Finished Year 2

Whelp, that’s that.

Finished the Pharm exam, headed to Charter for a slide show and champagne. Then a jump off the cliff behind the library.

Now my mom and brother are coming to visit, landing in just a few hours! Frond’s parents are coming in too – on the same flight. Yowzas.

Leah and I went up to visit another roommate from first year before heading home, and as we exited the elevator, on the other side was the Pathophys prof and a tutor! The tutor with the bump on his head, the tutor who i felt was giving me such a hard time, and at the time it shook my confidence up. I thought it was because I was the only girl in my small group. It was the start of a term that wasn’t as academically challenging as last term, but somehow it was one of the more challenging, emotionally, mentally. I had moments where I felt so full of anxiety and stretched-too-thin, that I felt something in my chest was going to burst. There were moments I felt so jaded about this career path, asking: why do I care?

Now it’s finished and there’s a new feeling settling in. Something about reaching the end. Days can seem so similar, and trudging along, it’s hard to see where things are going. But moments like these are a chance to breathe and soak it in. It’s a turning point, people!

When I saw the tutor during Pathophys quizzes, he always gave me a smile, which I thought at first was a smirk. But the more sessions I had with him, the more I saw he was really teaching me something new I hadn’t learned yet in school. Out to get me? I think he was out to push me to be a better student, clinician, and better me. He lit up when he saw us leaving the elevator and asked us how the last exam went. Good! we told him. Best of luck on the step and in your careers! he told us, genuinely.

 

Psych! week

It’s Psychiatry week in Pathophysiology.

In honour of this week of self-analysis and labeling everyone you know with a psychiatric condition, here is nice gem from my prof:

It’s SPEAK.  It’s what he counsels his patients with depression to do.

S – Schedule daily (this is important)

P – Pleasant activities (we really don’t get enough)

E – Exercise (get that blood flowin’!)

A – Assertiveness (express those emotions and feelings!)

K – Kind thoughts (kindness starts with being kind to yourself).

He said that med students especially need to look after themselves.  I’m not sure about especially, but looking around at students, there is a definite tend to letting yourself go – physically, emotionally, creatively, and socially (myself included).  On the one hand I feel one-dimensional if I spend my days only studying.  On the other hand if I don’t spend all my time studying I feel behind and like I am not living up to my potential.

In the end, it’s this: we are living now, not just working and preparing for the future – future career, future location, future life.  We keep ourselves going by focusing on our goals but it’s still worth living a good life now.  Besides, it’s only going to get harder to figure this balance out; may as well figure it out now.

 

P.S.  I’m cyclothymic.

Whoamygosh. Or, how I became a Glimpse Correspondent

The first time, I was in Thailand and my PayPal account was going to put me behind the deadline.  Sitting in an uncomfortable internet cafe in Bangkok, feeling the patience of my brother running down, I was clicking away at my computer, editing my writing sample while in other windows I was working on setting up a PayPal account to pay the application fee.  It was an old fiction piece I had written for my high school senior English class about the last days of your mother’s life, and letting go.  All interspersed with lyrics from “Across the Universe”.  I loved it back in high school.  When I reopened it years later, I was shocked at how bad it was.

That was after my MSc, when I was in that strange funk of excitement to explore the world, with simultaneous fear and disappointment of not knowing what I was doing with my life.

Now, three years or so years later, I’m in Grenada, sitting in Taylor, a chilly study hall on my medical school campus.  I’ve heard it described as a “freezer full of angry medical students” but when I opened the email from Glimpse it had at least one speechless one.  I shook Frond, and we headed outside where I could properly freak out, dance and yell unintelligibly in peace.  “The extensor surface of my arms are tingling!  My radial nerves are flipping out!”  I am such a nerd sometimes.

I am so fortunate.  Really.  To have finished my MSc then decided not to continue in the same field, so I had time to explore other options and stumble across the Glimpse Correspondent program.  To move to Grenada after having been rejected by all the North American medical schools I applied to, after two rounds and thousands of dollars in application fees, and just as many tears.  To have had Frond to help look over my application writing sample and tell me not to try so hard, to just tell the story and not tell people what to think or feel.

