End of Semester 1 - onto semester 2!

Semester 2

I promised myself I would at least try to document once a month (hopefully more) my journey at Saba School of Medicine. Last semester I got a little carried away and did not have any time for anyone almost let alone anything.

Due to my hard work, I was able to complete the course to my satisfaction. I think some of the gossip and drama got to my head though, and I am hoping to stay clear of everything this time around. Even if I have to spend a little more time by myself or not going out, I think it’s worth it.
This semester will be quite challenging, I will be taking physiology, biochemistry, epidemiology and genetics. Epidemiology is purported to be a relatively easy course, while biochemistry and physiology will be difficult. It will be an adjustment, due to the focus of the first semester mostly on anatomy, to having several courses to focus equal energy upon.

Once I arrive on the island I will post some pictures of the new place I have gotten and I will also have more to talk about so you can look forward to that!

After my arrival...
So it’s my second day on the island, the first day of school is over and it’s 9pm at night and I have reviewed all of my lectures. This has got to be a first. BUT it is the first day of school. I am just expecting things to get harder and harder. Biochemistry today was slow, but a bit of a slap in the face in terms of what I have forgotten in organic chemistry and biochemistry. It is slowly coming back however. I took a long time this afternoon reviewing everything and went a little ahead. We were to have physiology today, however, it was not to be – Dr. S had a family emergency and had to leave the island. So we are getting a few days of reprieve. But, I decided I would go ahead with the first lecture. It was pretty straightforward and that is the reason for my early finish today I believe. Also, our third class was epidemiology, in which we had a lecture, which we were told most likely had no material that was testable. However, I re-read that lecture several times as well. I have been quite productive studying at home and I am shocked.
I just can’t believe there is so much to learn, well I can, but I am still constantly overwhelmed. I am hoping that one of these days I will relax a little more – but I am worried as soon as I relax I will get too relaxed, let down my guard and start to not do well in my courses.

I started this as a potential aid to future students at Saba, so I will endeavour to continue providing information, but it’s difficult to also not provide gossip, which is the language of this place. Our class has shrunk considerably, from our bloated initial 103 students, to our current 76. But in each of our classes we have irregular semester students, who have dropped classes or failed courses and have ended up in between semesters taking a combination of courses. This scares me considerably. I am determined to work as hard as I can to make sure I am not one of these persons. I have been reassured by others that often these students did not have a background in the subject matter (i.e. biochemistry), and that may have been a reason for their failure but I am unsure.

I am sorry to say that this blog is not going to be very active. I doubt I will be able to write more than twice a block – but I will try my best.

I am posting some beautiful pictures today of my new little apartment and my view. I hope you enjoy.

I am going to try to tough out my first block in biochemistry, covering mostly DNA, RNA, Amino acids and some protein structure; physiology, consisting of muscle contraction, nervous system and some cell physiology; genetics, covering some molecular biology techniques, mendelian genetics and gene mutations.

I miss my family and other loved ones very much.

I hope you are all well and I will write when there is more to write about!!

Day 43

Over a month has passed. I need to quickly write this blog so that all of you know what I am up to! I know I left you more than a week ago, before my second block exams. So I will sum up what has happened since: I learned as much as I could about the arms and the legs, I wrote the exam, and I did OK, again. I think my biggest problem in that time was allowing the stress to get the best of me, and not sleeping enough. I am trying my best not to do that this time around.

I am still plagued with stress and guilt as I reluctantly, in some ways, go to sleep at 2am. My usually 3am bedtime beckons as I try to get ahead as far as I can in the next day’s lecture. I must be crazy. But I am sure I am not the only one. I have now had a couple of run-ins with the infamous student here who scores 100% on anatomy exams. He is quiet, respectful, and never looks overly tired. He sits in the back of the class on the side. Sometimes I look to see what he is doing, but I can never quite see. Not that he is an animal in the zoo, but we all want to know just how he does it!

