:00.000-05:00

I am having the “crave” to go fly fishing. I’ve scoped out what appears to be a classic spot. It is a shallow, clear, cool, rock-bottom stream that is literally 5 minutes from school. Since I think I can reasonably fit it in this weekend, Heidi and I may try to make our way there this coming Saturday. Of course, there seems to be a cold front rolling in, and I am worried that with it will come rain. Cold weather won’t stop me from getting out there in the middle of the stream, but the rain will bring the water level up making wading a challenge, and the wind will make casting a fly rod truly challenging (especially considering there’s little back casting room). I guess we’ll just have to wait and see.

Tonight I am working on Genetics. It’s only a 2 hour course, so it often gets put on the back burner. As I think about mutations, my mind drifts to the not-so-distant future. I am still trying to determine how I will approach the Christmas break. Seems there is never enough time for study.

The days seem too short, and the morning comes way too quickly. I have to start working on developing increased stamina. Studying for Step 1 will mean 12 solid hour days of study. I have done quite a few of these, but they are very difficult to endure—especially when life is happening all around me. Maybe the cold and snowy weather is one good reason to remain here and not to go to Miami for 5th semester.

Amazing—5th semester marks the 1st semester of 3rd year in the traditional format. I can hardly believe that time has gone by so quickly. I can still recall the naysayers who reminded people who knew me that I had been saying I was planning to go to medical school for years… (read: they were saying I’d never do it) …while all the time they were my motivation. **sigh**

Getting the hang

2006-10-10T22:31:00.000-05:00

I think I am starting to get the hang of this place. It has taken 5 solid weeks to get acclimated to the ways things work here. It is certainly a different environment with 24/7 study expected. There is little to no extra time for anything, much less additional time to prep for the Boards. Step 1 is on the horizon, and just tonight, I was thinking of what my strategy will be over the break. This one will not be much of a break, I am certain. It will be four solid weeks of individual study. It ultimately all boils down to 350 questions. Passing this ensures placement in clinical rotations. Failure means more than just back to the drawing board. I feel more confident by the day that I will at least pass this exam.

How time flies

2006-09-30T20:31:00.000-05:00

Another Saturday night spent staring at Pathology… This weekend and next will be much of the same. In fact, I think that every day here will bring about a ton if study—so much that I will certainly be burned out just in time for Step 1. Actually, every semester, I get into this groove of studying, and by the time break rolls around, I don’t really want to let up. I have to almost remind myself to stop studying. Hopefully, this will be a good catalyst for continued studying over the break.

Some of this stuff amazes me. I was reading about a disease state called carcinoid syndrome. Since I didn’t really understand what my notes were trying to say, I decided to read more about it on eMedicine (my favorite medical website). The incidence: 7-8 cases…per year. Yeah, that’s right. 7-8 in the United States per year. Now that is far more common than some other conditions I have had to study, but seriously, am I ever going to see this disease? Okay, maybe I will, if I am an oncologist specializing in a certain area.

Anyway, I owe a lot of you phone calls and emails. I haven’t forgotten you, I swear. Right now, I am just trying to stay afloat. This place is not like Grand Cayman. I have exams weekly. I even have quizzes in my Patient-Doctor class. This means I spend an hour break reading through a hundred or so pages trying to get as much as possible to sink in. You’d think there would come a time when there wasn’t much left to read. Every time I begin to think that, God throws me the change-up, and I am swinging at air. There will always be more to read and more to know.

I have started to look back and think, “Man, I am almost finished with my second year of med school.” My how times flies.

More veggies please

2006-09-27T22:39:00.000-05:00

Nothing real exciting here—just a lot of memorization of a million drugs for my Pharm exam on Friday morning. After this exam, I will quickly forget about Pharm for a weekend of Path and subsequent Monday morning exam. Shortly thereafter, I will even more quickly forget Path for a night of study for a Patient-Doctor mid-term the next morning. After that, I will breathe a little easier and maybe even play around for a night. That means turning on the tube and veggin’ out.

A steady diet of study

2006-09-24T07:10:00.000-05:00

Heidi, her mother, her grandmother, and Sasha deliriously strolled in around 4:45 A.M. on Saturday morning after driving for the past 2 days. Since then, they’ve been working diligently to “feminize” this place. All the blues have now turned to pink, and all the makeshift theoretical impossibilities have become pragmatic possibilities. No more cutting pizza with a knife. We have a pizza cutter. No more plastic-bag-hanging-from-the-door-serving-as-a-trashcan. We have a real receptacle for waste products.

This week, a steady diet of study begins. The wax and wane of falling into and out of routines due to life’s inconsistencies has made it challenging to accomplish anything thus far this weekend. Today, after a few prayers in the Church with large poles (and a minmal view), I will make my way down to the USM library to buckle down and buckle up for a long ride through the twists and turns of Pharmacology, Pathology, and maybe a bit of review (or flash-card-making) of Genetics.

As the trees and their fall colors are starting to threaten to drop their leaves, I am reminded to buy batteries for my camera. I have gone without them for weeks, and it seems that now, everywhere I look, there is an awesome view of something. Although there has been one freeze so far, the weather is still safely maintaining a comfortable 70-ish high and mid-40’s low. The drama about the weather here has yet to rear its ugly head.

Mapping it out

2006-09-20T20:41:00.000-05:00

The first two years of med school are like training for a marathon: you train daily for months, and every weekend you make a long run. Never do you run the entire 26.2 miles until the day of the race. It’s far too much wear and tear to put yourself through that sort of rigor. You don’t even really know if you can run it all until the day of the race. Two years of basic sciences. That means two years reading and theoretically learning about medicine. It won’t be until clinical rotations until I can put some of this learning to use. It won’t be until then that I learn how to adjust to the demands of a marathon race. I am about 6 months away from final training for the race—Step 1. For now, I will keep training.

1st exam in Maine

2006-09-18T09:47:00.000-05:00

Path II, Exam 1, completed. One step closer to the end. What I learned: how to study for these exams. Adaptation is going to be key to a higher score. Webpath questions combined with Dr. Wilhoite’s lecture notes and Dr. Goljan’s gems were quite helpful. I think I have learned a lot about the pathology of the blood vessels, heart, and lung. I will always have regrets. This is only natural. What helped the most was reviewing with another student, our notes, and a dry erase board. Had I done this sooner, I would have likely performed a little better. There’s always room for improvement. I suppose my score will dictate how much my study habits for this class need to be tweaked. Grades by 5 P.M. today—or so I hear.

Treading a path

2006-09-16T09:04:00.000-05:00

The first Path exam is Monday morning at 8 A.M. To say I am ill-prepared is an understatement. Will I get by this exam? You bet. What lies ahead of my weekend is a lot of study. Covered on this exam is the pathology, or dysfunction, of the vascular, cardiovascular, and respiratory systems. Even though I have yet to put together a true plan, I do plan to be ready by Monday.

a fish lost in a school of bland fishes

2006-09-12T22:38:00.000-05:00

My world turned upside-down. Some days it feels as though there is absolutely no light at the end of the tunnel. I watch as the residents, med students, and attendings come and go at MMC. It makes me think that I am such a fish lost in a school of bland fishes. Not that I wouldn’t much rather be a fish at this moment. It might be much simpler, but in reality, my worries would be survival rather than worry over what to study this single moment of every day.

Burn-out. We can politically now correctly call it “compassion fatigue”—especially among those in the helping profession. No longer do I consider myself to be in that profession. I am in the “helping-myself” profession. Of course, I say this light-heartedly, as I know deep down I still very much care for humanity on an individual basis. It’s the daily toil and lack-of-feeling of directedness that often makes me wonder.

I’ve changed some of my most ideal beliefs into ones of a more pragmatic nature. I still strive to do great things. Yet I strive to do them in a different way. For instance, I’ve been considering some sort of artistic personal development. This started out of a quick blip of imagination that devised the idea of making money while simultaneously losing it through the **gasp** inordinate amount of loan money that seems to daily go down the drain. Now comes the artsy ideas, influenced I believe, largely, by my brother, Mike’s great works. Never have I truly considered the importance of art as an outlet. Appreciation has typically stopped at creating inspiration that only went partially beyond my vision of self.

To take photographs and frame them. Not such a novel idea. To make any amount of money on anything requires some sort of unique idea, or simply an idea that is not unique, but is done so in a way that recreates or makes it seem original. How to do this? I do not know. What I do know is everywhere I look I find inspiration, probably out of desperation. Not that I am truly desperate. But I feel that the influences of life have sort of forced me to look beyond the aspirational ideals of yesterday and toward the pragmatics of tomorrow.

Looking downhill

2006-09-11T22:34:00.000-05:00

Some days, it’s just better not to get up out of bed. Today was one of those days.

I woke up this morning and hit snooze at least a handful of times.

Since that time, it has felt as though everything has gone downhill. I realize that most when I arrived to Path lecture a few minutes late. Immediately, I was subjected to the “Socratic Inquisition”. This is the Q-A session that the professor, Dr. Wilhoite, pulls off every morning. Even though I knew the answer without pulling from my notes (like everyone else does), my low tone of voice made it seem as though I couldn’t come up with the answer. Unfortunately, the advanced age of this particular professor may have contributed to my lack of inability to get it right.

I won’t even discuss the rest of the day. Just look downhill.

There you go. That sums it up.

The view from above

2006-09-09T20:30:00.000-05:00

Med school often means many early mornings and late nights—most of which is spent in study. This morning, I had to attend a CPR/First Aid class. There are so many certifications and loop holes in life—especially in medicine. We spent maybe an hour working with CPR dummies, and the lady teaching the class decided to skip to the chase because so many of us were getting far beyond what learning CPR encompasses.

I had to laugh—when we reviewed the material related to first aid, I had to hold back from describing well beyond the concepts the instructor was teaching. For example, she posed the question, “What is shock?” My thoughts, “Depends… Are you speaking of septic, cardiogenic, neurogenic, hypovolemic? There are many different signs and symptoms of each.” In other words, most of this was fairly remedial. Certainly I could not have said this just a little over a year ago. Still, unfortunately it is only a fragmented knowledge that I now possess. There are many times when I walk myself through concepts, and at some point, I get stuck and need a little push to allow me to “connect the dots”. Perhaps this will come with clinical experience and time.

I now find myself sitting in the library again overlooking the downtown Portland area and some significant expanse of water. It’s 80 degrees here today, and apparently this is quite unusual. Everyone seems to be bracing themselves for the worse. Talking with locals—like the instructor this morning—always seems to drift toward how the cold weather is on its way. It will be interesting to see how the town adapts to the cold and snow.

A couple more weeks until Heidi makes her way here. We had a good talk this morning. I sense she has a lot of anxiety about the changes that are on the horizon. She will start a new job at Ingraham, a local counseling agency in the downtown arts district. She amazed me with not only getting an interview when we first arrived here, but also landing the job the very next day—in record time according the HR lady. Back to the pathology of the heart.

the placebo of singing hymns

2006-09-08T18:18:00.000-05:00

Today we had our first Genetics lecture. This followed a 2-hour break and a Pharmacology lecture on the effect of placebos in medicine. The lecture was taught by the Clinical Dean, Dr. John Randall. Of course I like him—his name is the same as mine. Even though you might not first realize, he has so much information hidden beneath his humble-looking appearance.

I have to admit, I was quite impressed with his approach to medicine and his openness about alternative treatments. He talked of the Amish people he treated in Pennsylvania. What he noted most from his experience was that it seems to be that the stronger one’s theism is, the more likely they are to be believe that disease is related to punishment by God.

He related an interesting case: a young Amish man came into his treatment realm in a coma secondary to Measles Encephalitis. Of course, the Amish do not believe in vaccinations. The young man’s father would come in daily and sing religious hymns to his son. After a period of weeks, the young man awoke from the coma. The local Amish people declared this a miracle. Still, the young man’s father wanted to know why his son had been punished. Many times, it is the power of prayer that creates the placebo effect. Many times the placebo is delivered in other “alternative” forms.

Complementary medicine will eventually take hold, but it will only do so after much governmental regulation and, of course, only if the West Coast liberals don’t take it too far to the left. These other treatment options are not necessarily hocus pocus. They can be effective even if modern medicine cannot explain the mechanism behind the healing.

MMC

2006-09-07T20:32:00.000-05:00

First day of Patient-Doctor Skills IV: after 3 completely useless semesters of this class, we have (ever so slowly) begun to enter into the world of clinical medicine. Vitals—pulse, respiration, temperature, and blood pressure—were tops on our list of “to learn” today. Even though I have a bit of experience taking vitals as a tech, now at least I feel as though I (at least sort of) understand the meaning behind these common signs. Each time we learn a new skill, we are graded on our performance in the form of a “check-out”. This means that we must satisfactorily perform the intended objectives to move on to the next. Mission accomplished. I can now officially take vitals.

From there, it was on to Path for a grueling 3-hour lecture on the lungs. Shortly thereafter, a carpooled drive back to the apartment for a quick lunch and then onto the Maine Medical Center (MMC) for the 1st Pharm class at this location. MMC is actually analogous to a hospital system like BJC HealthCare. Apparently, it’s rated 1st class around these parts, and all of the top med school rotate through here—Harvard, University of Vermont, and some others. In my humble opinion, this place doesn’t even compare to what BJC puts out. The buildings at BJC alone make this place look like the minor leagues. The second I set foot in the door, I could feel the bubbling competition beginning to build. Seems no one in medicine ever wants to admit they’re inferior. For me, I’d rather not involve myself in these futile pseudo-competitions.

So now, I am in the library at MMC. It’s a small library with lots of books that look as though they haven’t been touched since they were placed on the very shelves they now rest. Who needs these books when easier access is obtained via the internet anyway? I guess you have to appease the old-timers who refuse to catch up to the technology. I guess I have to admit that it is always nice to step back and enjoy how it used to be. While technology makes the world a smaller place that does not always mean that things will be easier.

the Reading Room

2006-09-06T19:50:00.000-05:00

Tonight—a fellow classmate, neighbor, and friend—JZ and I decided to try finding a new place to study. It’s not that the apartment is not conducive to study; certainly, it is. But the temptation to do other things, like… nothing, relax, surf the internet, edit photos, tie flies, etc., is far too great.

We had heard that the University of Southern Maine’s campus, just down the street, has a library and is available for study. So we ventured out to find this quiet and study-conducive place. A quick right out of Terrace Pond and onto Forest Avenue for 3.8 miles and we were there. We pulled around the back side of the library, found a parking place, and headed in to our new place of study.

We decided to start on the top floor. I pushed 7, and we were quickly expelled from the elevator. As soon as we turned the corner, we made our way into “the reading room”. One look, and we were both sold: our new study hall.

Quiet and picturesque—the view of the entire city of Portland and some unknown, gorgeous piece of water. The kind of view movie stars and executives pay thousands of dollars for—right before our eyes. I wanted to call Heidi and tell her about it, but I knew she was working and couldn’t take my call. I thought to myself, “She is going to love this place. She will be able to do all of her studying here as well.”

