'Tis The Season

Super Cute Cookie Holiday Display that I helped some of the
docs from the GI Ward Decorate =)

Christmas Tree in the Sky Garden on the 35th floor of the Walkie-Talkie Building

Happy Holidays! 
Happy Hanukkah! Merry Christmas! Happy Kwanzaa! 

The end of the year is a time that many people celebrate with family and friends whether they are religious or not.  During the quiet moments many of us reflect on what went well, things we'd like to change, losses we've endured, and joys we've experienced.  We'll also make plans, resolutions, and set or re-visit goals for the coming year.  It's a time to close out and start fresh.

This has been a roller coaster of a year for me...I have: 
*Lived in 3 different countries & timezones (St. Maarten, USA, and United Kingdom).
*Had 8 different housemates.
*Endured some of the most challenging exams thus far.
*Had some epic adventures.
*Tried new foods.
*Learned new meanings of old words-think trainers, jumpers, pants, bins, subway, etc; they all mean something different tan what I was used to.
*Trained my brain to process a TON of different English accents. 
*Finally got the hang of looking to the RIGHT when I cross the street instead of left.  
*Reconnected with old friends & colleagues from the UK that I hadn't seen in 8 years.
*Been called doctor (by real patients!) more times than I can count.  I still find myself looking around for the doctor because it still hasn't clicked that they are actually talking to me and expecting a response, ha!  Although I'm not officially Doctor yet, I'm past the half way point.  According to the UK folks I'm in year 7 of 8, though I'm used to thinking of myself in year 3 of 4.  The majority of UK students go to school for 5 years TOTAL to become doctors (that includes their years in University, lucky ducks!).
*Seen patients & families at their worst and their best.
*Welcomed new additions to the family.
*Learned a lot about myself.  I've realized I can do anything I set my mind to.  I can not only endure situations I thought I would never get through, but come out victorious. *Learned to be more at peace with being alone while also being open enough to create lasting memories with people I've never really interacted with before.  
*Stayed in a hostel on more than one occasion--all I could think about was the movie Taken, yikes!
*Been reminded time and time again how wonderfully supportive and encouraging my family & friends are! 

I've been in the UK for 4 months now.  I've completed my Internal Medicine Rotation (Endocrinolgy, GI, Cardiology, and Acute Medicine) and I'm partially through my Surgical rotation.  I've seen some wild stuff!!!! Amputations, Abscess drainage, Laparotomies, Rectal Prolapse Repair, Reversal of Hartmans procedures, Brain tumor excision, Dermoid Cyst Removal, Vascular Surgery and more.  So far, surgery has been super cool and weird and gross and interesting and amazing and life saving!  I've worked with an awesome Anesthesiologist (and team) who has shown me many of the basics, let me intubate, reverse the anesthesia, and ventilate patients.  Ive spent time in A &E (the Emergency Department) where I have assisted with initial triage, assessment and management of patients brought in by ambulance or sent in for urgent care by their physician.  It's never a dull moment and I LOVE what I'm learning, experiencing and being exposed to on a daily basis.  

Everyone's journey is different and I'm so grateful that I'm finally pursuing what I've wanted to do for so long.  Many people don't believe me when I tell them I had so many doubts at different points in time over the years about medical school.  I wasn't sure I could make it.  Wasn't sure I had what it takes.  But look at God!  I'm here!  I'm doing well!  And I'm almost finished!  Well...not exactly, but I'm closer than I was before I started!  

The mind is so powerful.  We have to learn to be faithful, state your dreams and desires out loud, write them down, set short/medium/and long term achievable goals; tell people you trust who can hold you accountable to your goals, and then just step out and give it a go.  You may want to do something small or something huge.  If you want it, make it happen.  You know what I keep reminding myself??? YOU WILL NEVER BE SUCCESSFUL, IF YOU NEVER TAKE THE FIRST STEP!  And I can't even lie, many times the first step is the absolute hardest.  

A new year is upon us, its a perfect time to set new goals and start to Make S#IT Happen!