My mandate these days though is to do as well as I can, focus on studying learning, knowing the human body. That is my responsibility as a doctor, to know my stuff. It scares me when I have run-ins with the upperclassmen though. For instance, today, in the study room, running into a 5th semester student who is one of 35 students remaining from a class of 85. I just want to make it out of this place alive, healthy, smart and strong to take on my clinical duties. I am going to be one of those students! I have the drive! I can do it! Sometimes you need to chant it to keep you going too....
We are learning the abdomen these days, lots of relations, “The ascending colon is lateral to the coils of the small intestine, and it is superior to the ilihypogastric and ilioinguinal nerves, as well as the right ureter and quadratus lumborum muscle.” Obviously I remember this stuff. I know it is important, and I revel in the power of my mind, picturing a curved pancreas or the coils of the jejunum, the naughtly appendix which has a multitude of positions. The power of the “ectomy” in the abdomen is strong, every clinical application for an organ tends to be some sort of removal, spelenectomy, colonectomy, etc. What else is difficult? Well just about everything. We just keep on plugging away, knowledge is power and I am gaining more of it.

I have started another method, yet again, for this block, involving note-taking and reading of both lecture material and the text book. We will see how this works out too, plus, I have a friend to study with too, and he has agreed to review with me frequently so we keep each other up to date and on our toes.

Still looking for a place to live here too for next semester, I am hoping to get one over the weekend.
Interesting things:
1. I am constantly running out of food. I can’t understand if I just eat too much, I don’t buy enough – or I buy the wrong things. I had a ridiculous snack this evening that I cannot even divulge because there was just not enough available. I think the only person I could tell is my sister! Haha.
2. There is a fly that lives in my room. I am so mad. I keep on thinking I get rid of it every day and I don’t.
3. The abdomen is pretty cool. At first it seemed like such a jumble, so much fat and mesentery. Much of the inner abdominal cavity is covered by a layer of mesentery (fat), called the greater omentum. Omentum means apron in latin. Beyond this fat layer, lays the stomach, liver, small intestines, large intestines, and on and on. I think the coolest thing today was holding a spleen. It was small and grey and seemingly insignificant, yet so important. I did some dissecting today as we reached the posterior abdominal wall, dissecting out the abdominal aorta! Cool!
4. I think if I had learned latin my life would be so much easier:
a. Cecum = blind sac
b. Pylorus = gate-keeper
c. Epiploic = to float upon
I am loving this Latin. It makes everything make perfect sense. Why is the lower sphincter on the stomach called the pyloric sphincter? Well because it is the gate-keeper of the foot in the stomach, allowing only a certain amount into the small intestine at one time.
The cecum is the blind sac in the intestine. There are also a set of “gastroepiploic” vessels, which I now know mean, “floating on the stomach”! Fantastico.
I am dead tired. I want to write more and I will try on the weekend after I attempt to find lodging in Windwardside.
I witnessed a crazy lightning storm on my balcony this evening. It was quite a sight!
I miss you all at home.

xoxo

A month and counting...