If only I had my camera. There’s always tomorrow…

scenes from Maine

2006-09-03T16:03:00.000-05:00

I thought it would be nice to show you some of the scenery here. As you are aware, the lighthouse is a mainstay in Maine. I ventured out yesterday to Two Lights State Park to capture some of these scenes. The others were taken last week as Heidi and I toured Casco Bay by boat and the riverfront downtown by foot.

For such a small town, there sure are a lot of shops and people. Seems wherever I have gone, there is traffic most any time of the day. The people are generally friendly, but I still sense that they are generally a bit stand-offish. Funny, one small outlying cities is called Standish. I wonder if it is a truncated version of what they really mean.

Today the rain is falling. It's far from the downpours we experienced in the Cayman Islands. It's more of a Londonesque gentle, but steady, drizzle.
Our new view is of a parking lot, but just beyond this is a row of towering Pine trees. I can hardly wait to see the snow falling onto the branches of these awesome trees.

As I drive here and there, I always take notice of these small streams. These are the ones I imagined while I was in Grand Cayman daydreaming of the elusive trout. Here these streams are commonplace. I hope to have the time to set foot in one of these at some point during the semester. From what I have been told, time management is key to survival at this campus. Many fail because they fall behind. I am almost ready to break through and make the push to true studying. It has taken a week to get to this point. Hopefully it will be easier once I get fully settled. I am told that the furniture arrives Tuesday. Until then, I am comfortable in my new mummy bag on the floor. I had to fork over $35 for a nice chair to sit in. It's called a SoHo chair, and I just got it at Target. I set it up to face the outside, windows open, steady rain falling, with a cool, gentle breeze. I am confident that I can now study.

It will be another few weeks until Heidi and Sasha arrive. They are making the drive here with Heidi's mom and grandma. I can hardly wait to show them some of the things that I have seen here. Heidi's mom will enjoy the arts district. Since Grandma Jo is an expert quilt-maker, she, too, will enjoy seeing some of the specialty shops downtown. I even found one store called Jo-Ann Fabrics.

I am planning to study the rest of tonight. Heidi suggested that I go downtown to the public library and spend a few hours there. I was just about to leave when I changed the plan to finding a comfy chair so I could study at "home". So now I will be able to sit and listen out loud to my audiofiles with a blanket as the rain falls.

I hope everyone is doing well. As I left St. Louis, I did so in a hurried manner. I apologize for not giving everyone the goodbye that they deserve. While moving is easy to some, I find that I over-estimate how much time I truly have. Nonetheless, I end up neglecting to spend it on some of the people I should. Trust me, this is an error of self, and I hope you can understand. I think about you often.

Two lights

2006-09-02T13:14:00.000-05:00

One week into Maine. It’s still a beautiful place with lots to see and do. From what I hear, there will be little time to do anything beyond the throes of the classes. For now, with a bit of a break before it all starts to collapse, I have tried to adjust to this new place by venturing out and about into the world of Maine. From what the locals say, there is little time left anyway to be out and about, as the winter snow is looming.

Where we live, it’s a 15 minute drive to downtown and a 20 minute to SMU. We are now sort of in the middle of both—and being between is a nice place to be. There will be a lot of travel here. Fortunately, both of us have reliable vehicles to get us to where we need to be. And I have two friends here with whom I will be carpooling. That will save time and money.

We decided the Marriott Towneplace Suites was too small to accommodate our need to have a little extra room to study. So we moved. We now live at a place called Terrace Pond Apartments in South Portland. And Heidi and I both switched back to cell phones as our primary means of communication. Vonage served us well in Grand Cayman, but we have no need for a land line anymore. So email us for our new cell numbers.

I have yet to really dive into studying. I need to do that. Until I get this place set up, I cannot get into the groove. I am trying. Maybe by Tuesday I will feel the flame getting hotter, and the inspiration will force me to become motivated.

These are some photos I took this morning at a state park highly recommended by my best friend's brother, Chris and his wife, Linda.

From the mountains to the prairies...

2006-08-30T19:23:00.000-05:00

I haven’t woke up to cold toilet seats in over one year. I guess this is the price of being back in the land of the free and the home of the brave. If it is, I’ll take it.

Maine is an amazingly beautiful place—from the mountainous, rugged, tree-filled woods to the saltwater, cold Atlantic ocean to the bustling, trendy, artsy downtown Portland—it has everything one could possibly desire. Again, this comes with one major trade-off (apparently): the cold and snow.

Snow reportedly begins in November, but the last year was mild, so some local people speculate that they are in for a vicious year of snowfall.

A New Yorker in one of my classes told me that the population in Portland is only 60,000, and the total population in Maine is only 1.2 million. Downtown Portland seems like so much more than just a small town. There is so much to see and do.

Heidi and I will be living in Portland for the next 8 months. We found a great apartment that has quick access to SMU SOM and Downtown. After Heidi’s seminar in Chicago, she will make her way back her with Sasha, her mom, and her grandma. In the meantime, I am struggling to get back into the swing of things. With a new car, a new city, and little familiar to me, I find myself drifting through the daytime in a surreal haze. Soon that strange feeling will fade, and we will call this place home.

Making it to Maine

2006-08-27T18:33:00.000-05:00

Heidi and I left for Maine two days ago. From St. Louis, we headed north to Springfield for one last good ole home-cooked breakfast at the Danner Diner. I had the usual heaping-helping double plate of farm fresh home potatoes. Heidi had fried eggs and toast. We left with our bellies full and our hearts set on making it to Maine by noon the next day. Of course, this would never happen.

After driving through the cornfields of Illinois, we made our way through the hills of Ohio and eventually to Akron, Ohio, to meet my great uncle for dinner. We had a great time laughing at his stories while we dined on a good home-cooked American meal at a local Bosnian restaurant. Thanks to my uncle, we now know the true way the seasons occur in Maine: June 21st is the first day of summer, June 20th is the spring, June 22nd is fall, and the rest is winter. After again filling our bellies with good food and a lot of laughs, we began the remaining portion of our journey east. Only 850 miles to go…

We drove til midnight, finally finding a place to crash in Clearfield, Pennsylvania. The morning came quickly, and after eating breakfast at a local diner, we were again on our way. Through the mountains of Pennsylvania we drove sometimes slowly through downpouring rain, never ceasing to stop for anything more than a quick refill on gas.

The rain continued the entire journey. Through New York, then Massachusetts, and eventually Maine, we found ourselves driving, through the rain.

Upon finally reaching Maine, Heidi and I stopped at the visitor’s center—relieved. Immediately, we were both amazed. Maine is a beautiful state, untouched in many ways by overzealous human hands. 1394 miles later, we checked into our new place of residence and quickly called it a night dreaming of what lies ahead.

Hi. You'll do.

2006-08-22T08:25:00.000-05:00

Walked with Dr N. into Room # 2. Sitting still in the chair in the corner was a 21 year-old girl. One eye shot at the front of her T-shirt: ‘Hi. You’ll do’ in big, bold letters.

<Doc N> “What brings you in today?”
<Patient> “My face hurts. I think I have an infection.”
<Doc N> “Any chance that you could be pregnant?”
<Patient> “No. Umm, well, I did miss my period this month.”

T-shirts like these can be very telling. The dialogue actually may have been a bit more detailed. However, the aforementioned is truly all that I heard. Can you imagine? A girl, with a shirt on that reads, “Hi. You’ll do”, being pregnant? Now how is that possible?

Pre-approved!

2006-08-21T08:51:00.000-05:00

It's funny: seems in life you work so hard for things only to regret or not appreciate those things shortly thereafter. This morning, I woke up, after spending the night working on getting things organized for Maine. I had this sinking feeling that I would not be approved for the student loans, and I have been worried about this for the past two months.