On to the more interesting stuff...
I've become obsessed with a number of things over here.
Like the insane flavors of crisps (potato chips).  Some seem cool but others seem very weird! Would you try roast turkey & stuffing or pigs in blanket flavored potato chips??? Check out some of the other funky combinations...

Cornish Sea Salt & West Country Cider Vinegar; Lightly Sea Salted; Mature Devonshire Cheddar & Caramelized Red Onion; Pigs in Blankets; Roast Turkey & Stuffing; Root Vegetable; Sea Salt & Balsamic; and Lightly Salted

I'm a weirdo when it comes to public restroom facilities. Some of things I've seen over here takes the cake.  I thought the signs in St. Maarten telling you not to put toilet paper in the toilets were strange (I disregarded that one every time!).  Some of the signs I find in the bathrooms here give me a chuckle and some of the restroom facilities make me feel like I'm in a medieval torture chamber or something. Oh! And you must not forget: There aren't always accessible public toilets--and if you find one, hopefully you have some spare change in your pocket because in many locations (like the train stations!!!!) they cost 30p per visit.  
I have no idea what happens if you don't have any money and you really gotta go!!!!

Why would someone need to
stand on the seat????

SUPER CREEPY.....





The nicest bathroom I've been in so far!



Have I weirded you out enough with the crazy crisps and medieval toilets???
At least the posts can only go up from here.  
Have a wonderful Holiday Season!!!!

Until next time..........

A Moment for Reflection

Here it is Friday evening...I just got home from another week at the hospital.  Today is one that I probably won't forget for a long time. While walking home from the bus stop, all I could think about was how precious life really is and how in an instant everything could change and your world as you know it can fall completely apart.

Today, I lost my first patient.  I spoke to and examined the patient this morning, spoke with the doctors about what their plan was for continued care and then went on with the rest of my day.  The family was waiting at the hospital for the patient to be discharged this afternoon and all of a sudden everything changed. The patient went into cardiac arrest.  There was a team of doctors, nurses, and other support staff that did everything possible to resuscitate the patient but were unsuccessful.  I was in the middle of it all, trying to be as helpful as possible and not in the way of the efforts.  At one point I heard "medical student, you're next to take over chest compressions."  I realized that was addressed to me because I was the only medical student there at the time.  OMG flashed in my mind, but didn't escape my lips and I prepared to take over.  Another doctor ended up next in the CPR rotation and I continued attempting to find an access line for medications and fluids to be administered, preparing & handing over supplies as needed, and doing whatever they asked of me.  

During the entire code, I was much more calm than I anticipated I would be in this type of situation (similar kind of thought I had back in Anatomy lab for the first time).  One can be much more useful when you're calm and focused vs when you're freaking out.  As I was walking home, with a massive headache--probably due to the adrenaline crash that was happening, I couldn't help but reflect on how precious life really is...What's important in the grand scheme of life...Petty disagreements...rifts between family/friends...holding grudges...being a mean person...none of it makes a difference when our time is up.   The difference comes when you are the one left to pick up the pieces and realize there will be no more opportunities to say "I love you"..."I miss you"..."I forgive you"...or "I'm sorry."  

Today, I was reminded to be grateful for every moment.  Don't take anything for granted.  Appreciate every opportunity you have with those you love because tomorrow is never promised.

7 Weeks Down Plus a Trip to Scotland

It's hard to believe that I've been in the UK nearly 2 months already! 

So far things are going well.  I'm pretty comfortable with getting around the area I live in and going into Central London.  I haven't been a hard core pedestrian/commuter in ages but here it's all walking, trains, or buses to get around.  It's not always convenient but many times during my walks/public transport trips I'm able to really process a lot of what's going and focus on my innermost thoughts.  

Hospital life has been interesting.  I've completed Endocrinology & Gastroenterology rotations so far and now I'm in the MAU (Medical Assessment Unit, which is the holding location post Emergency before you get admitted to a ward if warranted).  I've seen patients with diabetes, end stage kidney disease, heart failure, liver failure, pancreatitis, alcohol induced peripheral neuropathy, Crohns & Ulcerative Colitis, paracetamol (think Tylenol) overdoses, asthma, pulmonary edema, COPD, pneumonia, abscesses, dementia, gallstones, cancer, and more.

