Practice Dummy

Sticking to my plan of shorter, more frequent updates (I know...for now...)

Fun week this week. On Thursday, I volunteered to assist the Behavioral Science department as they test the 3rd semester students on their patient interview skills. Basically, we're handed a "script" of our chief complaints as patients, plus a bunch of past medical history and family history data. The 3rd semester students come in and interview us as if we were real patients coming to their office/hospital for the first time. There's a professor in the room with us to grade the 3rd semester students on their skills and give them feedback. After months (and months) of doing bookwork, taking tests, etc., it was nice to be in a setting where you can see the outcome of all of this. In addition, while I was acting like a patient, I was learning what I should be asking as a physician, especially as a prep for when I have to do this next semester. That reminds me: I need to copy down some thoughts before I forget them and the river of time sweeps me along.

Yesterday, I participated in a Neuroscience study that is examining the efficacy of simulator usage on medical training. Unfortunately, I was not placed into the group that got to play with the plastic "dummy patients," and I got put into a "reflection" group. I was concerned that this exercise would be a boring conversation, but I was completely wrong. The gentleman running the group was an emergency physician, and as soon as we were assembled and ready to go, he ran through a case with us: "You have a 52-year-old patient that's brought into the ER by EMTs, who report that he has a pulse of 50 bpm, O2 sats in the 80s, BP of 150 over 96...what do you want to do?" And we have to quickly ask the right questions and decide how to go about treating the patient: his O2 sats are way too low and he's registering below 8 on the Glasgow Coma Scale, so we have to intubate him; he's seizing, so we have to administer anticonvulsive medication (all we know about thus far is phenytoin); etc. The session was fast-paced, and the physician running the group was very demanding, asking us tons of questions. If we waffled, he'd keep grilling us. Lots of fun, and hopefully another good indicator of the work we'll get to do in the future.

Also, on Tuesday, I took a break from class with a friend from Bermuda named Janaya. We went to the capital of Dominica, Roseau, to watch a cricket match between Bangladesh and the West Indies. It was a ton of fun, and well worth having to make up a couple of skipped classes to go (all of our classes are videotaped and put on the web, so we can watch them at our leisure, although it's unwise to get behind). I didn't know anything about cricket beforehand, but this was a once-in-a-lifetime opportunity for me, and even for the locals here. It was the first international cricket match hosted by Dominica, so there was a national holiday declared to exhort the locals to come to the match! I'll have to check and see if there have been enough improvements to the network to allow me to post photos on the blog. If not, I'll add 'em to Facebook and my me.com account.

I admit that I made a bit of an ass of myself, though. Useful reminder for the future: if you get confused about which side of the body the spleen is on (it's on the left side, fyi, unless all of your viscera are backward, which is extremely rare), PLEASE don't correct someone loudly in the middle of a crowded room, like I did. You WILL feel stupid, and people WILL stare at you like your head has turned into a Mr. Potato-Head. Forewarned is forearmed, people.

Until next time, take care of yourselves and each other!

Upon Reflection

I know it's been forever since I updated my blog. This will be a very brief update for everyone.

I plan on doing more frequent blog posts, with briefer descriptions of what I've been up to. I will probably give you some more meat-and-potatoes type blogs, with some of the classes I take each week, which labs/ICMs I'm doing, etc. There will be less emote-a-posting about how things "are going."

I got some good advice tonight about monitoring my online "presence," and how important it is to maintain a proper online persona in the event that it is misused to profile me as I prepare for residency positions, employment positions, and the like. It isn't that I was unaware that such use of people's online postings took place, but I was reminded of how seriously many things can be taken once they've been put on the web.

To wit, I've also taken a look at my Facebook and Twitter accounts. I'm revamping my entire online image, and the dust might be shaking things up soon.

I hope everyone is doing well. I'm about 4 weeks from returning to Florida for my 2-week break between semesters 2 and 3, and I can't wait to see everyone! Take care!

Med School, Part Deux

Here comes Semester Two.

I had a great break for the past three weeks. There was a ton to do, and I accomplished all of it except for a visit to Sweet Dreams, BW3s for trivia, and a 64-team Mario Kart tournament.