I have so much more to learn about writing!  I’m so excited.  I really want to become a great communicator; to tell stories that make people think and feel, and to use this when I keep going on, to help people around the world learn about each other, and to connect them.  Maybe along the way I’ll learn how to stop using commas so much too.

My extensor surfaces are still tingling, my schoolwork has gone totally untouched, and a mosquito is having the time of it’s life with my knee.  But that’s all great.  Somehow, sometimes, when you really put yourself out there, the stars align and you get that email.

Here’s what I submitted to Glimpse as my writing sample.  It might seem a bit familiar as it has pieces taken from other blog entries.

New In Town.

Rumbling down a dusty unpaved road in Shervin’s jeep, we whipped around a leafy green blur and came to a clearing.  There were two small buildings, surrounded by knee-high kids in twos and threes, running here to there, stopping, then taking off again in a new direction.  They were each monochromatically dressed in either green, red, or yellow.  It was a multicoloured ant hill.  On the other side were older kids dressed in long navy blue pleated skirts, white collared short-sleeved blouses and red ties or navy pants and white dress shirts.  These kids were leaning over the railing of the second floor, many yelling, some throwing food onto the yard, most just gazing about coolly.

We had come to talk to the principal about a new pilot program we were starting.  In light of the diabetes and obesity epidemic on the island, we were proposing to help teach some life skills and healthy food choices on the backdrop of fun physical activities.  Healthy Grenada, we called it.

As the three of us were standing under the sun discussing how we would run the first session, a pair of girls in their pleated dresses walked up to stand behind me and giggled when I glanced at them.  After a few minutes we were ready to leave, and we started back towards the jeep.  The two girls, still giggling, followed us a few steps behind and in the instant just before we pulled away, I heard one say: “I want to be white too”.

—

Two months earlier, I was on a bench under a tent in the Carenage in a concrete room with two walls and no roof.  It felt like an old construction site, perhaps abandoned after Hurricane Ivan in 2004.  There were about 70 Grenadians patiently standing in line to sit beside me, ranging from middle aged to elderly.  I was helping out at a school health fair, a student-organized event where students and our physician clinical tutors come out to screen the community for high blood pressure and diabetes.  My job was to take blood pressure and ask a few questions before they went on to see the physician.  Beside me was Helen, a well dressed lady in her 50s or 60s in silver rimmed glasses and a white blouse.  I asked her how she was doing, and she said, “Fine, just a little warm but that’s okay”, with a smile.  It was humid and hot, with an occasional spattering of rain, but typical of Grenadians, the participants were patient and without complaints.   I apologized for the lack of set up early on.  There was a miscommunication with the organizers and although the volunteers and participants arrived on time, the equipment, tables, chairs, and tent was about an hour late.  “That’s fine”, Helen said “we make do.”

I wrapped my blood pressure cuff around her arm and began to pump it up.  The crowd around our small table leaned in slightly, watching the process.  160/90; it was high.

“Have you ever been checked for blood pressure?” I asked.

She had.

“What kinds of things are you doing to manage it?”

Helen looked at me and said, “Well I have a prescription.  But the pharmacy is out so I haven’t had it.”

“Do they know when they’d be restocked?”

“They’re not sure.”

“Since when have they been out?”

“Three weeks.”

“How often are you supposed to take the medication?”

“Every day, morning and afternoon.”.

The next woman eased onto the bench beside me and I pulled the table closer for her to rest her arm.  It was hard to tell her age, but she was young, perhaps in her 30s.  She was well obese and had come during her break-time from work, as clear from her green uniform shirt and baseball hat for a local grocery store.  I introduced myself and asked her name.  “Angel”, she said.  As I unwrapped and wrapped the cuff around her arm I noticed the Diet section of her questionnaire hadn’t been filled out.

“Can I ask, how many meals a day do you have, typically?”  I asked.

“One or two.  Usually one.” she answered.

“Do you get to eat regularly?  Or do you find yourself skipping meals here and there?”  I started.

“I skip meals, maybe every other day.  When things get busy.”

“And what’s your typical meal like?” I asked Angel.

“Juice, bread” She trailed off, still looking around.

“Any vegetables or leafy greens?”

She looked directly at me for the first time since sitting down.  She had hazel eyes but was wearing no make-up, unlike many of the young women who had previously come by.  “I eat what I can find.  When you have no money, you eat what you can find.”