As I completed the forms necessary for the application, on the bottom of every page read, "Submit". So each time, I paused before clicking the button, quickly praying for approval. After 3 of these, "Congratulations! You've been preapproved... "

**sigh of relief**

I can finally breathe a sigh of relief, and Heidi and I can make plans for our trip to Maine.

all these numbers

2006-08-18T13:01:00.000-05:00

Finally, going from patient to patient, I feel fairly confident with not only coming up with a differential diagnosis, but also, I am able to look over their labs and sort of understand what some of these numbers mean. I like the pace. I like seeing a wide variety of complaints. As Dr N. has told me many times, my background in psych is going to come in very handy. Nearly 8 out of 10 patients that walk in have some sort of “psychiatric” complaint. Of course, I tend to see this differently; much of the time the interrelatedness of the medical and psychiatric is unforgiving. I aspire to develop a different approach to this—in due time—so that there is more hope for some of the individuals having a difficult time dealing with these conditions. Now it’s time to stop avoiding the loan re-application process.

Who wants ice cream?

2006-08-17T22:54:00.000-05:00

I’ve spent the last few days shadowing a physician in his office. After racing from room to room seeing a new patient every 10 minutes or so, it’s already time for lunch. Every day we go to lunch on pharmaceutical dollars. Today, after yet another complimentary lunch, the ice cream man arrived outside of the office. Apparently one of the pharmaceutical reps paid for this to happen. Some things never cease to amaze me. This is certainly one of them.

I'm goin' back to Cali... I don't think so.

2006-08-09T18:08:00.000-05:00

I woke up tired. Not used to getting up early anymore. Only 5:37 A.M. But still… Broke out the Path notes and sped through them. I covered two-thirds of the material in an hour. Thinking I was a sitting duck, I nervously crammed until 4 minutes after the starting bell. As I walked into the lecture hall, much to my surprise, everyone was already engaged in a full on battle. I opened the back of the exam packet, as I usually do, and found the section on slides. So I turned to the other packet with the slides and wrote out what I thought each of them was. Then I dug into the questions. Easy, this one, I thought, as I worked my way through several pages. As I arrived at what appeared to be Dr. Zaza’s portion, I started to worry a bit. I noticed that his questions actually involved some thought. So I reached into my pocket for the St. Jude prayer card, and bam! Nothing. For the 1st time in all of my medical school exams, I realized my usual routine of prayer would be disrupted by my forgetfulness in bringing my worn-out prayer card. I still said the prayer for hopeless cases that I always say, but this time, I was on my own. A 62 year-old United Nations worker boards a 15 hour flight from New York to Beirut… Continuing to be stymied by Dr. Z’s questions, I counted out the number I felt 100% right on. 49/75. Way more than I needed to get by, but still, I feared the worse. I know this is my greatest downfall sometimes. Long story, short, after taking Brian, Laura, and Will to the airport, I stopped by SMU to see if the grades were out. One girl ahead of me, same semester, seemed she was way to anxious for her own good. She got the copy of her scantron; then I did the same. I looked closely at it, as the wrong answers always pop right out. None. I turned it over. None. I looked at the bottom and saw that my score was an 87%. Five points added. Apparently the ink on the machine had run out. Still, I was amazed that I had even passed. Now Heidi’s dad is shaking his head, but, for me, these tests create some strange misperception. When I think I blew it out of the water, I’m done. And vice versa. Looks like we’re heading to Maine (pending loan approval). Back to St. Jude. In a few… Miami, Chicago, the Lou…

Speeding past Psych

2006-08-08T09:49:00.000-05:00

I’m going in… for the last Psych exam, that is. One hour til green light. Since I have only briefly studied this material, I am certain there will be some questions to which I will not know the answers. The NBME’s “shelf” exams are notorious for coming up with some truly obscure material. At 1:00 P.M., my focus becomes two-fold, at minimal, passing the Path exam, or at least getting solidly on the board, and two, studying for the Path exam. Tomorrow morning, at 9:00 A.M., it will all be over, and there will be no turning back. Successfully completion of these courses allows us to move on to the next chapter—Maine. Well, that’s, of course, pending successfully reapproval of student loans. That will be my task upon arrival in the U.S. My brother is supposed to be picking me up at the airport in his new convertible at 11:38 P.M. on Wednesday. I look forward to being able to drive fast on the 4-laned highway. Right now, I have to slow myself down. The speeding will come later.

A microscopic cancer

2006-08-07T16:50:00.000-05:00

Today is the 3rd to the last day for me here. The weather is overcast and cooler than usual. I’ve been holed up in this apartment for the last couple of weeks, making trips to and from the library and to take exams. Tomorrow is the Psych final. I would take it right now if I had the chance. I took the Micro shelf exam this morning. As I worked through some of the questions, I realized that it would have been helpful to have studied more. Balancing studying for classes and Step 1 is analogous to investing. If you don’t diversify, you’re likely to lose your shirt. It’s better to safeguard your knowledge base by simultaneously studying for both at the same time. Working on the Goljan audios all week was more of a long-term investment that will hopefully pay off in the not-too-distant future. Studying for the Micro might have paid smaller dividends now, but I have to be more concerned with investing for the future.

As I write, I can see that I need a change of scenery. I really have nothing new to report. This will soon change, as I learn to adjust to a new city, a new environment, and a different pace of life. Heidi said that it seems that people do seem to be much more rushed in the U.S. She took Sasha to the vet today because she found what appeared to be a tick embedded in Sasha’s leg. Turns out it is some sort of skin cancer. The prognosis is good, according to the vet, and at face value, this appears to be a common occurrence among Labrador Retrievers. A biopsy was taken, and Sasha will likely have to return to the vet to have it excised. She is such a sweet dog.

Anxiously waiting

2006-08-06T12:00:00.000-05:00

For some reason, I am nervous about the Path exam. Since there is only 20% left in Micro & Immuno, as well as Psych, I am in the fortunate position of having already passed these classes without even taking the final shelf exams. The Path final, however, is 30% of the final grade, and unfortunately, I do not have a hundred in this class. This would be the only way to guarantee a passing grade going into the final. To pass, I do not need to do well. For the past few weeks, I was focused on keeping my grades, but now I just want to get the minimum so that I am assured of leaving Grand Cayman. This is mainly because nearly everything is in place to leave. If I didn’t pass, we would have to go through the process of everything we did one year ago. I don’t think Heidi would like me too much if we had to do that. Only 4 days til my final flight out of here! See you guys soon!

The yellow lobster

2006-08-05T12:07:00.000-05:00

My bags are packed. The refrigerator and pantry are bare. I’m finishing the list of lasts. As I go through a series of checklists, I realize many of these are my lasts—last Saturday living on a tropical island, last time to attend mass at Christ the Redeemer, last few days of writing about island life. No more waking to the awesome view of endless waters.

I just was thinking, “I am going to have to change the name of this blog.” I haven’t even thought about changing the name of the blog until recently. I guess I didn’t really think as far ahead as I am now when I decided to start this thing over a year ago. I originally named it when I thought we were going to be going to Nevis. At that time, I found out that Nevis is referred to as the “Queen of the Caribees”; and so, I decided that I would self-proclaim this blog the “King of the Caribees”. But my reign is ending, and I am glad to be moving on.

This morning, I watched a video on cnn.com about a “lobsterman” in Maine who just caught a yellow lobster. Odds of doing this: 1 in 30 million. Quite rare indeed. I like rare. I like unique. I like eccentric. I like the novel. Originality is intriguing. So, as of today, since we will soon be moving to Maine, the name of this blog will change.