Thanks to all of my friends and family for making it such a great time. List of goals attained on this break:

- "Choir practice" with the Bay High Science Department

- PJ party at the Enclave

- Coram's after dark

- Spaghetti Carbonara

- Family Reunion

- The Red Bar

- Walsingham/Edmondson wedding (I caught neither the garter nor the bouquet)

- El Presidentes for Cinco de Mayo

- Batting cages

- Mini-golf

- Midnight movies

- Destin shopping

- Scene it x 100

What's on tap for next break:

- Orlando, including seeing Mike "Family" Jones and Mark "Crooner" Jenkins, O.A.R. at Hard Rock, Pete's Specials at Pat O's, and CHIPOTLE. I'm looking forward to it.

For now, it's game time. OOSE.

Practically Relevant

Since Notre Dame's hockey team lost to Bemidji State in the opening round and my NCAA tournament bracket fell apart completely when Louisville lost to Michigan State earlier today, I've found myself with not enough to do (except study). So...time for another round of blogtopia! Today's topic: the DPS Practical Exam!

One of the 5 courses I'm taking right now is called Doctor, Patient, & Society I. When I first arrived at Ross, I thought this could be a great course. Young doctors need to learn how to interact with their patients from the get-go, and this course could be a great vehicle for that.

Unfortunately, the course has not really met my expectations. No methodology is being taught in it. It seems as though we're supposed to know how to accomplish certain parts of the doctor-patient relationship by the end of the semester, but there hasn't been an adequate level of instruction on how to actually handle those parts. For instance, one of the first things med students should learn to do is be able to sit down with a patient and take a history of their present illness (HPI). Essentially, you find out what the patient's chief complaint is, and ask all the questions you need in order to be able to come up with a few options for the diagnosis. For instance, if a patient comes in complaining of lethargy or fatigue, the differential diagnosis is extensive: anemia, myasthenia gravis, hypothyroidism, diabetes, cancer, major depression, etc. But by asking certain questions, the student should be able to rule out certain disorders - if the patient has had no weight loss, then cancer is less likely; if the patient doesn't have any problems performing light tasks like combing their hair, then myasthenia gravis is less likely. The HPI is only one part of a complete report on a patient, but it's the easiest thing to learn.

We haven't really learned anything about it, though. More than that, we haven't even been given a breakdown of what information belongs in each component of the complete report. Regardless, we have to go in tomorrow and "take" an HPI, based on a chief complaint we're told about (in advance). The chief complaint we're covering is fatigue/tiredness, so I admit that my example wasn't just chosen at random.

Get this, though: instead of interacting with a human being, we have to make up a conversation that we might have with a patient. Tomorrow, I'm going to sit down in a crowded classroom in front of two blank sheets of paper, and write out a script for an imaginary HPI. Here's how mine starts:

I (Interviewer): Good afternoon. I'm Dr. Palfrey (extends hand).

P (Patient): (shakes hand weakly) Hello, doc. My name's J.J. Johnson.

I: Nice to meet you, Mr Johnson. Can I take your jacket?

P: Actually, it's pretty cold in here. Do I have to take it off?

I: You can keep it on for now while I ask you a few questions, but you'll have to remove it when we come to the physical exam. I'll turn up the temperature a bit for you.

P: Thanks.

I: So, what brings you to see me today?

ET CETERA

To ruin the ending...I decided that my deceased jazz trombonist has Hashimoto's thyroiditis.

Tune in for more medical wackiness next time, folks! Take care!

Addendum: Quick shout-out to Jessi...thanks for the comment! I missed you guys on St. Patty's Day, too. Sadly, I did not visit the bar for a beer. I didn't even wear green. What's worse: no one pinched me for not wearing green! And let's get it out here in the open - I believe that Jessi's bracket selection (accurately named "Jessi's Gonna Win") is a LOCK to win the Yahoo.com group's bracket competition. If and when it does, I will pay homage to your basketball tournament prediction prowess on this very site! Meanwhile, Andrew's "Let's Go Duke" and my own "I Like the Irish in the NIT" will have drifted so far off the radar that we will have to drink many beers to overcome the sadness that will set in shortly after your assured victory. ;-) Arrivederci, Fiero!

(Looks at watch) Wow! Look at the date!

Let's get caught up, friends and relations.

It's been a full month since I last posted. As you might have expected, time seems to evaporate during medical school. Since February 15th, I took two practical exams and another Mini. I'll quickly describe the practicals, for those of you interested in the minutiae of actually being a medical student.

The first practical exam was based on our lab for Histology. Typical Histology courses will have laboratory components where students will look at tissue slides through microscopes, learning tissue type characteristics as well as techniques for preparing tissues for visualization and how to use the microscopes to examine the tissue samples. At Ross, with so many students, the decision was made long ago to eschew the microscopes in favor of essentially having lab via lecture. So we meet in the lecture hall, and the slides that we would have looked at are projected onto screens and plasma TVs for us to view. We're not getting the "feel" of using microscopes, but we also don't have to deal with the pain of keeping up with them, so I don't feel too bad about doing Histo lab this way. The one thing I think we're really missing out on is slide preparation, because I've never really done much of this, but we won't be doing much of that type of gruntwork as physicians.

Our practical exam for Histology involved us going into the same lecture hall and answering multiple choice (up to 10 options, A-J) questions based on slides that would be projected onto screens/TVs that were changed roughly every minute. In, out, and largely done for the day. I'll do another post on PBL, which was the only scheduled activity I had for that day.

Meanwhile, let's talk about Gross Anatomy lab. I've already posted several times about the Anatomy lab - mostly about how bad I am at it! Like I've already said, we're broken into groups, and the groups each have a cadaver to work on, and the groups trade off dissection days. We recently (this was after the practical, but it's illustrative) did our dissections of the lower limb. Group B started on a Tuesday by dissecting the anterior and medial thigh. My group (C) did a dissection two days later of the gluteal region, then A did the posterior thigh and popliteal fossa on the following Tuesday, etc. We always work on the same body we start with.

The Anatomy practical exam involves opening up all the cadavers. The professors tag one or two structures on each body and ask us to identify things like muscles, arteries, veins, nerves, some aspects of bones, and some connective tissue structures (e.g., the dura mater overlaying the spinal cord). All the questions are multiple choice (A-E), and we answer them as we walk up and down the rows of lab tables in a serpentine fashion, pausing at each body to answer a question. There is usually a tag/question on one side for me to answer, and a tag/question on the other side for someone ahead of me to answer. They can also ask us secondary-level questions based on tagged structures (e.g., what function would be lost if the tagged nerve were severed?). Finally, there is a small radiography component to the lab, so there will be several x-rays on computer screens, with a question added to the side (e.g., which of the structures in this MRI corresponds to the initiator of arm abduction?). There is a "bell" that rings roughly every 40 seconds, telling us to move to the next station/question. With so many students, they have to move quickly to get everyone tested in the same afternoon.

I did pretty well on both of the practical exams, although not as well as I wanted to do. If I do a little analysis of my performance, I come up with one strong belief: Timed tests are ok. Timed questions are not. When we take our full lecture-based exams, we're given a total time based on a given amount of time per question (75 seconds, I think). When I'm in this situation, I handle it very well. I can beat up on the easier questions and answer them in 10-15 seconds, saving a considerable amount of time to focus on the toughies. For each the first two lecture-based exams, I went through the whole test, answered the questions I knew, skipped the ones I didn't, then went back to the questions I skipped, answered them, and went through the whole test a second time to check my answers. I ended up getting out about an hour early each time, and performed well each time. During the practical, I can't beat up on the easy questions in order to move on to the toughies. As a result, my performance on the toughies suffered. I'm going to have to figure out a way to maximize my performance on toughies despite restricted time per each question. I can probably do this easily with the Histo practical: our questions are in a big stapled document, so if I beat up on an easy question, I can read the next question before time starts. The Anatomy practical will be more difficult, as the questions are kept at the stations. I can look ahead to some of the radiographs, and maybe take a look at the tagged structure on the other side of the bodies ahead, but I certainly don't want the proctors to think I'm cheating or acting inappropriately in any manner. Please post any comments with other recommendations.

As a general kind of update, I've got straight A's thus far (woohoo!), and I'm doing my best to stay motivated. I'm really looking forward to the two-week break I'm getting in April, though. I need to take and post some more pictures of the school, especially the classroom where our lectures are held, and the Anatomy laboratory. Hopefully, I'll take care of that this week! 

Quick shoutout to Adam Loverro. Adam was my roommate at Notre Dame during our freshman and sophomore years, and it was his message to me on Facebook that gave me enough of a kick in the rear to put up a new post. I had kind of let the blog sit around for a while, but I'll try to keep up a little bit better for those of you that follow it. As always, questions are welcome, as I run out of stuff to talk about unless prompted! Take care, everyone!

Gotta Hand It to You

Feeling much better after Saturday evening's dissection of the hand went off pretty well.  Gotta stop complaining, and just get in there.

Give 'er!

Give 'er!

The title is a shout-out to Canada. Oh, and to Vijay from my anatomy lab group.

So, some quick news: lots of studying in the weeks leading up to my first exam paid off. I ended up with A's in all subjects! Unfortunately, I didn't have a lot of time to celebrate - we have two lab practical exams in the two-week period following the first written exam. However, I did celebrate a little bit. I joined a bunch of schoolmates at a local "club" on the beach in Portsmouth called The Purple Turtle. At one point, I needed a walk to clear my head, so I walked along the beach, and was offered marijuana by at least two locals (a third local was unintelligible). I declined, and got the hell out of there. It was time for bed.

I took the Histology practical exam Friday morning, which didn't go as well. I nailed the cell biology part of the exam, but a lot of the light microscopy slides were difficult to distinguish. I'm pretty sure that I'll be taking a small hit in the grade because of the practical, but not too much.

This weekend is almost completely devoted to anatomy lab. We have a practical exam coming up on Thursday, so all of the first and second semester students have flooded the lab to go over the cadavers. The practical exam will make use of nearly every body in the lab, so it doesn't help just to know the details of your table's specimen. Students are going from table to table, looking them over from head to toe to make sure they are familiar with the anatomy of the bodies in general, rather than the specific anatomy of their own body. Unfortunately, this flood is preventing me and my group from finishing up our dissection of the hand.

Speaking of which, I really need to vent. I'm so frustrated with gross lab. I'm not good at this. In fact, I would go so far as to say I'm bad at this. I know the theoretical anatomy cold, and if you handed me a copy of Netter's Atlas of Human Anatomy without any labels, I'd be able to label everything there. When I try to dig around and find structures in the real thing, though, I end up cutting through things I shouldn't, horribly dismantling structures that need to be left intact. This even happens when we're being extra-cautious, because it will take us forever to do something, and then when we get tired of making zero progress, we'll try to move a little more aggressively, and BOOM! goes the dynamite - the patient's axillary artery has been severed, and he's dead on the table (again). Thursday, I was trying to get underneath the palmar fascia and aponeurosis - the stuff covering the muscles, vessels, and bones of the palm/hand. And as soon as I make a small incision, I see that I've cut an important vessel: the superficial palmar arch, something we were supposed to find, clean up, and keep intact.

Surgery may be off the table, which is a shame, because I really enjoy anatomy and I thought that surgery would be a great way to pursue it. But not if I do to patients what I've done to the cadaver.

I promise that I'll post a little more about the island stuff soon. I have a three-day weekend next week, and I'm planning on going out to the Cabrits, taking a bunch of pictures. That'll be more fun for everyone, blogger and reader alike. Until then, take care, and Happy Valentines' Day!

First Test: Vanquished?

Friends and relations!

Long time no blog. Actually, that's kind of a ridiculous statement, considering that when I first began my blog years ago, I never wrote a second post. Instead, I deleted the whole thing to start this puppy. So what if it's been around two weeks since my last post? I'm doing great here! Stop complaining!

Monday, February 9th, I took my first test in medical school, and I thought it would be a good opportunity to give some insight into the testing that takes place at Ross University.

I'm taking the following courses this semester: Gross Anatomy I; Biochemistry I; Physiology I; Developmental and Microscopic Anatomy I (really, it's Histology); and Doctor, Patient, and Society I. All of the courses are lecture-based, but there is a minor lab component to Histology, and a big lab component to Gross Anatomy. When we take exams for all of these courses, we take big block exams with questions from each class. So the test I took on Monday featured 14 questions from DPS, 22 from Anatomy, 36 from Histology, and 44 from Biochem. Actually, that only adds up to 116, whereas there were 117 multiple choice questions on the exam. Oh, well, you get the idea. The exam began at 1 pm and we had about 2.5 hours to finish. All of this is designed to mimic the licensing exams that we'll have to take after we finish our coursework at different points in medical school (I'll leave off explaining all of that until I get there). We'll have 3 of these "Minis" as they're known here, and then a cumulative comprehensive Final Exam in the last week of the semester. Additionally, we will have at least two lab practical exams for each of the lab components, the first of which is on Friday the 13th, in Histology.

I was pretty nervous about the exam as it approached. I had been studying every day this semester, and as this weekend came and went, my motivation declined a little. I just didn't feel like I could learn any more than I already had. I went through a lot of practice questions to identify any trouble areas, but mostly I just tried to get my mental state right for the test. I finished the test early after answering everything and checking my answers, and I feel pretty good about how I performed. We'll get our grades for the exam sometime this week. If you see me back in Panama City in two weeks, you'll know that it did not go well. Actually, if you never hear from me again, you'll know that it went really badly.

After the exam, the SGA here threw a party down on the beach, and there was a party at a local club. I went out and woke up feeling ragged today. I don't think I'll repeat THAT part of the post-exam performance in the future (and my tortured brain thanks me).

Send me any questions you might have. I want to do a quick post on where I'm actually living and student residences later this week, with pictures for my me.com web gallery. Until then, take care!

Quick Photo Post

Hey, friends,

As promised, here are some of the pictures I took on my whale watching tour. The link is below. I know that they get a little redundant, but I took some series that I used to stitch into panoramas, which I think you'll enjoy. Take care!

http://gallery.me.com/taylorpalfrey/100031

Cadaver, Dissect Thyself!

Howdy, partners!

It's time again for a round of "What has Taylor been doing this week?" I'll have to start with last weekend.

I told you in a prior post that I signed up for a Whale Watching tour. Let's get some trivia out of the way, first. Dominica lies on the boundary of two tectonic plates: the Caribbean plate and the South American plate. This boundary is the site of a subduction zone; that is, the Caribbean plate is moving east and meeting the South American plate, and as they approach, the crust of the Caribbean plate is forced down beneath that of the South American plate, which hits the Caribbean plate and is forced up. This subduction zone is the whole reason why the islands of the Lesser Antilles (including Dominica) even exist! I'll talk about that a little more in a future post. Anyway, all of this takes place in very deep water - about 2 km deep not far off the coast of Dominica. This depth is awesome for big whales, which like deep waters to fish and play in. Supposedly, species like sperm whales and even whale sharks will spend a lot of time in the deep waters off the western coast of Dominica.

The tour started at 9am, and about 50 of us took off on a about a 50-foot twin hull vessel. It was a beautiful day, but no whales. These guys told us that they see whales on these tours about 95% of the time, but we batted a big fat .000. The nice thing is that I got some good pictures of the island from the boat. I'll load them onto my me.com gallery, and put the link up later this week.

Classes are going fine. There's a lot of up and down in the quality of lectures, mostly because the lectures are given by different professors a lot of the time. It really varies. We've only had a single histology lecturer so far, but we've had 4 biochemistry lecturers in only 2 weeks!

My first exam is coming up in about 2 weeks, and we have a day off today, so I'll be studying. All. Day. Long. Exciting, right? I was afraid this would happen: the blog would start off all adventure-laden and fun, and then the reality of medical school would come crashing down upon us all, blogger and reader alike. Not so, my friends! I haven't even told you about Anatomy Lab this week!

So, there are about a million students in my class, and we have to be subdivided into 3 lab sections. I'm in Group C, so my first dissection was the latest. Group A dissected the superficial and deep muscles of the back, Group B did the suboccipital triangle, and we as Group C were supposed to perform a thoracolumbar laminectomy to reveal the spinal cord and meninges. I was excited, because the laminectomy is a procedure that is performed on live humans! It has also garnered a lot of attention recently with the treatment of Buffalo Bills tight end Kevin Everett - he received a nasty blow during a game against the Miami Dolphins, and to take pressure off of his swelling spinal cord, physicians induced a mild hypothermia, administered methylprednisolone (an anti-inflammatory steroid), and did a laminectomy. Well, things started out pretty poorly - we weren't properly instructed on how to remove the deep muscle layer to expose the vertebral laminae, and so that part was really slow-going, and the cadaver got pretty beat up. In fact, I was feeling pretty inhumane before we even got to the next part: we had to use a chisel to cut through the laminae. Unfortunately, we severely overestimated the size of our patient's vertebral canal, and made cuts that were too vertical and too lateral. We got really far behind as we tried to correct this, but we had already cut through almost every spinal nerve he had. We didn't get far enough inferiorly on the cord, so we couldn't demonstrate the end of the dural sac. We only barely showed the cauda equina and conus medullaris. And, in the end, the video we produced was pretty shoddy, because I was doing the speaking and pointing, and I didn't know we were recording. So, in the middle of the video, I said, "wait, Khalid, have you been taping this the whole time? Oh, uhhhh, HERE you can see a dorsal root ganglion..."

All in all, if he hadn't been delivered to us in his current state, we would have lost him on the operating table. Gotta do better next time.

Until then, guys & dolls, take care! Pictures to be posted later this week!

EDIT: Quick note on Kevin Everett. The hypothermia may not have been "mild," as I described it. It appears that he was intravenously injected with ice-cold saline, according to the wikipedia entry under his name. The anti-inflammatory agent he was treated with WAS methylprednisolone, according to an NPR Science Friday interview from September 14, 2007. The same interview described the surgical treatment on him, though, as "decompression" of the spinal cord; it may not have been a laminectomy. Laminectomies, however, are performed on patients suffering lumbar spinal stenosis, as a means of alleviating pressure on the spinal cord arising from the narrowing of the vertebral canal in the lumbar region.

No, seriously, Taylor: WHERE ARE YOU?!?

For those interested in figuring out where I'm located (people like international spy/assassins, the IRS, etc.), I've uploaded a series of pictures in my me.com web gallery to orient you.  Here's the link: http://gallery.me.com/taylorpalfrey/100021

I'll get another update up sometime this week.  Classes may have begun to "slow down" a little bit, or I've become accustomed to the pace.  Take it easy!

White Coats and Bloodshot Eyes

Happy weekend, friends and family!

So, my classes began this Monday. 20 sweet hours of lectures on Gross Anatomy, Biochemistry, Physiology, Histology, and a course entitled "Doctor, Patient, and Society," or DPS.

By the way, I just wanted everyone unfamiliar with medical school to know the primary difference between weekend nights and weeknights for med students: on weekend nights, you stop studying at 11:30 PM instead of your customary post-midnight collapse!

I'm only kidding, of course. Classes have been pretty great so far. Lots of material to absorb, and it's not going to stop any time soon, but a lot of it has been review from undergraduate courses up to this point. So, really, the question isn't whether or not I understand it, but whether I can recite all the details of what we've been covering from rote memory. For instance, do you know what type of epimers glucose and galactose are? DO YOU?!? Well, then, send in an application for medical school today!

The class that I've been enjoying the most (as I kind of figured before I got here) has been Gross Anatomy. I loved the Musculoskeletal Anatomy course I took at Notre Dame, and this has been largely an extension of that one, with more vasculature, physiological integration, and clinical correlations. Additionally, it's the course here with the greatest lab component incorporated into it. That's right, chums: we get cadavers!

The first lab session was this past Tuesday, and I was extremely amped up and ready to slice. You could tell that everyone else was excited, as well. One student even fainted during lab! Of course, if you told me that someone would faint the first day of lab, I would have assumed that it was from the odor of formaldehyde, or perhaps squeamishness associated with confronting a deceased human being, preserved for the purposes of instructing young doctors-to-be. But oh no! This young man fainted because we were standing up for an hour and a half, not doing anything, and he locked his knees --> no musculovenous pump to return blood to his trunk, and presto! Med student, meet floor. Two of my new buds were standing right next to him, and couldn't respond quickly enough to prevent his collapse. Fortunately, the student only injured his pride, and neither his coccyx nor his cranium.

Yesterday we had our White Coat Ceremony. This was a small event where the faculty bestow upon us the white coats of the profession. A medical student's white coat is typically much shorter than a full M.D.'s, descending to about the level of the waist, rather than the full professional's mid-thigh. At the ceremony were several dignitaries from the Commonwealth of Dominica, including the President, Dr. Liverpool. I think (and I kind of hope, given the climate down here) that it will be the only time that I will be dressed in slacks and a tie for the entire first semester. Typically, my camera was nonfunctional!

