uh...don't know what to say about this...

I came across this picture and it actually made me laugh out loud. I'm tempted to think that this is a photoshop job, but there are weird people in the world.

St. Maarten roads: 3, My tires: 0

St. Maarten appears to be utterly incapable of fixing their roads. They sometimes fix potholes, but they open back up within a week or two. I'm beginning to think that it's a conspiracy to give the tire repair people more money. This is now the third time that they have taken out one of my tires. The first time, John was driving and went through a pothole that took out the tire and the rim. The second time, the entrance to my neighborhood ate my tire (the road is so bad that you can't avoid the rocks and holes). Today, on my way to the pharm review, the road again ate my tire. This time, it was a misalignment in the road that is also pretty much impossible to avoid. On the plus side, I am now a pro at changing my tire.

There is an upside to the story though. I took my tire to be repaired right away since the actual tire doesn't fit in the spare's spot and I don't want it in my car. They made the hole bigger, put some nasty brown semi-solid crap in the tire, and say that it should last a couple years. When I asked how much it would cost, he said "4." I fully expected that to mean $40, and thought that was a fair enough price. I asked if he took credit card and he said, "no, not for $4, this is not the states." I almost felt bad only giving him $4 to repair my tire, change the spare back out, and fill all the others with air. But, then I remembered the conspiracy that they have going to keep the roads in such bad condition, and I didn't feel bad anymore.

Note: For those wondering, that picture definitely was not taken by me, or in SXM! There are evergreen trees in the picture, but certainly no evergreen trees in SXM. If the road were lined by palm trees and oddly placed boulders, then I'd guess St. Maarten roads.

Ghetto pool filling

Our pool has been either empty or too dirty to swim in for the past 6 months or so. Every week, the landlady has been telling us it will be fixed in a week. Now, finally, it seems like it may finally be getting filled. But, instead of having a water truck come to fill it, they're siphoning water out of the cistern. Yes, that is the same cistern that we use for showers, cleaning, toilets, and everything else. And yes, the cistern is significantly smaller than the pool. Will we have water for a shower tomorrow morning? I'm not holding my breath. But, at the same time, the water isn't flowing very fast, so maybe.

So sad

As I've mentioned multiple times, St. Maarten's internet leaves a lot to be desired. What I find very sad is that I'm currently downloading Apple's iLife '09, and I got very excited that the speed got up to 25 Kbps, meaning it may only take another day or two to download. When you get excited over that speed, you've definitely been in St. Maarten for too long.

ICM 5

ICM 5 = intro to clinical medicine, 5th semester
Basically, this class is all cases that are presented to us, and we have to diagnose them. I thought they'd be boring, but they're actually very interesting and teach you a lot. At the beginning of the day, we're presented with a case. We can ask any questions we want, run any necessary labs, and can ask for the results of a complete physical exam. After that, we can usually make a diagnosis. But, then we get a ton of questions related to the case that we have to research that night. For example, our first case was an acute abdomen. Turns out the patient had acute pancreatitis, caused by gallstones which were obstructing the flow of the exocrine pancreas. But, the case required us to research cholecystitis (gallstones), appendicitis, pancreatitis, and a few other causes of abdominal pain, how to differentiate them, necessary lab tests and interpretations, detailed anatomy, etc. So, at the end, a very good review for the step.

In any case, thought people might like to see what the dry erase board looks like at the end of the day. Yes, by the end of 5th semester, you do know what all this means. This is a pretty early case, so they'll just get a lot more complicated from here.


Note: We weren't really considering sarcoidosis as a diagnosis. But, we included it because, according to House, sarcoidosis is a possible cause of just about everything!

things you give up as a med student

A couple weeks back, a firefighter from Cleveland contacted me. He's been reading my blog for a while (so he'll likely eventually come across this) and wanted to buy a fellow firefighter a drink. I just got word from him that he'll be arriving in St. Maarten shortly. Not only did he keep up his drink offer, but also offered to take my girlfriend and I on a dinner cruise! Unfortunately, I cannot accept that offer. The reason? Well, when the boat leaves at around 5:30 PM, I will be performing a rectal exam on some man who actually is flying from the US, explicitly to allow students to practice rectal exams! While that's a skill that I hope to very rarely have to use, it's an important one to learn. But, couldn't I learn it when I'm not invited on a dinner cruise? I could have gone the night before, but that night I'll also be performing a rectal exam, along with a female pelvic exam, on a different patient.

There are a lot of people that can't wait to get started in medical school, and usually I am very happy to be here. But, if that is not proof that medical school is far from glamorous, I don't know what is.

Picture of people taking pictures!

So many people wanted a picture of the Honors Society, so I decided to take their picture! The picture that they're all attempting to get is below.