I believe that in Maine, Heidi and I will find a turnabout from the warm waters of the Caribbean Sea—cold and snowy, something now rare to us indeed.

This time, we will have Sasha with us to enjoy this leg of our journey. I can hardly wait to see her set foot, (well, set all four feet), into a cool stream, as we make our way out into the wilderness to check out the renown fall colors and try our luck on landing the elusive trout.

Y Goljan is king

2006-08-03T11:17:00.000-05:00

Final exams are next week. I have no distractions now. Therefore, I have no excuse not to crush these exams. I have been listening to these Path audiofiles—done by a professor at OSU med school. Everyone who has these pirated copies says they have so many gems hidden within—and from my experience—they really do. Dr. Goljan tells you how it is—leaving out all the formal garbage. What’s left is a nice collection of high yield facts necessary to pass Step 1. There are approximately 37 hours worth of these audiofiles, and so far, as I type out notes to the audios, I have gotten through about seven hours of material.

Even though I started on the 27th, I am barely a fourth of the way through them. I have set some goals to finish them by the end of the break. The way I am doing this is very time-consuming, but I think I have a good plan. Yeah, there are notes included with the audiofiles, but I prefer to have my own set of notes. Not only does this help me learn the material, it also allows me to put together a central place of Step 1 “gems”. I plan to review these periodically throughout the remainder of basic sciences. I also plan to add other high yield facts to them as I go through other references such as First Aid and the PASS videos. When it comes time to review for the big exam, I will have a good roadmap to guide the way.

In the words of Dr. Gojlan, “Why? Why! That’s how you think. That’s how you study. Mechanisms. Know as many as you can. You’ll annihilate this test. Annihilate it!” That’s what I strive to do.

Tropical Storm Chris

2006-08-02T18:53:00.000-05:00

Will this be an early goodbye for me?

A storm on the horizon

2006-08-02T18:27:00.000-05:00

The weather since Heidi has left…
Apparently, another tropical storm, (soon to be hurricane), is somewhere out in the East Indies. Tropical Storm Chris may be heading this way. The wind is now blowing fairly hard, whistling, angry, and the rain is becoming constant. This is never a good sign. With only one week to go, I just want to be home.

Heidi's journey back home

2006-07-31T10:46:00.000-05:00

Heidi’s last day in paradise… we knew this day would come, but had you told us that it would be here so soon, we would have laughed (and then cried). She’s packed and nearly ready to go. Her flight leaves bright and early tomorrow morning. She will venture out of this tropical island to find herself back on the right side of the road with easy access to a multiplicity of stores and fast-food chains like McDonald’s. For now, she will take in the awesome view, spending her final hours with me, Laura, and Will.

What a year we have had together in this foreign land. We’ve learned together how to make it outside of the U.S. Now comes the challenge of separation again. Being apart is challenging, but it helps us learn the differences of being together. We will go ten days without each other’s presence, but upon my return, we will get to enjoy the many pleasures of US life together including seeing our families and friends and having access to many things to do.

While these things may present as distractions, since I am in the stretch run now, I will have to work ever-so-much harder now to prepare for the Boards. This will not be an easy feat; 12 hour days of study do get old really quickly. This will be my life for the next 6 months.

Heidi’s will consist of a similar, but somewhat reduced level of study, with work to make up for the difference. Her doctoral classes will take her to Chicago in September for a weekend seminar only shortly after working many overnights at BHR. She will finally make her way to Scarborough, Maine, sometime in September, if only for a few quick trips out into the wilderness in search of the elusive trout. We both look forward to the change in scenery, but the cold weather may hasten our desire to remain in this opposite-of-tropical environment.

As we look forward to seeing our family and friends, we are reminded of your importance. An Irish blessing to all of you who have helped us along the way:
May the road rise to meet you,
May the wind be always at your back.
May the sun shine warm upon your face,
The rains fall soft upon your fields.
And until we meet again,
May God hold you in the palm of his hand.

The end in sight

2006-07-29T20:03:00.000-05:00

Reality check: Heidi’s parents have been here. My parents have been here. Jordan has been here. Karen has been here twice now. And Dennis has come and gone. The car and belongings have been sold. Round 3 of exams are over. Heidi has packed most of her belongings. I have sorted through papers and other things, and I have packed much of my belongings. Heidi leaves the island for good on Tuesday morning. I leave just 10 days later.

Reality check: This thing is coming to a close. Soon there will be no more waking to the sound of the ocean and the roosters calling. No more daily sunshine. No more staring out into the vast Caribbean Sea. Soon we will be back in America.

Heidi and I spent our last Saturday cleaning, sorting, and organizing. Then we went to the beach. I drifted lazily on the raft that Dennis left behind for us while Heidi laid on the beach. We’ve talked about the end. Heidi has already found a theme song for our time spent here. She has spent her last night babysitting Will. After Tuesday, the next time she sees him, he will be a different person. Quite possibly, no longer a baby.

It has been a challenging year for us. Your prayers have helped us tremendously. We are thankful for all of you who have shown us your love and support. We are thankful that we have made it safely through a year of uncertainty. The journey back home will bring much mixed emotion. So glad to be home, (or at least closer); yet saddened to leave such a strange, but sometimes inspiring place. This is where Heidi and I spent our first year of marriage. It’s a place that we will forever have so many memories. We have both grown. We have both learned a lot about life. Right now, we walk carefully through many of our lasts. We hang onto many of the things we have found here.

Tomorrow, we plan to go to church together here for the last time. We will then go to Eats, our (or maybe just mine) favorite restaurant together. We will then go to the beach, maybe for the last time. On Tuesday morning, Heidi will fly out of the Cayman Islands for the last time, at least until graduation in a few years. For now, we will savor this special time together.

Living the life...

2006-07-20T19:43:00.000-05:00

Heidi said to me the other day, “You’ve made some really good friends here”. I told her that I agreed. I have made some really good friends during my time at SMU. Some are going along for the ride in Maine; some are staying behind in Grand Cayman. One of my good friends for the past several months knows quite a bit about world politics and many other worldly things. Even though he’s not in my classes, we spend a lot of time talking politics and life during my breaks. As the time draws nearer, I start to recollect on the last year in living abroad on a tropical island. So many things I won’t hesitate to leave behind, but many, like my friendship with Marvin, will be sorely missed.

Life is Hell

2006-07-19T00:04:00.000-05:00

As my parents left the island today, my brother and sister arrived. After Heidi picked them up from the airport, I almost immediately took my brother to Hell. I have always wanted to have the power to do that. Actually, Heidi and I took my parents to Hell earlier this week. Even though we pass through Hell every single week to get to Church, I really haven’t ever really spent any time there. It’s a place I try to avoid. Hopefully, I’ll never end up there for good.

The White Coat ceremony was this past Saturday. It was a nice reminder of why I am doing all of this to myself, Heidi, our families and friends—the chance to get a Dodge Viper and one day be able to drive real fast while remembering how much energy goes into this process. Med school is, so far, purely theoretical, but, by all means, this is soon going to change. Maine will be the portal of entry into the clinical world of medicine for me. Fourth semester will find me taking the first of two doctor-patient courses that will be for credit. That means I will have to actually take them seriously. Combined with the three masters classes I will be taking, I’ll have to somehow deal with Pathology II, Pharmacology, and Genetics. For now, I need to find myself everyday in the library til it closes. I am there right now as the bewitching hour approaches.