I've participated in out patient clinics, observed upper endoscopies, colonoscopies, ERCPs (endoscopic retrocholangiopancreatography procedures--bet you can't say that three times fast without getting tripped up!) which have included gall stone removal and biliary stent placements, laparoscopic colostomy surgery, fistula excisions, and a reversal of an ileostomy--that's one I actually scrubbed in and assisted!  I've learned how to take blood, insert cannulas, catheters & nasogastric tubes. I'm working on honing my interviewing skills and physical exam techniques and getting more comfortable overall in a clinical setting.

It's been a great learning experience so far.  Understanding how to manage the patients with so many different health concerns has been one of the biggest challenges yet  The diagnosis and procedural steps are usually fairly straight forward but the work comes in knowing what to do for the acutely unwell patients and how to manage those with multiple chronic illnesses.  It's a process that I'm slowly getting better at but there's soooo much to learn....That and managing my time after work to study for the upcoming shelf and STEP 2 exams is where I could use some improvement =(  

Aside from the steep learning curve and readjusting to a new department/specialty, staff, and style of teaching/working/patient interaction every 3 weeks, things are going well.  I've been very lucky so far and worked with some great Consultants, Registrars, and Junior Doctors.  Everyone has been willing to answer the most basic questions, incorporate teaching when applicable, and generally support my educational progress.  

It's not all work all the time.  A few of my classmates and I actually took a weekend trip to Edinburgh Scotland.  Between hospital life, and really settling into this new lifestyle there are a few things I've noticed that are different here in the UK compared to what I'm used to in the US:

-Everyone loves my American accent! The sweet lady in the hospital now calls me Ms. America, ha!

-Parents walk their kids to school, kids ride bikes & scooters and in the morning, I can time my progress based on where I cross paths with certain ppl in the mornings.

-Ambulances have blue and white lights and in a medical emergency you call 999 (instead of 911).

-All temps are in Celsius vs Fahrenheit so I've had to learn to quickly estimate what the weather will be (besides rain)

-You can only order well done beef burgers/steaks according to the English health code...bummer.

-Light switches are turned ON by switching them DOWN instead of up

-And of course, I have to remember to look Right when crossing the street and always mind the Gap!

I'll leave you guys with a few pics.....

                                                                        Edinburgh Trip

                           Edinburgh Castle that contains the Crown Jewels of Scotland

Loch Ness & Highlands Tour

                                                                     

                                                                        Arthur's Seat

They told me we were gonna climb up a hill!  I don't think anyone actually realized we were climbing up a ragged, jagged mountainside, more than 700 feet in the air.  The first few minutes of the near vertical trek up had me seriously winded and wondering how long it would actually take to make it to the top. There were many stops for pictures (and to catch our breath) but once we made it to the top the view was breathtaking.  We also found out on another path down, that we chose one of the difficult routes to the top!

                                           The view once we reached the top was amazing!!!!

And yes, we even tried Haggis!!!  (pictured with turnips and mashed potatoes) It reminded me of a mushy textured meatloaf.  It actually had a decent flavor and no where near as bad as I thought it would be after hearing the tales of a creature in the hills of Scotland who's legs are shorter on one side than the other so it can only run around the mountain in one direction...All a bunch of BS but still pretty unpleasant thoughts when you actually find out what Haggis really is o_O  

 

                                                                      First time scrubbing in

Until next time...

Welcome to London!

Long time no see!! 

Before I get to how I ended up in London, I’ll back track a bit and fill you guys in on what’s been happening over the last 4 months that I’ve dropped off the face of the (blogging) Earth.

Post Island Life
Once I got home from St. Maarten, it was all about STEP 1 Prep.  I was literally locked away in my office at home for 2 months.  Day in and day out.  I took off 2 days to celebrate my birthday but felt a bit guilty the entire time.  The office was nice and cozy…it was actually my dad’s newly remodeled man cave, retrofitted with a 6ft table, desk chair, and every electronic device you could think of with USMLE World, First Aid, and notes for days on the displays at all times.  He willingly turned it over to me for the entire time I was studying.  Bless his heart.