I thought back to the brief training we had done for the health fair. “Offer a bit of counselling,” the coordinators advised us. “It’s easy, basic nutrition and healthy eating – balanced meals, being active however you can.  You guys will do great.”

—

We walked up the long road toward the school with a group of volunteers and a folder full of quizzes, worksheets, and activities we had planned for our first session of Healthy Grenada.  Alongside us were a group of young boys, about 9 years old, in burgundy pants and white polo shirts, laughing and running about.  One of the boys had a long thin stick and was playfully swinging it about and making growling noises.  They told us they were playing a game they made up called Daddy.  “It’s a different culture,” Shervin said to me, “let it go.”

Later that night I slipped quickly out the door, trying to leave faster than the mosquitoes could enter.  It must have looked pretty comical, like Kramer from Seinfeld as I opened and closed the door in one movement, manoeuvring my gym bag out of the way.  I glanced around to see if anyone saw my awkward exit.  There was no one, but a silhouette of two little boys, maybe 10 or 12, drinking cartons and rummaging through the trash bins outside the apartment.  Neither had looked up.  Not wanting to embarrass them, or perhaps embarrassed myself, I started walking towards school as if I hadn’t just seen two kids looking for food in my trash bin.  About two minutes later I passed the security gate of the school, and as I approached the student center, I passed a group of students chatting and holding takeout containers full of food.  I walked past students playing basketball on the lit-up court, filled up my bottle at the water fountain, and ran on the treadmill for a half hour.

Shorts too short, and other lessons in culture

The school Healthy Grenada is working with had a PTA meeting tonight, so Frond and I went to introduce the program to the parents. As we were sitting waiting for the meeting to start, the principal pulled us aside into another classroom and asked who was going to be presenting. Frond said both of us. But she replied that I wouldn’t be able to do it because of my shorts. I don’t have many shorts, and the one pair that I wear a lot while here are pretty short I suppose. Not by North American standards, but for a Roman Catholic Elementary school, I could see what the principal was talking about. She said that I could hand out the fliers we had made, but I couldn’t be presenting. In the end, I went home to change and we presented together.

I appreciated the principal pointing this out to me, as it’s important. But I felt bad because I had worn these shorts to the school before, while doing activities with the kids. It really hit me that for all my trying to make Healthy Grenada a culturally competent program, I had overlooked many basic things.

We stayed for the entire PTA meeting, where parents shared some things they had learned about food, artifacts, and songs that their “forefathers” used. Grenada’s independence day is coming up in February, and judging by the efforts going in to it around town, it’s a pretty big deal. The principal and vice went on to talk about programs they are running for the students, including Sports Days (with an “Infant Cross Country Race” where the kindergarteners run a cross country course — incredible! People were saying how it was such a short course, but to me it sounded like quite a length), Spelling Contests, Reading Contests, and an ongoing school-wide Physical Activity competition. I was thinking the whole time about how I had came in to the school with so many assumptions about what the school had to offer their students. It had me wondering what exactly Healthy Grenada had to bring that would benefit the school. Was the school doing us more of a favour, by giving us a chance to volunteer with their kids? During their school time? I felt like a silly tourist.

After the meeting, we went to thank the Principal for inviting us to the meeting. She asked where we were from, and when we told her she said how we’re three different cultures. We agreed, adding that we’ve got a lot to learn from them, and she said, “Yes a lot to learn from each other” and gestured her hand back and forth between the 3 of us.

Interdisciplinary: Who dat?

I met up with a couple friends from undergrad two nights ago.  One of them, BM, is in Physio school.  It was pretty cool to compare how our respective programs have been similar or different.  Mostly different so far.

She said that she was surprised how much writing is involved in PT school.  She had to write 3 papers so far.  I forget what the first paper was on, the second was on an experience with someone with a disability (this paper was done in partnership with a student from Osteopathic school), and a third paper on a topic of her choosing, which she wrote on Physio clinics under the public payment system.