Hi everyone. Sorry for the lack of update, for those keeping up. It has been a crazy week. I instituted my new study strategy which entails never falling behind in classes, i.e. reviewing and studying every lecture before going to bed at night. That has kept me up late, combined with an evening run and attempts to do nightly lab sessions has prevented me from writing sooner.
Block exams are in just over a week so it will probably be another week before I write again. In retrospect, noticing that it is now a month since I have been here it is kind of unbelievable. What would I have done on any other June 1st? Would I have been working, been in summer school? Revelling in the newfound Canadian warmth? Meanwhile, it is quite hot and has been this way since I have arrived. I never check the weather; I am not sure how accurate it would be anyway, I just assume that it will be hot and perhaps rain. Bu t you can easily wait out the rain spells here.
Now to what’s going on with school. We have finished the arm, and now I can tell you all the muscles, where they originate and insert, the nerves, their course in the arm, which muscles they innervate, what part of the skin cutaneous nerves receive stimuli from, joints and their accompanying ligaments, movements, and arterial supply and venous drain. This along with an assortment of other anatomical features. After an initial struggle with the number of muscles to learn, I have found that most anatomists are not actually crazy, they at least try to name this logically. For instance, flexor carpi ulnaris, is a muscle that assists with flexion of the elbow, it attaches to the carpal bones, the wrist bones, and it runs close to the ulna and is innervated by the ulnar nerve. I feel like I am learning some latin and it is fun how they name things. At least I enjoy some of it!
In histology we have moved from hemopoeisis (the formation of blood cells), to cartilage, and today we will begin bone and bone formation. I have been relatively good at keeping up with the class this block, though I wish I spent more time on it this past weekend. I was pretty tired out from the week, and spent Friday catching up on lecture reviews, Saturday I spent concreting my arm knowledge and Sunday I was out of steam, slept a large chunk of the day to make up for during the week, and worked on getting reviewed on the leg for Monday (including some muscle memorization). So the weekend was a bit of a mix-up of things. I really hope I have kept up with what I have needed to, and that this week will not be too bad. The way things are starting out today is not good though – 3 ½ hours of sleep due to going to bed at 2:30am, and not being able to sleep past 6am.
In running matters, I have been running in the evenings every day pretty much. The best time of my day, as I am sure I have mentioned. I constantly want to be taking pictures, but I feel like there is no way that the picture could possibly convey how beautiful the landscape is on the island. I saw a giant lizard too the other day, the wildlife is pretty varied! I feel like Saba could maybe be like another Galapagos island because it is so isolated and the wildlife can specialize here, perhaps like the birds in the Galapagos. I have almost increased my route to the point where I can get to the beach. But – the thing is – there is only a beach here about 6 months a year. It depends on the tides, and every June it disappears until October. I think by the time I am able to reach that distance that there will be no beach left. I have heard there is hardly any at this point!
Anyways, my running is going fantastically, and it is a great way to see the island. I love it. I think training for a marathon here would be impossible though due to the terrain. It looks like my marathon goal is going to be delayed at least for a couple years. Well – you never know, but it looks like planning for training here would be difficult. If anyone has tips in terms of training on very hilly terrain let me know!
Interesting things for the day:
1. I love it when anatomy is easy, while reviewing the femur last night and fractures I learned about the Bumper fracture, which has to be the simplest fracture to remember. Aptly named, it is the name for a compound fracture that occurs when the bumper of a car hits a persons’ leg.
2. Histology is getting really complicated – I knew bone was difficult from the complicated presentation during studying for my MCAT. But the understanding of the cells in that context was quite simplistic, simply an understanding of osteoblasts and osteoclasts (different types of bone cells) was necessary to understand the constant breakdown and creation of bone. Now identifying the more complex parts of bone is more challenging. Also contrasting to other connective tissue will be difficult.
3. I feel like I go in and out of feeling comfortable with material. It’s such a roller coaster. I loved in undergraduate courses to feel confident about the material that I am being tested on. I feel like I cannot ever master anything! As soon as I do, I have spent too much time on something, or I am falling behind in some respect on another concept or class.
4. The vending machine here is terrible. It took my money on one occasion, and then yesterday, the dollar change machine ate my dollar. I would stop using it, except for the fact it is the ONLY food source on campus past 4pm. That is just ridiculous. They need a cafeteria expansion, or at least a better vending machine!
5. Block exams in a week and I am so scared. I really want to do well. Let me be clear, I want to be a knowledgeable doctor – and I want to know as much as I can! Learning more will help me be the best I can be at what I do.

Have a great week everyone!

21st Day +

I only know it has been 21 days, because it was 3 weeks ago today that I arrived on the island. I was pretty unproductive today. But I hope I have given my body, and especially mind, a rest. I think one of the difficulties here is readjusting my scheduele. I have always been a night person and now I need to go to bed at a decent time more regularly.
After the blocks, the week passed by in a blur. We covered the embryology material for this block; cardiovascular and respiratory system development. I officially find embryology incredibly difficult. The way the embryo looks and changes seems to have no rhyme or reason, and the method by which the material is taught in the book and the professor I find disjointed and complicated, without a flow. I wish they would just teach it chronologically, but instead it was taught in pieces, and then clinical correlations thrown in willy-nilly. Not so cool.
Anyhow, pretty good week ending in an initial arm dissection. I though the arms would be easy, but the forearms have more muscles than you can shake a stick at and the palm is even worse. Not looking forward to this week a whole lot. But last week, we learned the brachial plexus which is the combination of ventral rami, connecting, intertwining, intersecting, joining and branching off on their way down the arm. We need to know what “root”, that is, what original nerve each muscle is innervated by. Interesting stuff. Seeing the nerves dissected out from the spinal cord really give you an idea of the complexity of the system.
Today, I personally dissecting out several nerves! How exciting! We looked at the back of the shoulder and the forearm muscles and some other relevant structures/spaces. My favourite part was finding the suprascapular nerve which was in the suprascapular notch that went to innervate the supraspinatus muscle on the top of the back part of the scapula. I love how all the names are the same. It’s great. It’s funny how dissecting and finding things will help you to not forget, as Dr. A had originally told me days ago.
This blog has been a composite of a couple of days and I am finding a little harder to write. I have to find more and interesting things to write about. There have been a lot of basic things going on, but also a lot of rumours. Now I know that things go around really quickly, you really have to be careful what you say, the walls are thin, and you only fully understand when you are here.
An example of this is probably a little mess up I made the other day – a couple friends and I went out to Windwardside (a little town about 15 minutes away from the school by driving), to look for a place to live for second semester. Through word-of-mouth, a friend of mine had found a house that was about to become available for the next semester. We went to see it, I really liked it , and we told the current tenants and landlord we were planning on signing leasing papers a month before leaving.
Unfortunately, a couple days later, after re-evaluating and speaking to my parents, I decided against this place. The location was in general impeccable, near this cute little organic farm where they apparently sold cheap fresh vegetables, it was in a quiet neighbourhood too, outside the main town. The main issue for me was the transportation. You see, even though the island is very small, due to the topography and location of the towns, the distance that has to be traveled on roads along the hillsides to the towns. Anyhow, long story short, you need to get some sort of transport. There is a school bus, but rumours of unreliability, as well as the limited transportation times dissuaded me from considering it as a viable transportation option. The idea was that all of us would get a car. But it is more complicated than that, shared between four people, things get financially difficult potentially – as well, it costs 200 USD$ to get a license here in Saba. One of my current roommates and I have decided to stay in The Bottom, the city in which the school is located. I feel pretty guilty, because I know our ex-potential roommates are not incredibly happy with the fact that we both backed out on the deal. If you guys are reading this, sorry about the trouble we caused you! Transport continues to be the main issue, as well as money to buy and maintain a car over two years on the island with four different equal owners.
That’s pretty much my life over the past couple days! My roommate and I had a fantastically fun time at the anatomy lab last night, we have a grand old time thinking about hilarious acronyms to help us remember muscles. To use the same example as above, we think of the suprascapular as the “super muscle”. It is “super” because the nerve exits the superior trunk of the brachial plexus, and is called the superscapular nerve (C5,6), it is located superior to the spine of the scapula, but it is also super lazy, as its function is only to abduct the arm from 0 to 15 degrees away from the body!
Sorry I don’t have anything much more exciting to share.
I will include a list of interesting things another day I promise!
:)

The Day After.