How do you get to be in the Honors Society?
1. Do about average in school (you only need an 83% overall average)
2. Complete a community service activity in your 20 months here
3. Most importantly, don't piss anyone off. The deans apparently do not look highly upon blog posts being published in the local newspaper ;)

White coat pics...still uploading!

As I said before, the process of uploading the white coat pictures takes a while! Although it should have been obvious, I didn't even think about the fact that the photos from my new camera take a lot longer to upload, since the images are 50% larger (15mp) than my previous camera! Also, for some reason, flickr always uploads much slower than any other website, possibly because flickr does no compression to the images and most other places probably do. Flickr uploadr is also not very reliable though and it tends to time out, even with a very fast connection. When it does time out, it's not good at resuming where it was.

Long story short, I can send all of the photos to my parent's computer at home using dropbox.com, and that transfers the pics a lot faster than flickr. It still took 3 days to do, but in that same time, I only got about 40 pictures up through flickr. Now that the pictures are all there though, I'm uploading them using their connection (20mbps FIOS). Needless to say, it is going MUCH faster now! So, another day or so, and the rest will be posted!

My first attempt at Tilt-Shift photography

OK, I'm cheating a lot here. I definitely do not have the money to buy a proper tilt-shift lens, so I faked it in photo shop. The idea is to take an actual place or object, and make it look like a picture of a tiny model (like a train set or something). To do it quickly in photoshop, duplicate the layer, apply a gaussian blur of about 15, and erase out a part of the blur. There may be better ways to do it, but this way takes about 15 seconds, and I think it gives a decent result. Make sure you lower the hardness of the erase brush way down.

5th semester fridays are amazing!

I was just a little upset with myself for going to bed so late. But then, I realized that tomorrow is Friday, and I'm a 5th semester. So, when most other people are just getting out of 3 hours or so of class, I will still be just about to wake up! What a wonderful thing.

White coat pictures....DONE!

I finished editing all of the White Coat ceremony pictures today, and they look pretty good (if I do say so myself). They are currently in the long process of exporting from RAW files to jpg files, which I will post online. Unfortunately, converting a couple hundred pictures is pretty processor-intensive, so I can't really use my computer for much else while it's happening. Once that's done, the much longer process of uploading them to flickr will begin.

President Obama = free phone calls?

While in class this morning, I got a text message from Chippie, the local cell phone provider. I'm too lazy to look up the exact wording, but in celebration of his inauguration, Chippie is giving free mobile to mobile calling for the day. I would have never expected that Obama's inauguration would be such a huge deal here! The coffee shop was decorated, they gave us off of class to watch the ceremonies, and now, free cell phone calling! Unfortunately, I don't really have anyone to call today, but I intend to find someone. It's not often that you get anything for free here.

To the first semesters: I'm still working on White Coat pics. But, I do have to find time to study also, so please just bear with me for a little while longer. For my white coat, we had to pay for any pictures, they weren't very good, and they took over a month to get. So, I'll deliver them for free, higher quality, and much faster. But, it's still going to take me a week or so.

WhiBal - something every photographer should own!

I recently purchased the WhiBal to improve the White Balance of my photos. I was not sure how good of a job it would do, but I can now tell you that the tiny little grey card that is the WhiBal, is pretty damn amazing! According to the manufacturer, every WhiBal that goes out the door is individually measured with a spectrophotometer, to assure that they are perfectly neutral.
To use it, you just snap a picture with the WhiBal in it (you can either hand-hold it, or have someone hold it for you), and then take the rest of the pictures as usual. When you get back to your photo editing software (I use Adobe Lightroom), you just select the appropriate tool (it's the eyedropper in the develop module of Lightroom), and click on the grey card. Then, you apply those white balance settings to the rest of the pictures.
Below, I took a sample picture, so you can see how well the thing works. The first picture is just a regular shot from the camera on program mode, with auto white balance turned on. As you can see, it doesn't do a great job with the energy saver bulb that I've got in my room, and gives everything a horrible yellow cast. The second picture is just a duplicate of the first, with the white balance settings from the WhiBal. The fix literally took about 3 seconds in Lightroom, but the difference is night and day. I did not make any other changes to the picture, except the white balance settings copied straight from the WhiBal picture.


The WhiBal can be purchased here

White Coat!

The white coat ceremony and party were last night and aside from possibly the single most unprofessional speech that I have ever heard, it was very nice! Dr. Model was the keynote speaker, and he did a great job. Joel also did a good job as MC, keeping people interested. I was debating not going to the after party since I wasn't really in the mood to stay out late, but I'm glad I stayed! It was definitely a very nice break from studying...probably the last one I'll have until the 5th semester party. I'm in the process of editing the pictures from last night, but it's going to probably take a week or so before they're posted.