It was really cool, how right off the bat her training is integrated into the training of other health professionals.  She recently finished a rotation in the neuro oncology ward, where she sat in on case reviews with med students.  She also completed some assignments where cases were reviewed by a team of students: a nursing student, a physiotherapy student, a medical student, and so on.  Each student reviewed the case and discussed their treatment plans from their discipline’s perspectives.  It must have been so interesting to see how each member approaches a patient, and to see how the treatment plans can compliment (or maybe even contradict) each other.

I told her how my mom recently hurt her shoulder when she fell on her elbow, and has a partial tear of rotator cuff muscles.  The orthopedic surgeon can’t do anything for her, so she was told to just let it heal on it’s own.  She had lost quite a bit of her arm’s range of motion (i.e. couldn’t put on her seat belt without help or a lot of pain) so she booked an appointment with a physiotherapist and has been really happy with the help she has had from there.  My friend BM was happy to hear this.  She said, “See?  We aren’t just support staff!” — I got the feeling this was more so directed at the world (Them!) than me.

One of the assignments BM had was for a group of the physiotherapy students to find out the different roles of various members of the health care team.  Her group did pretty well but in the end couldn’t figure out the difference in role between a licensed nurse practitioner and a registered nurse.  Her tutor asked them, “If you don’t know the difference between a licensed nurse practitioner and a registered nurse, how do you expect them to know the difference between a physiotherapist and an occupational therapist?”.   More than support staff for sure, but still trained to be a part of a team.  Definitely more than my training has been so far.  For sure these discussions haven’t come up in medical school, and yet I’m sure doctors will always be a part of the health professional team.  From my perspective, it’s too bad.

I thought back to when I learned about some kind of wrist-related pathology in first year Anatomy.  Was it carpal tunnel?  I don’t remember.  But I remember being told that the treatment for it was surgery.  Perhaps to cut open the flexor retinaculum, if it was carpal tunnel.  Frond was sitting beside me, and during break after lecture he told me he was so surprised that we were being told the treatment was surgery, rather than the much less invasive manual therapies he had learned and treated clients with in his previous life as a body worker.

Maybe it’s just my med school.  After all BM goes to a university that has made it’s name on “innovative” (unconventional) teaching styles.  It seems to work.  But regardless, more interdisciplinary training from the start of med school is something every med student (and patient!) will benefit from.

My first flu shot

I have such a great big brother.  He came by this morning to get his flu shot from my mom but he agreed to let me give it to him instead!  I don’t know whose idea it was.. maybe his.

I was a little nervous but just pretended it was no big deal.  I’ve always had a big discomfort around needles that sends creepers up my spine every time I see an uncapped syringe.  It helped that I told Andrew it might take a little a while and he didn’t mind.  I didn’t tell him it might hurt more than usual, but I’m sure he figured.  I watched my mom give a shot to Andrew’s girlfriend, and then it was my turn.  We took some practice shots with the cap on, just getting the motions down right.  Wipe with the alcohol swab.  Stretch the skin.  Pinky on the shoulder to steady the hand.  Pop in the needle – “Bok!  Bok!  “Bok!  Just like that”, my mom advised me, miming the wrist action in poking in the needle.  Pull out the plunger slightly to check for blood (don’t want to inject into a blood vessel, better into the muscle).  Then ease in the vaccine, and pull out the needle.  Easy peasy.

My mom was going to prepare the needle but Andrew insisted I do as much as possible.  There was a tiny bubble in the vial of the needle that I couldn’t get out and I was concerned about sending in an air embolis to my brother and killing him with a flu shot (i.e. your typical med student moment where one’s textbook knowledge reveals one’s lack of understanding the relative importance of things and one’s inexperience in clinical realities shines).  My mom took a look and said it was “insignificant” but she still flicked it out like a pro.

Andrew’s girlfriend took some pictures (again, Andrew’s suggestion) as my mom, Andrew and I hammed it up for the camera with shot poses.  I was kind of nervous still, but the two of them were breaking the tension.  Finally I was looking at Andrew’s freshly swabbed and shiny skin, the point of the needle pointing at the slope of his deltoid.  I had nothing left to do but Bok! in the needle.  I hesitated then unconsciously thought to pretend like this is no big deal and it’s easy, and suddenly it felt that way.  The needle went in and I felt a slight give and pop as the skin broke.  My mom suggested I push the needle in a bit further so I did and it slid in quite easily.  I adjusted my other hand so I could use the plunger, and the needle slid a milimeter or two out.  I was surprised how easily it was sliding in and out.

I had asked my mom ahead of time what it was that made taking needles painful.  She said it’s when the needle is pushed in and is slid horizontally, parallel to the surface of the skin, which leads to more broken nerve endings.

I pushed in the vaccine (which I know from experience is the most painful part) and then it was done.  I quickly slid the needle out and a red blob of blood quickly replaced it.  Some gauze on it and that was it!

Andrew was impressed, saying it was a pretty good job and didn’t hurt at all.  I was shaky afterwards but so happy — it was even kind of fun!  The pop of the skin is like popping bubble wrap.

In the pictures everyone looks relaxed and jokey, while I look a little gaunt and stiff.  My chin is pressed to my chest, my neck stretching back as if my body is trying to get closer to the needle and shoulder, but my brain is still trying to get away.

My second needle given, my first flu shot, and now a little less scared of needles!

A vaccination in action

Just finished.

Post vax dim sum - curry squid, leechee/goji berry jellies (shaped as fish), and yes a hello kitty mango pudding with condensed milk.

Medical verbal diarrhea

Since coming home I can’t help but bring things I’ve learned into every-day conversations.  I’m starting to realize that not everyone is necessarily always interested in being counseled.

Par example:

At a baby shower for my close friend.  It’s my first time getting to catch up with friends from home, and I go get the attention of M, who has a strange skin rash that hasn’t gone away in weeks.  Since we didn’t cover Skin in Pathology, I tell her what I heard from my brother (a doctor) about rashes: that generally speaking if it’s itchy it’s not life-threatening, that if it’s been hanging around for a long time it’s not life-threatening, and that often they don’t bother finding out exactly what it is, but they will prescribe first a steroid and then if that doesn’t work, an anti-fungal.  At least the last part is helpful for M, who thought the doctor was just humoring her by prescribing an anti-fungal when they still weren’t sure what it was exactly.

Later in the shower, Ktown, M and I are talking about high blood pressure.  M is worried because she has had a couple slightly high readings in the past few times.  Eager to ease her worries, Ktown suggests she shouldn’t have to worry because her eyes aren’t bloodshot.  M agrees; her eyes are not puffy like her father’s – he has high BP – and so she probably doesn’t need to worry so much. Later in the day I realize I never made it clear to them that hypertension is typically totally silent and doing it’s damage over the long term while the person is totally unaware until it’s well advanced.  I write a message to both M and Ktown clarifying this and saying that maybe it’s something she can talk to her doctor about.  Ktown responds thanking me for clearing it up and letting M know she probably doesn’t have much to worry about, but later cheerfully tells me that she was kind of perplexed why I sent the message that would likely just make M worry more.

Another conversation Ktown is telling me about, a silly one, about circumcised and uncircumcised penises.  She’s recounting this conversation, laughing at the awkwardness, where basically it comes up that a couple people we know are uncircumcised.  I can’t just laugh at this, but I have to bring up how circumcision isn’t just a matter of religion, there are also health benefits such as avoiding phimosis and paraphimoses, preventing HIV transmission, and decreasing the chances of smegma buildup which would lead to squamous cell carcinoma of the penis (the latter is something I didn’t quite understand until a fellow student kindly explained the whole concept of foreskin and the gunk that gets stuck under it – smegma – to me using his arm, his t-shirt sleeve, and the appropriate theatrics).

How doctors die

An article shared to me by another friend in med school.

How Doctors Die

I’m not sure about CPR doing more harm than good (no references), but it’s something to think about when it comes to doing “everything” possible to extend someone’s life; in terms of quality of life, financial strain on the system (and families), and even the actual extension of life.

Not exactly…

Thinking back to memories from Year One back in the UK, and when I was helping the Global Health Committee host Dr.Paul Roux for a Global Scholars Lecture Series on Pediatric AIDS in South Africa.  A great talk.

One of the best quotes from the night was from a pre-lecture chit-chat with Dr.Roux and the rest of GHC.

So why does Grenada need so many doctors?

 

A look back on Healthy Grenada, launched!

Ready?

 

Who's the fastest?

 

Grade 4s at Grand Anse RC race for the title, at the first official Healthy Grenada outing.