Wow. I can’t believe it is over: The infamous first block. It sort of conquered me rather than the other way around. I won’t let the next one be like that though. Now I know better what to expect. After having a run around the coast a little , I have cleared my head, and I am still unsatisfied with my grades but I am glad that I passed and I did “adequately” per se. I think that is the most I can say without telling you my actual grade. However, let it be known that 33 people failed histology, and more than that failed anatomy, at last check, 42. Mind you, I also know people who I did very well. Pretty incredible, but keep in mind that to pass you must have earned a grade above 75%. This is above the required passing average in the states, which I believe ranges from 60 to 70%, and I assume the figures would be similar for Canadian schools.
It is great here that the second semester students are sort of like big brothers and sisters. I have some great TA’s asking how I did, encouraging me, and cheering me up despite this minor setback. I feel really lucky in that way. They are understanding and cite their stories and others as people who have vastly improved from the first exam. It is one thing getting used to the questioning. It is helpful to study more how the questions are asked. Only in the last hour or so did I look at questions from BRS (Board Review Series) Anatomy books. These texts summarize all the key concepts in an easy and accessible way, as well as including some fantastic clinical application questions. The fact that I found these questions challenging as the exam quickly approached was a hint at the fact that I was unprepared.
We went out in the evening after spending a blissful afternoon stress free. I finally felt like I was living on an island for a moment. We chatted with friends and everyone was breathing a collective sigh of relief. There was a party at the Matthew Dorm, so we all went over there and had some drinks. There was lots of dancing and I did a bit of that, but retired relatively early. As it was I was exhausted the first day back!
Yesterday was quite a dull day. Full of new histology about the blood, anatomy was the embryological development of the lungs – quite a handful. Finally we had a bone lab in the afternoon, followed by evidence based medicine. I unfortunately mixed up my days in regards to when I had a meeting with my Faculty Advisor. I was convinced it was Wednesday, but after checking the scheduele I realized I was completely wrong. It’s crazy how your brain goes a little “awry” shall we say as you study for blocks. I just realized today that I know nothing about what is going on in the world. That is so sad! But, everyone makes time for certain things. For me, I knew I wanted to run, write this blog and talk to family. That takes up a good chunk of my time. If I have too much time left over, I pretty much know I am not studying enough!
What have I learned so far:

1. Caribbean Medical School is difficult and challenging. This is only the beginning of the journey. As my sister once told me, it’s a “marathon”. And she is right. You don’t want to burn out half way. Days feel long here, but in all essence it is a short time in my life, and I am living my dream.
2. For the human fetus to develop normally, it needs to ingest some ofthe amniotic fluid in which it lies and pees in. This helps develop the lungs. An interesting condition called oligohydramnios occurs when there is an accumulation of excess amnion, due to the fetus’ inability to ingest this fluid. This can be caused by a variety of issues. I find so many of these embryonic malformations fascinating. There is a ridiculous amount in our textbook about them. Clinical applications are the bomb.
3. I know all the bones in the hand: Hamate, Capitate, Trapezoid, Trapezium, Scaphoid, Lunate, Pisiform, Triquetum + (Metacarpals and Phalanges). I remembered them on the first try. I am getting so much better at this! Also thanks to the teaching of Dr. P.
4. The Brachial Plexus is the next thing to memorize.
5. The development of an embryo is a ridiculously complicated task. I thought that pictures would help me understand anything. But these pictures of the early embryo and folding seem like scribble to me at times.
6. I have been running almost every day. It is so wonderful to see the ocean. It reminds me of the beauty I am surrounded by.

Enjoy the summer! It is just beginning here, and it is already too hot to handle!
:D