I can’t even lie: STEP 1 was tough.  The preparation was insane.  Classes for the last 20 months prepared us in a way, the Becker online review class I took helped, and all those hours of self learning/studying/reviewing coupled with hundreds upon hundreds of questions is what it took for me to pass! WooHoooooooo!!! That was the most relieved I’ve felt in a long time; to know that it’s time to move forward.

My parents and the rest of my village were so so supportive.  My dad cooked breakfast, lunch & dinner for me while my grandmom brought me lunch once a week to give my dad a break =).  My mom brought me snacks and drinks and offered encouraging words when she felt bad that I was still in "the room".  They celebrated with me just as much as I did when I finished and when I got my passing score back.

Over a Major Hurdle
Once THE exam was over, I was pretty much in a catatonic state for the next week.  I did nothing! Absolutely nothing! Nothing to the point of just laying in my bed staring at the ceiling or sleeping all day long.  My family thought something could be wrong with me.  I gradually came out of it and started to go out and visit my extended family and friends trying to salvage what I could of the summer.  I’ve only been back in "the room" one time to sit and relax on the couch.  I couldn't bring myself to go and enjoy it…maybe in a year or two. LOL.

There was also lots of paperwork and appointments to attend to get ready for the transition to Clinical Student.  There was a Criminal Background Check, Drug Screen, Physical, Immune Titers and Blood tests for communicable diseases you don’t want your patients to be exposed to (Hep B/Hep C/HIV/TB).  Note to future students: If your going to do rotations in the UK and don’t want to have your blood drawn again—make sure the lab DOCUMENTS on your results that your photo identification was verified at the time of the blood draw.  I tried to explain that in the US no one takes your blood with verifying who you are first, but guess who had to get stuck again…me =( 

Getting a UK visa was a whole different ordeal.  The school coordinators for UK students made the process as pain free as possible with respect to providing all the documentation we needed…but the time, energy, and EXPENSE was more than I expected.
If your staying in the UK more than 6 months you need a Visa.  I paid $1,179.00!
Here’s a breakdown of the costs:
Visa-$515.00
A. Briggs Expeditor Fee-$175
Priority Rush Service Fee-$192
UK NHS Health Insurance Fee-$240
FedEx Mailing to NY-$25

Fed Ex Return Mailing-$32

AUC started a program to help ease the transition from Basic Sciences to Clinical Medicine.  An AUC Clinical Fellow (recent grad) meets with small groups of students to discuss a variety of patient cases and answer questions we have about life once we leave the island and enter the hospitals.  Ish is about to get real!!!

Transition to Clinical Medicine
All the expenses, blood draws, doctors appointments, & STEP Stress has lead to this….I’m now in LONDON!  For real.  Its a little surreal.  I left one warm sunny island to come to a wet rainy one.  However, even with the rain and lack of constant sunshine, it will be another amazing experience! 

I’ve moved into a house share with 5 other Britishers (I don’t even know if that’s proper)—er…Brits?   They all work in or around London and so far they have been so welcoming and hospitable to me.  My mom is relieved =)

I arrived exactly 1 week ago and in that time I’ve managed to: 

-Get settled and unpacked
-Have a visit from extended family 
-Link up with some new friends that my DST sisters have put me in touch with--looking forward to meeting them in person soon

-Explore the Romford area and figure out how to get to the two hospitals where I’ll be rotating via foot and bus (Queen’s and King Georges Hospitals—how English right?!?)

-Visit Ealing (West London) to hang out with some other AUCers & attended their Mess (a party hosted by the Junior Doctors at the hospital once a month when everyone gets paid)

-Do a little sightseeing in Central London and had my first English meal of meat pies—pretty tasty

-Have a "proper" welcome to Essex by two of my housemates=partying at Pubs & Clubs all night

-Go London’s Carnival—OH EM GEE!!! There must have been at least 700,000 people there!!!!!!! IT WAS CRAZZZYYYYY!!!!!! But a ton of fun.  Food, vendors, music trucks, lots of drinking in the streets, bands, DJ's, people in costumes, stilt walkers…you name it, it was at Carnival! 