Even more exciting than my O2 sensor....

The office just started downloading!!! I was wondering when that show was gonna start up the new episodes again. Finally, the best show on television (ever) has returned!!

My first O2 sensor!

Two major things happened today
1. a USAir flight crashed into the Hudson River
2. I bought my first O2 sensor for my car.

First, my car, since that happened first in the day. My check engine light has been on for a little while and I finally had time to check it out today. Toyota wanted to charge me $100 just to hook the computer up to a little machine that tells you what's wrong. The device can be bought for about $80 online and takes all of 30 seconds to hook up and use. Fortunately, I didn't take my car to the dealership, and took it to another shop that did it for free. The problem wound up being that one of the 4 O2 sensors has gone bad. Unfortunately, it's probably the hardest to access of the 4, but at least the replacement part was not terribly expensive. I also changed my air filter for the first time (not the first time it's been changed, but the first time I did it)! So, with my utter lack of knowledge of anything car-related, these were pretty major accomplishments for me.

I'm sure you've all already heard about the airplane crash into the water. I always assumed that the life rafts were a little stupid and that if your plane ever crashed, you weren't going to be alive enough to make your way into the raft. However, it would seem that an experienced pilot can actually put an airplane, with no engine power, down safely into the water. Fortunately, even though the plane was completely full, there were no fatalities and everyone made it out relatively unscathed.

For now though, it's time to get back to studying for the Med Ethics final tomorrow. I thought that med ethics would be quite the experience for me, since I have some pretty strong views on a few ethical issues. Fortunately, it turns out that my views on most of the issues are the proper views. At the least, they're the ones that are commonly accepted by the medical profession. Probably the most important thing I learned though is that people just love to sue doctors, so it's best just to consult your hospital's lawyer if you're not 100% sure.

Get ready....

I may have forgotten more than you've learned...

I just took the Kaplan diagnostic and I learned two things from it:

1. AUC does a good job of presenting the information that you'll need for the USMLE
2. I have an awful lot of studying and re-learning ahead of me!

There were maybe 1 or 2 questions on the diagnostic, out of 150, that I did not remember ever hearing about. Everything else, I know that I was taught at some point, but I just don't remember it right now. According to Kaplan, biochem is BY FAR my weakest subject, with pharm and anatomy not far behind. However, even though we've only had about half of pharm, I got a 45% on the section, so I don't really feel too bad about that. Biochem and anatomy were also first semester, so it's been a long time (over a year) since I've looked at that stuff at all. I'm surprised how well I did in micro, but I think that's the product of lucky guessing. I've got a lot to review in path, but there are just so many little details to differentiate between many diseases, so I think that Kaplan can help a lot with refreshing my memory on those things.

Kaplan says that I should spend between 3-4 months studying, based on my performance on the diagnostic. I've got 3 months to study at AUC, and then I'm taking a 7 week intensive Falcon review course (which they're definitely not factoring into their equation), so I ought to be good to go!

Note: The title is, of course, assuming that you are not a 5th semester student or above!

The number one reason to buy an iPhone!

The iPhone is an amazing device, probably the most impressive phone currently in existence. However, there is one new application which puts the iPhone squarely above any other device on the market: the Chipotle Mobile application [app store link]. With this application, you can order anything on their menu, pay for it with credit card, and save whatever you ordered for quick access later. After ordering, you just go to the store and pick it up, already paid for and put together on a special line in the kitchen area. I cannot wait to get back to the US and use this....every day.

Welcome Back Beach BBQ

As they do every semester, Phi Chi and AMSA hosted the Welcome Back Beach BBQ today. And, as usual, I was asked to take pictures. Update: The pictures are now available on flickr. Clicking any of the pictures below will take you there.

Ravens vs. Titans

Which team will win? I think the Ravens, and it seems that most of the US agrees with me. In the map below (pulled from espn.com), blue is Ravens, red is the Titans. Actually, it may be close, but I think it is the Raven's game to win.

To vaccinate or not to vaccinate

Here are the facts:
1. The MMR shot (measles, mumps, and rubella) does not cause autism
2. Seriously, the MMR shot does not cause autism...there is not a single properly performed study to say it does, and there is tons of evidence that it does not
3. Some parents, who are likely not properly educated in the scientific method, or who have not performed nearly enough research into the subject, still believe that vaccines may cause autism
4. However, despite what some parents think, there is still no evidence that any vaccine has any link to autism
5. If you do not have your children vaccinated for MMR, they may get M, M, or R
6. If your child gets measles, they can get encephalopathy and a whole host of other nasty problems, including the major side effect of death
7. If they get rubella and pass it on to their children, their children may either die or have some other nasty issues.
8. