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!