Some pics from my travels this week: 

The Ealing crew, Central London and traditional English food, & Carnival

 

After all of that excitement, Clinical Rotations actually begin this week.  Luckily, there are a number of other AUC students at my site so it’s nice to see familiar faces and realize that I'm not the only one that has no clue what's about to go down.

Once I get into somewhat of a groove at work, I'll be sure to check in and let you guys know how it’s going!  My roomies have already promised we’ll go for English Tea at some swanky place.  I’ll be here for the next 10 months, so if you're familiar with this part of the world let me know what you think I should see and/or do while over here!  

Until next time…

Top 10 Things I'll Miss about SXM...and a few things I won't!

I can't believe I'm home and totally finished in St. Maarten!
The next time I go back to the island it will be to visit friends/vacation.  The time went by so fast and I already miss that little island.  Being home is taking a bit of adjusting however I'm slowly but surely settling in.  I've given myself a few days to unpack and get organized before getting back into the swing of studying.  That down time is now up =(
I figured before I'd completely drop off the face of the earth for the next couple months, I'd highlight a few things I'll definitely miss about my home away from home.  


10. Going to another country on a regular basis without needing a passport
There are great restaurants, bakeries, shopping, beaches, & more just across the border between Sint Maarten and Saint Martin. Brush up on your French because English is NOT the primary language! There are many people who don't speak English at all. Grocery stores/pharmacies/directions are often all in French so a little French would get you far.

9. Variety of Food

You can opt for local style cuisine like rice & peas, fish, curry chicken, oxtails and soup; fresh seafood; or you can have fancy French food with names that you can't pronounce.  There are many good restaurants here in SXM  A few of my favs: Alexander's Kitchen (both locations), Bamboo, Cafe Atlantico, Crave, Greenhouse (both locations), Lee's Roadside Grill, Mati Beach, Toucan's at Divi Little Bay and even A's After Party Fish Shack no bigger than the size of a newsstand) across from the movies.

8. Road Rules (especially the unwritten ones)

Traffic circles and speed bumps abound.  I've only seen 2 traffic lights here on the island.  One on both French and Dutch sides of the island.  Drivers will pass on the opposite side of the road with a median between you and you can make a free parking space wherever you need one.  Just beware, the afternoon traffic jams are mostly unbearable; and heaven help you if one of the bridges opened up while you're waiting...Be prepared to sit parked for a little while while the boats are coming thru the bay.  Reynauldo (my car) allowed me to zip around the island and find some cool local spots and other popular places outside of the AUC bubble. I highly recommend getting transportation of some sort.  School is stressful and sometimes you just need to get away from it for a little while. Going to the beach or for a drive was my way of escaping and clearing my mind a bit.  

                                               This is how people park!

                                       Gonna miss my Reynauldo.....

7. Seeing someone you know almost everywhere you go!

It's nice to know that if you need help at any time, you're bound to recognize someone almost everywhere you travel around the island, especially on the Dutch side. 

6. Fresh Pastries

I love that on any given morning you can pop into almost any little shop/supermarket and get fresh baked croissants, pastries, and bread on both the Dutch & French side. I've definitely had my fair share of chocolate croissants!  

                                                  Sarafina's Bakery                                                        

5. Boatloads of Beaches
A beach is never more than 5 mins away!  With 37 total beaches on the island you/re sure to find one that suits you.  Go check out Pinel Island, Sunset Beach, Dawn Beach, beaches in Grand Case, Great Bay, Little Bay, Friars Bay and Anse Marcel. And if you want to venture out a little farther, ferry over to Anguilla from Marigot (45minutes), St. Barths from Oyster Bay (30minutes), or charter your own private boat for the day/weekend which can also make stops at other islands and protected Beaches like  Tintamarre, Columbier, Shell Beach or Green Cay Bay.
The Private Charter was SOOOO MUCH FUN!!! The folks at PYC do an awesome job (http://www.privateyachtcharter-sxm.com/)

4. Beautiful views and great weather EVERY DAY
Palm trees, turquoise blue water & boats are everywhere.  You don't have to fly or drive anywhere for a great view.  If you want to be a tourist for the day, check out the planes taking off and landing at Sunset Beach Bar; head to Philipsburg and walk the Boardwalk, Front Street, or Back Street; check out the docked cruise ships; try the underwater Sea Trek Adventure, Jet Ski, or visit Pic Paradis...there's so much to do here.
During rainy season it's more hot, humid & of course rains a bit more...sometimes 2-3 times/day but overall nothing that ruins the day.  While I was there, only Hurricane Gonzalo kept everyone indoors for a few days otherwise it's smooth sailing everyday!

 

 

3. Friendly attitude of people you meet

As it is in many Caribbean islands in general, people are all about respect and having a good time. Whenever you enter a place or pass by people they greet you Good Morning/Afternoon/Night. They don't reserve their greetings only for people they know. Try it while you're here. A "Good Afternoon" will get you helped much faster than a sour face will.  Also remember, nothing usually happens very fast, so leave the hurried pace at home because you will be frustrated if you don't adjust your thinking right away. Slow down a bit and enjoy the moment. 

2. The reaction I get when I tell ppl I live in St. Maarten

If I'm home in the US visiting and someone finds out I live in St. Maarten they get this look of wonder & amazement & a tinge of jealousy...especially if it's during the winter months. The nice part is being able to play host when people come down to visit on vacation or even just a stop on a cruise. I've had a number of friends & family visit which has been very nice when you're so far away from your home and family.
Here were some of my visitors ;)

1. Great Friends

What I'll miss most!!!! I've crossed paths with some pretty awesome folks here and made friendships that will last a lifetime. From my very first friend I met on the island at the car rental spot, my roommate, my core group of sister friends plus a handful of guys that look out for us like brothers, lab partners, ICM group members, classmates, colleagues from other classes and a few super cool locals too!!!  I can't complain one bit...I've been blessed beyond measure! I've added more members to my family and the sense of community we've built has been a great support system.  Our networks have all increased exponentially as well because we're all from so many different places.  We've celebrated holidays, birthdays, post blocks, end of semesters, and sent off friends who left the island before us.  It's been a wild ride so far and nothing short of amazing.  We're all going separate ways for now but I'm sure many of us will cross paths during clinical rotations and professionally in the future.  So glad to have met you all!
 

Overall most things were pretty good and I don't have many complaints about the island...but as with anything, there are a few things I won't miss like...

5. Mosquitos 
I wouldn't get a bite for months and then in a few days time you can play connect the dots with the insane number of bites I had. Thank God I was one of the lucky ones that didn't get Dengue or Chickungunya from these blood suckers!!

4.  Being so far from home
I've definitely missed my family and friends from home.  Now that everyone is going separate ways, I'll miss these people just like I missed the ones from the States.  As I move around and add new friends to the fold, I guess this feeling won't go away. At least a relatively reasonable plane ride could allow us to reconnect in the future. 

3. Not having a cell phone signal
Depending only on wifi to remain connected is painful at times.  Luckily many restaurants have wifi so you can check in and contact people.  But if you're on the road, be sure you have minutes on your island phone or you will be up the creek.

2. The seemingly endless classes and study schedule

There have been plenty of days that I've asked myself why anyone in their right mind would sign up for this punishment.  However, after a few grey hairs, added pounds, and countless hours of sleep I'll never be able to make-up...I know it's all worth it!  I would do it all over again knowing that I could get thru it.  Now, I just have to focus on preparing as best I can for STEP 1. 

1. GEBE!!! OMG--the BEST RACKET RUNNING IN SXM! That company is the bain of my existence. The problem...Intermittent utilities and arbitrary billing amounts.  When's the last time you've been mid shower and the water just stops flowing??? It doesn't happen often but when our water was out, I copped a major attitude. We've been lucky and never lost power but that's not  the norm.  If you have the time, I'd suggest reading your own meters every month bc someone is dropping the ball and/or padding the bills.  We were charged almost $60 for 3 days of electricity and water...Good Riddance GEBE!!!!

I'm already missing you SXM but I'll be back!
Until next time...