Day 14

Day 14
I did not think I would have time to write this, but I am taking a break from my studying and I figure, this is a good way to get my stress out anyway. I am preparing for my “block exams” on Monday and Tuesday. Block exams are sort of like mid-term examinations, except for the fact that they are pretty much every two weeks. They are non-cumulative until the final block where we have a cumulative lab exam, shelf examination in anatomy and histology final. If you don’t know (as I had no idea until just before arrived here), the shelf examinations are exams taken by American Medical students. They are essentially standardized tests in a particular subject (sort of like taking an old published MCAT test and they have already standardized the scores), and are picked off “the shelf”, in a box where they have quite a few, and they are chosen at random for students to complete at the end of term.
Monday I will be completing an anatomy lab practical examination and on Tuesday I will write two practical examinations in Histology and Anatomy. The histology professor expressed disappointment when he told us in our introductory class that we did not have the capability to do a histology laboratory due to the lack of equipment, but I cannot imagine having to do more than one practical examination. Every second semester student I speak to tells me we have not covered much material. But I think for less than two weeks we have learned so much. Summarily, we have learned introductory anatomical information, embryology (basic, not system-specific), nervous system organization, back (spinal cord, muscles, blood supply, venous drain, innervations), thorax, including lungs and the mediastinum (with all the above subcategories). On top of this I have barely touched Histology, you would understand why if you ever took it. It is like a slow biology course, except less exciting, and focuses on the analysis of slides of various cells from all over their body and their characteristics. Oh. And it is at 8am. A lot of people sleep through at least part of it. The professor is fantastic though, and is very knowledgeable and helpful.
Apparently the stress and work will simply increase. I am slowly adjusting to this. But I am learning so much. I have never felt so mentally alive really. I feel like I am learning so much. Who knew my brain could hold all this information? Yet, I can still seem to remember the words to songs that I should have long forgotten. I always vaguely (and with no real scientific backing) believed that there would be some displacement of information, as if your brain has a some sort of limit. I guess I likened it to filling a cup up with water, and you can only fill it up so high before it spills over the brim. But, I think it is more like large Brita filter. You can only put so much water in it at a time, you need to let it filter through before you can add more to the top part to be filtered. Right now I feel like I don’t have enough time to filter. Being a perfectionist and competitive about school does not help.
I went for my second run on the island today. It was incredible. The beauty of the island continues to stagger me. I think it is because I spend most of my time in the library, class or anatomy lab on campus! My injury is much better now as well! I injured my Sartorius muscle before I left Toronto, and just before the marathon I was not able to complete. But that is not related to this point. The point is that the runs here are beautiful, not only that, they are so hilly! Thanks to the hill training at the running room (Thanks Ben!) I am taking them in stride. Some of them are steeper than even the Donwoods hill, but I love the challenge, and the thumbs up from motorist passing by indicate they are even impressed at my stamina!
I just wanted to write a little note to express my excitement, in these wee hours of the morning, about what I continue to learn. I think holding a human heart is a pretty fantastic thing, something I was recently able to do in anatomy lab. I know it is cliché, but I remember an episode of Grey’s Anatomy, where a surgeon was explaining why she wanted to be a surgeon and couldn’t do anything else. Her reasons included the opportunity to hold a beating heart. But, I am just excited, to be able to name all of its structures, its blood supply, venous drain, action and then some clinical applications. Every experience I have here is pretty incredible, they all tend to get lost in the shuffle, but anatomy is one of the things here that does not cease to amaze me. I love the Latin that is used to name a large number of the body parts and I really wish I knew more of it! It would make my life so much easier in terms of memorizing things like coronary sulcus, which I believe means depression of the crown, crown (because it is the heart) and sulcus which means depression or groove. This is a groove in which the right coronary artery lies. What a beautiful language.
The extensive knowledge of all my TA’s knocks my socks off. I do not know what I would do without such great teachers! I was lucky enough to get couple of great ones, who take a large amount of time out of their day to help me learn. I can’t thank them enough. They give me confidence in the knowledge I have, and give me the information they think is important to help me succeed.
I don’t think anything exciting has happened in the past couple days other than my recent run with minimal leg pain! I have been studying like crazy and we even had classes today, on a Saturday, for histology, and two tutorials – one in anatomy and the other in histology. Tomorrow is really crunch time, and countdown to the exam. I will write all about it sometime afterwards. At least I have Nutella and bananas to get me through it.
:)