Tomorrow, I'm signed up for a "whale watching" tour! I'll be sure to take some photos (if the SONY gods are kind), which reminds me - I finally uploaded pictures from my first week on the island, but I had to do so to my "me.com" site. Here's the link: http://gallery.me.com/taylorpalfrey/100017. I wanted to add all of my captions before I posted the link, but I've been trying to focus on courses as much as possible. First exam is only three weeks away!

Hopefully, as the semester rolls along, I'll be posting weekly updates about my activities (assuming I continue to, you know, DO things) and about life in general as a med student on the island. If it gets boring, or if there's some burning question on your mind, please comment or email me to let me know what you want to hear about, and I'll be happy to oblige. For now, take care!

Reality Bites, but the Bugs Have Been Merciful

(Originally composed Friday, January 9, 2009)

Hey, sports fans!  Or med school fans!  Or fans of me!  Or just total losers with nothing better to do than follow my blog!

Just kidding.  I had a bit of free time and decided that it would be a good thing to try and fill out a more complete blog post about my first week here on the island of Dominica.

I arrived on the island Sunday, around 2:30 PM local time.  The island is bigger than I previously thought, but still pretty small.  However, the highest point is close to 4,700 feet elevation, so the island has pretty steep sides.  This means that the plane has to approach lots of hills very closely, and if you watched the helicopter landing in the movie Jurassic Park, that's about how it feels.  The runway at Melville Hall Airport is very limited: only one paved strip.  Once the plane touches down (thank God!), it must turn itself around and taxi back down to the middle of the runway, where the terminal sits.

Once inside the airport, all of us student were made to fill out our immigration forms and pass through customs.  Then we collected our luggage and presented the bags for inspection.  We hauled our bags out the front of the airport, where they were unceremoniously dumped into the back of a pickup truck, and stacked one on top of the other, extremely high above the "lip" of the pickup's bed.  The luggage was wrapped up with a tarp for transport.

Meanwhile, we boarded a bus bound for the campus.  The Melville Hall Airport is north and east of campus, and we took a long and winding road counterclockwise along the coast to get to the University.  The views were spectacular, especially as the vehicle wound around up into the hills along the shore.  Unfortunately, as we kept going, we came upon a car collision that blocked the road!  We had seen the sedan that was at fault speed by us during our drive, and we caught up to him after he had run into an oncoming truck.  Traffic was completely jammed, and many of the locals came out to view the wreckage!  Anything for some entertainment, right?

We made it to the housing office, and my apartment is right behind that office.  I was able to check in and move my luggage (now having been unceremoniously dumped out of the pickup truck) to my room.  The room is essentially an efficiency apartment: one main sleeping area with a full-sized bed, a desk, a mini-fridge, a microwave, a bookshelf, and a built-in closet with shelves.  My bathroom has a toilet, a shower stall, a sink, and a mirror/medicine cabinet.  The room has an A/C unit, but I run it infrequently, because it burns through my electricity credits, which I have to pre-pay for!  I can guarantee that if I have a ton of credits left at semester's end, my room will be frosty cold!

This week has been spent mostly standing in lines and sitting through orientation sessions.  As far as the lines, go, my entering class (January 2009) is at least 350 students, and I have heard some rumors that the class is actually closer to 500 students!  That is enormous!  I'll do a quick comparison; most medical schools probably have around a full compliment of 500 students total for all 4 years.  Ross has as many students in a single class, and 3 classes enter the school each year!  That's amazing, although I have not decided if it's a good thing or a bad thing.  In any case, the sheer number of students has overwhelmed the staffs at the various offices around campus.  Additionally, the administrators have done very little to schedule things so that the lines are minimized, and they have done very little to automate processes that could be automated.  For instance, some people waited 5 hours in line to open a bank account here on the island (I waited 1.5 hours, on the second day).  Now, if there were more than one bank on the island, I can understand that the school might want to allow students the choice of selecting one bank or the other (as they have done with mobile phone companies here).  But come on!  There's only one bank here!  We should have been able to take care of this prior to arrival.  The longest I have waited so far was 4 hours, just to get my picture taken for my student ID.  Insane!