Exams are on the horizon. Round three begins next Monday. I am far from being prepared to tackle this round, but I hope and pray that I get the energy to make it through another grueling week of study. **sigh** Heidi and I have one foot out the Caymanian door. She leaves for good on August 1st, and I will be saying my goodbyes on August 10th, ideally with only the same two suitcases with which I arrived last August. 23 days til liftoff…

It's begininng to look like Maine

2006-07-12T16:26:00.000-05:00

We had a videoconference at school yesterday with some of the faculty and students at the SMU SOM Maine campus. As I looked through the materials they gave us, I found out that there is housing at a Marriott hotel that is all-inclusive. It’s more like apartment-style living, but with a smaller studio-type set-up. Okay, it’s not like one of those resorts that provide you with “umbrella” drinks, and you only pay one flat rate. And it won’t be right on the water like we have now. But there’s some really good perks that Heidi and I think will make life much easier:

a complimentary daily “Grab-N-Go” breakfast and 24hr Green Mountain Coffee

free high-speed internet access. Free local and toll free calls.

Digital Cable TV

24 hr fitness center and free access to a local Bally’s Total Fitness

24hr on-site coin laundry

weekly housekeeping service and friendly 24 hour staff

seasonal outdoor pool

can bring your pet

So for now, this will be my new address in Portland, Maine:

TownePlace Suites by Marriott700 Roundwood DriveScarborough, Maine 04074(207) 883-6800

And here is the link to their offer:

http://www.stayattowneplacesuites.com/stmatthews/

I called and made the reservation at Heidi’s urging. She also thinks it will be a great set-up for us. No worries about trying to find a place, moving belongings, getting electric, cable, gas, water hooked up. No contracts. No headaches. And best of all, we can even bring Sasha with us. It may be a tight fit, but we’re going to make it work. My brother, Mike, in Portland, Oregon, and me in Portland, Maine: the coast-to-coast brothers. It may be only until December 8th, or it may be for one additional semester. We’re not sure yet. We may go to Miami to finish up the 5th semester since we have that option now. Heidi is pushing for that. It all depends upon how things go in Maine.

Now I just have to go through that awful loan process again. If I am approved, there is nothing stopping me from starting classes in Maine on August 28th. As of today, I have less than a month remaining in Grand Cayman. I will be back in St. Louis on August 10th for about 10 days, then it’s off to Springfield for the weekend before the long drive to Maine. So little to do, so much time… yeah right!

The wide abyss of unconfidence

2006-07-06T23:35:00.000-05:00

I’ve been a complete and utter slacker this week. I have blown off classes and just felt a bit out of sorts. The weather has turned a bit rainy and gray. It looks like there may be a storm out there somewhere. The waves have started showing signs of anger.

I am trying to get motivated to get caught up. (It’s so easy to fall behind.) I have to admit that I have done quite well staying on top of things this semester, but it has been easy because I have had enough psych in the recent past to almost entirely avoid it.
Next week, there is a meeting scheduled for those students planning to go to the campus in Maine. I have notices that I have started to detach from this place already, even though there is still about a month left. It will be such a dichotomous twist of emotion to be leaving. I will be sad to have Heidi leave her new-found best friend, Laura, and her baby, Will. Heidi loves that kid, and I know she is going to miss her normal routine of doing a little schoolwork, going to the gym, and planning her daytime activities with Laura. No more days spent relaxing at the pool, going to the beach, going for walks… I will miss the fishing, but I look forward to returning to my endless quest for the elusive trout. I have already scoped out a bit of a plan to find time for some fly-fishing in those awesome northeastern streams. Some fellow students and I are planning to take a road-trip to Boston for a Red Sox/White Sox game over Labor Day weekend. Heidi and I are planning to see the band, Live, once we return to St. Louis in August. Man, I miss the United States…

I am going to miss several of the friends I have made here. I have committed myself to getting their addresses and phone numbers back home so that I can keep in touch. Many of the ones I have really grown fond of—Promise, John, and a few select others—are going to remain in Grand Cayman for another semester. I have had less contact with them this semester; maybe it has been part of the detachment phase or something. Weird how the unconscious protects and maintains. This semester is a blur; where has the time gone?

Pathology and Microbiology have been two of the best classes for me so far. Finally, especially with Path, I can see the medicine in what we are doing. In just one year, I have learned nearly all of the material necessary for Step 1. For the students in US medical schools, they are given two school years to master this same material. And they have summers off to brush up on old, forgotten material.

I am proud to (almost) be able to say that I have survived the initial cut. Many have fallen behind. For me, in retrospect, to stay on track is analogous to the salmon runs in the Northwest. These amazing fish expend so much energy trying to return to their original birth place to mate and die. I, too, have felt as though I have been traveling upstream against a current of challenges.

Many times, I have questioned my stamina to the point of wanting to give up. At times, those thoughts entered my head on a daily basis. They are now fully absent and have transgressed the formerly wide abyss of unconfidence. For that, I thank God. Prayer is an amazing thing that only develops with much controversy and challenge. For those who deny it, I am saddened. I pray that they may one day see the power in prayer.

M-80's and whistlers

2006-07-04T13:59:00.000-05:00

The 4th of July… always a memorable occasion, especially during childhood: being able to light off bottle rockets, whistlers, M-80’s, and other explosive fireworks was always such a thrill for an energized, young kid like me. My family used to spend the day at my grandmother’s house, which at the time, was out towards, but not in, the country. It was far enough out of suburbanville that fireworks had not yet been declared illegal. You could still pretty much light up a stick of dynamite, and no one would really care. My family always had a barbeque of sorts, but it was not the food that enthused me. It was the explosives that I was most excited about.

With the usual trip to the fireworks stand, my dad would give each of us a 20-spot. This allowed me and my brothers to get a paper bag filled to the brim with all sorts of fireworks. We always got a few useless ones—like the tank that rarely fired the right way and the parachute guy that only sometimes worked. It was always a lot of fun chasing the parachute man to see who could catch him. Either way, after an evening of smoke and fire, I could have still spent another few days blowing things up. That’s why I usually tried to save at least a small, secret bag of fireworks so that I could continue the fun somewhere in the woods behind our house for a few days after the 4th.

The next day, at my parents’ house, we used to spend an hour or so helping pick up the sticks from bottle rockets that were randomly strewn across the lawn and in the pool. Whiffle ball bats were great devices used to aim bottle rockets at targets. Even though they have only a little bit of accuracy, it was still fun to try to aim them at a target to see how close you could come to hitting it. I usually preferred whistlers over bottle rockets, as they not only tore through the air, but also screamed along the way before giving off a big bang. Those were the days…

Now here I find myself in a foreign land on the 230th birthday of our great nation. There’s not much of a hint of the usual celebration. Last year, we just returned from a family vacation in Marco Island. My parents, brother, and grandmothers are there now enjoying the beach and fireworks. As I skip my second straight day of classes, I think about what it’s like to be an American, and I wish we could be there with them today.

In remembrance of the birth of America, Happy 4th of July to all those dedicated and firm believers of freedom! The United States remains the greatest country in the world.

One in the same

2006-07-03T17:17:00.000-05:00

I skipped classes today. Heidi and I went to the Botanical Garden. Roaming throughout the very natural grounds are several of the nearly extinct blue iguanas. They are very tame, for the most part, and weren’t afraid to come right up to us as we fed them these pretty yellow flowers. As we wandered around looking at the various plants and other scenery, I began to feel this major itch. Not from the poisonous machineel tree that we passed, but to get back onto U.S. soil away from the confines of this small island. As Heidi pointed out, it seems like we have been here forever, when in reality, it is just a month shy of one year. It seems the longer one stays here, the more eccentric one becomes. This place is truly an international melting pot, which is incredibly unique, but sometimes it seems that it is a melting pot of misfits who haven’t found their place in the world. Now that may sound a bit extreme, and it probably is, but after a while, the monotony of sameness makes me yearn for something more. Not that the experience hasn’t been positive, but after a while, there’s just this desire for something different. Monotony can sometimes stifle any desire for creativity. Surely, it won’t be long until I board my final flight out of here.