I have met some really good people among my fellow classmates so far: people from Michigan State, Cornell, Georgia, Ghana, etc.  Of course, it's difficult to keep up with everyone's name, but everyone has approached this experience with a positive attitude.  As for me, I am maintaining my optimism.  I know I can succeed academically here.  I feel like I am at least as gifted as my classmates, and I know that my level of dedication to what I'm doing is second to none.  But I think that the classes could be the easiest part of this (of course, I could easily change my tune in a few weeks).  For now, I'm really just kind of uncomfortable most of the time.  It's about 83 degrees here all the time, with about 75% humidity or more.  The island is gorgeous, but we have to worry about things like where to purchase food, or how to even get clothes washed - things that I wouldn't spend more than a second thinking about in the U.S.

That's it for now.  This week has been crazy, and I'm sure next week will just mean throwing things into overdrive.  Thanks for all the messages and emails so far!  One additional point of organization: if you have a general comment or a question that you think others would enjoy reading, please post it as a comment on a blog post.  If you are trying to contact me personally and want a faster response, please email me or send me a message via Facebook.  I check my email at least once a day, but I only log on to blogger when I've kind of run out of things to do.  So don't expect a response from a blog comment for at least half a week, and more like a week, after you post it.  This blog is meant to be more unidirectional in terms of content, as in: me --> your.  If you want more back-and-forth, it's gotta be email or Facebook.

Again, thanks, friends, family, and freaks!  Take care, one and all!

Technical Difficulties

Sorry, blokes and sheilas, I'm having a bit of trouble with the blog thus far on the island. I wanted to upload some pictures that I've taken, but the wireless networks down here (even the school's network) are moving a little too slow to operate adequately. However, I want to tell everyone about what I've been up to since I arrived. I have to edit a post I had composed (it was going to contain pictures), and I'll publish that tonight or tomorrow morning. Until then, see you around!

Bienvenue a Wai'tukubuli

(Before I get into it, a quick word on using this blog: if you leave a comment - and I hope you do, especially if you have a question - I have to either publish or reject it.  That means I need a little time to react to some comments.  If you leave a comment without logging on, you have to do so anonymously.  Please sign your name to even anonymous comments.  I'll try to fiddle with my settings to see if I can fudge this a little bit.  Thanks!)

OK, gang!  Here's a lightning fast update, that I will augment this weekend.

I have made it to the island, and have experienced a bit of culture shock.  I'll describe a lot of it later.  Here's what you need right now:

1. I'm in residence at the school, Ross University.  It's located just south of Portsmouth, Dominica.  You can kind of find it on Google Maps.  I'll try and fiddle with some photos and point out the locations of everything in a post this weekend.

2. I have all of my luggage.  I count myself truly lucky so far, because people that arrived two days ago still have not received luggage.  In fact, the island of Antigua is experiencing some kind of strike, and there are about 30-40 students that are stranded on Antigua.  They can't even make it to the island right now!  Damned unions!

3. Everything else will follow.  The other students are nice, and the island is beautiful (sorry to tease without offering pictures).  I have 107 more days until my exit flight, and they'll either pass too quickly or too slowly.  You'll have to be the judges!

Again, I'll give a better (and much longer) update this weekend.  Until then, take care!

¡Buen Viaje!

Just a quick word about my travels, for those who are keeping tabs on me.  I'll blog about my last few days in the U.S. in a little while.

I began the morning rudely at 4 a.m., and arrived at the Panama City/Bay County airport with the belief that I would be in San Juan, Puerto Rico around 2 p.m. local time.  Of course, if any of you have ever tried flying in/out of PC, or through Atlanta, you know how unreliable their service can be.  Sure enough, I was delayed from the get-go.

Fortunately, I have arrived at my hotel in San Juan, and it's 11:45 p.m. local time now that I have checked in and made it to my room.  I have another flight tomorrow for the island of Dominica.  My next post should be from The Island!

Love to all my friends and family.  I really don't think I'll be able to post on here without being reminded of how blessed I am to have you all in my life.  I don't deserve you, but I will do my best to make you all proud in this new venture.

As always, take care!