230 years and counting

2006-07-02T07:33:00.000-05:00

The battery in my watch finally died. So now, time stands still. This was one of my greatest worries about being on an island—trapped in time. I think it is officially the 1st of July today, but I have to check to make sure. If that’s the case, less than 6 weeks remain until I am finished living in tropical paradise.

Another day of increasing waves: makes me wonder if there is a storm out there somewhere. Heidi’s parents are on a cruise of the eastern Caribbean, and my parents are in Florida vacationing with my grandmothers. I hope and pray my parents get better weather than Heidi’s; seems someone placed a hex on their time here, and it rained throughout most of their holiday here.

Soon my parents will be here to finally see what this place is like. I am eager to show them. My brother and sister arrive the day my parents leave. I want them to enjoy their time here without the presence of a tropical storm or hurricane. I distinctly recall many friends saying that they’d be the first ones here to visit, but we have had only family visit us, and I have yet to see a soul of a friend here. I hope that I still have these friends when I do return one day.

In a few days, we will celebrate the birth of our great nation, only this time it will be outside of the country. This will be a first for both me and Heidi. Our time spent outside of the United States has only strengthened our love for our country, and it has broadened our understanding of the world. Although everyone strives to be like the U.S., no longer does anyone truly like our great country. This is a sad, but true, reality. We have personally and unofficially sampled this across the board—from the Jamaicans to the Caymanians to the Canadians to the British to the Syrians and beyond. It will take a great effort to regain the status we once so affluently held.

Still, today, I think about the United States of America, and I am proud to say that this is my home, even if, for now, time stands still.

Off to beat path

2006-06-27T14:32:00.000-05:00

Walking around campus this morning, I could hear the usual after-exam question, “Is Micro out yet?” Everyone is anxious to find out how well (or poorly) they did on their Microbiology and Immunology exams. Then later, after it is confirmed, you can hear people saying, “Micro’s out.” The lingo signals doom for some and joy for others. When the grades are available, you must wait in a long line to obtain your results. It’s sort of funny, as you are standing in line gradually moving closer to the front, you can feel the tension in the air. Some people talk incessantly; others stand in silence. Then you say your name, and you are given a copy of your scantron. As you take it in your hand, you can either look at it right away or fastidiously move away with a pulsating heart. I have made it my rule to look at my score only after having left the presence of the long line and the sometimes overly inquisitive onlookers.

As I glanced down at my score today, I noticed there were only two marked wrong on the front sheet. Since there were 80 questions, they attached a second sheet for the back side of the photocopied scantron. Usually, it is on a double-sided piece of paper, but this time was different. As I turned the page, I found several other questions marked wrong. I could have done better, but I did beat the average (which is always a personal goal). Fortunately, I remain standing tall with an A in Micro. The results made me realize that I need to put more time into the Immunology material. That is the goal, so far, of this next block.

Tonight my focus is Pathology. None of the other classes exist. I plan to review both sets of notes that I have—one from the class lectures—and the other from the Kaplan videos. The latter goes into more detail and covers other disorders that were not covered in class, but there is some overlap. This can only be advantageous for the future, especially when I advance to Path II. For now, I remain steadfast in my desire to stay on path. As I conclude, I set off to beat Path.

Asleep at the wheel

2006-06-26T18:23:00.000-05:00

The 2nd Micro/Immuno exam is over. I am not sure how well I did on this one. The first one was definitely much easier, but I was better prepared for this exam. Hopefully, the results will balance out. I was far more confident going into this exam than the last, but the results might prove otherwise. I added up the “for sure” answers and tallied at least an 80%.

Tomorrow is Psych, but it is Wednesday’s Path exam that has me most concerned. The professor is doing a review the night before the exam at 8:00 P.M. I am not very sure that that will be of any help at that late hour, but I am going to attend just in case I missed something.

Tonight I will spend a couple of hours reviewing the Psych notes, and then I will move on to Path. Understanding Pathology seems to require a great deal of synthesis of the material. I guess I’ll see if I have synthesized well enough.

I have some sort of infection, as my ear hurts. This has caused me more to be more tired than usual. I could not help but take a couple hours nap after the Micro exam this morning. Hopefully, it will not be detrimental. I weighed it out in my head, and it seems that I would have been even more useless had I not rejuvenated a bit with some sleep. Because the psych exam covers normal and pathological sleep, I suppose I was just preparing for the exam. Sometimes you have to get pretty creative with excuses, I guess.

Catch me if you can

2006-06-23T18:56:00.000-05:00

I decided to throw a lure at the tarpon out back the other night. As usual, there were several big ones feeding in the shallows. The first cast drew a strike, but I couldn’t land him, and after several acrobatic leaps in the air, he tossed my lure back to me. I tried again promising to myself that I would head in by 1230 A.M. (at the latest), as I need to get enough sleep this week to tie together the loose ends of this round of exams. I was only out there in the first place because I rationalized that I deserved it after a long night of study at the library. As I threw out one of my last casts, I finally hooked another one. I changed my strategy a bit and decided to let the fish run out some drag. As he ran, the drag was screaming. In turn, I reeled him back toward the shore. After several bouts of this back and forth dance, he was cashed. I carefully spelunked along the iron shore, pole in hand trying to balance myself and the tension on the line. Finally, I dragged him up on the shore, picked him up, drop my rod, and ran up to the apartment. I set him down as he flopped and flopped. Trying to get inside to awaken Heidi was a chore in and of itself. The door was so slimy after I tried to turn the handle that it took a couple of tries. “Come quick, I landed a tarpon,” I said to Heidi as she awakened in a deep-sleep stupor. I asked her to take a photo, and as you can see, here’s my evidence of the little fella. I quickly ran him back to the water and began to start reviving him. But as I put him in the water, he was gone sooner than I had a chance to do so.

Pressing on

2006-06-22T23:01:00.000-05:00

Almost at panic mode: this block has pushed the material to the hilt. Too much to memorize, not enough time to understand. When I get to this point, I thrive on the pressure that simultaneously creates much (after-the-fact) undue anxiety. My strategy: cut to the chase. As I ask myself, what is really important, I realize that I have to start cutting down trees. Time to clear-cut as much as possible so that I can survive. Survival mode instinctively creates a different type of scenario. The most important thing that I have learned throughout all of this: stay calm, stay focused. Eliminate distractions. Put off what can be put off such as things like writing on the blog. Eat well. Sleep well. Keep the same schedule. For now, I am focused on pathology. Tomorrow, I will be consumed with Microbiology, and especially the Immunology material. As far as what the future holds, I don’t know. Today I will just keep pressing on.

Rounding the turn

2006-06-20T19:48:00.000-05:00

As round 2 of 3rd semester exams approaches, I am a bit fatigued. It seems that, no matter how much I get caught up, they keep piling on the material. Taking notes by hand provides a barometer of the pace of the professor. For Path, the professor covered 120+ slides this past Monday, and he had the class come in half an hour early so that he could race through the material. In Micro, the professor who normally provides us with a snail’s paced slide has stepped it up a bit too. But her trick is to gloss over many slides of material, excusing herself as she goes. Psych has been the only class to maintain a similar pace. He lectured on the DSM-IV-TR today. For my fellow colleagues in psych, you will know how remedial this material was for me: “Let’s begin, the DSM stands for Diagnostic and Statistical Manual. It utilizes a multi-axial system of assessment which provides for the diagnosis across five axes…” That’s about the time I stopped listening. Truly, I have to admit that this was the very first time I was more than just bored with material being presented.

I did find out that selling the car involves a $20 fee and completion of a form for change of ownership. I have yet to tell Christen and Frank, mainly because I have to verify what I was told. As I gloated to friends who are beginning to worry about moving back to the US and having to sell their cars and other belongings, I felt a sense of relief. I am going to try to talk with Dominic, the landlord, tonight, to see if he will help make our transition out of (and Frank and Christen’s transition into) Oceanside Plantation as easy as it needs to be. Ideally, it will be him in the office tonight for their daily painstakingly-difficult one-hour stint.

Tonight will be another long night of study in the library. Lately, I have been praying for knowledge and endurance. On the home front, early reports indicate that Eric is well on his way to recovery, and he has even been sighted in the pool. My sister, Karen, is the newest and best school counselor in the St. Louis vicinity. Congrats to her on getting the job she’s been seeking. Heidi continues to work online with her doctoral studies. That’s of course, in between naps and brief trips to the pool and the gym. So the story goes…

The end is the beginning

2006-06-18T21:04:00.000-05:00

The end is the beginning. As I begin to mentally prepare for exams next week, I am consumed by the realization that in only 7 weeks, Heidi and I will move from the Cayman Islands to Maine. Looking back, it all seems so surreal—as if living here for almost one year was just a dream. The longer we have been here, the more we have grown accustomed to the ways of island living. I am confident that I can speak for Heidi when I say that she has enjoyed her time here. In fact, we have both really learned to like living here. Of course, not having family and friends is a definite downfall, but aside from that, it has become quite comfortable here, and it feels like home. But I do realize the end of our time here is just the beginning of the next phase in our lives.

Meet Christen. Meet Frank.

2006-06-18T16:35:00.000-05:00

Heidi and I always wonder if God is really looking out for us. We seem to have so many ups and downs lately that sometimes we wonder – why us? Always though, in the end, God seems to push us to where we need to be. Case in point: In consideration of our anticipated move to Maine, there are many factors to consider. For instance, our move is dependent upon my successful completion of my current classes. As well, our move depends upon my successful re-approval of student loans, and these, in particular, are based upon my credit score and history. To add additional stress to the matter, I have to try to sell all of our “new, Caymanian” belongings prior to moving to Maine and then re-gather our stuff in the US as we make the march to Maine. This doesn’t even consider the stresses associated with moving and reorienting to a whole new world.

Next point: I corresponded with a future SMU student on ValueMD a while back. Out of the seemingly-never ending blue, I received an email from said soon-to-be-student this past week. As an aside, I have spent much useless worry on wondering how I am going to be successful in pulling off all of these feats almost all at once. Meet Christen.

By email, Christen asked me some questions about the in’s and out’s of medical school at SMU. I gladly answered her questions, as I pride myself in being able to share the little bit of knowledge that I do claim have. After an exchange of emails, we began to talk about finding a place of residence in Grand Cayman. Immediately, I found myself emotionally drifting through the initially stressful times of last summer when Heidi and I moved to the Cayman Islands.

After thinking for some time about this issue on my own, I kept going back to the stress that Heidi and I had to endure while trying to secure housing and a vehicle last summer. The first 10 days of medical school were spent living out of my suitcase in a hotel. Five weeks renting a go-kart disguised as a car. The cost: a lot of unnecessary stress and over $3500. I thought about how nice it would have been to have someone show us the ropes.

Final point: I sent an email to Christen suggesting that her and her husband consider the place with which Heidi and I currently reside. As I thought about again, I thought, maybe we could make it work so that they could just move into our place, as our lease expires on September 1st, buy our car and the rest of our stuff from us so that it would be simple for both of us. Win-win is never an easy feat, but this one seemed like a no-brainer. As I thought about it, inevitably, my guess was that, it would be more difficult than I first realized.

Meet Frank. After another exchange of emails, photos, and ideas, I received a phone call message from Christen’s husband. At the time, I was upstairs talking with Brian, our neighbor. Out of nowhere, Heidi seemed to have appeared behind me with the phone in her hand. She informed me that a call came in with a Michigan number. I decided to return the call before heading to dinner with Heidi.

I listened to the message. Since it was Frank that had called and not Christen, I immediately developed preconceived notions that this was fast becoming a possibility for both of us. His tone of voice was quite positive. I had hoped this would be the case, because as I had played this scenario out in my head, it seemed win-win no matter which angle I considered. Now, you have to recall that as much as I was considering how easy it could be for Christen and Frank, it would also make things that much easier for us.

Frank and I talked easily for a good 30 minutes, and still, we probably would have continued had I not terminated the call prematurely due to what appeared to be a dive-bombing, single engine fixed-winged aircraft. (I swear, I thought there was either a problem with this plan, and it was looking for a spot to land, or worse yet, some pilot had consumed a bottle of first-class-Caribbean rum and then decided to end his life. Fortunately, Dr. Heller reassured me that the plane was just spraying for mosquitoes.)

Since Frank is also an avid fisherman, I could tell that he was as enthused as me about dropping a line into the Caribbean Sea. Quickly into the call, Frank made me an offer, I accepted. Shortly after-the-fact, Heidi and I discussed this “deal”, and I think it put both of us at ease. Not only will Frank and Christen arrive to Grand Cayman with a place already set-up for them to walk into, they will also have a car to call their own. The only real issue is figuring out the logistics of the deal. That will happen over the course of this week, and likely into next, as exams are quickly approaching.

I think that once I am able to get the pragmatics figured out and draw up an official plan, Heidi, me, Frank, and Christen will all be able to rest easier. For now, I am glad to know that God does work sometimes in mysterious ways, and sometimes, He works in a most obvious and explicit manner. Thank God that all of us will be able to do what we need to do with as little pressure as possible.

The path to much debt

2006-06-17T09:56:00.000-05:00

Some people, including my father, have asked me to include the path leading to a medical degree. I have included the first part of the path, and I will post the rest at a later time. So here goes…

Medical school: 4 years in duration. The 1st two years are “Basic Sciences”. The 2nd two years are “Clinicals”. (These clinicals may also be called, “Clerkships”. However, in the US, this term is not as commonly utilized.)

The main part of clinicals is “Core Rotations” which take place in the 3rd year after taking the USMLE Step 1. A passing score on Step 1 is required before you get near the hospital setting. The following “cores” are required:

Internal Medicine, 12 weeks

Surgery, 12 weeks

Pediatrics, 6 weeks

Obstetrics & Gynecology, 6 weeks

Family Practice, 4 weeks

Psychiatry, 6 weeks

This is hands-on time for the med student. Finally, after all this classroom study, we get to do something other than sit at a desk all day memorizing fine medical detail.

After core rotations, the student does elective rotations, called “Selectives”, which may be in:

Allergy and Immunology

Anesthesiology

Cardiology

Dermatology

Critical Care

Endocrinology

Emergency Medicine

Family Practice

Gastroenterology

Gerontology

Hematology

Infectious disease

Nephrology

Neurology

Oncology

Ophthalmology

Pathology

Preventive Medicine

Pulmonary Disease

Radiology

Rheumatology

Community Health

Urology

For some reason, the selective in Neurology is required. I am not sure why they don’t just consider it a core rotation.

I am approaching the time when I begin to think about taking Step 1. Likely, I will sit for this strenuous 8 hour exam sometime next year.

Since I am probably choosing to go to Maine for the 4th and 5th semesters, I will truly begin clinical preparation next semester by shadowing some physician every week.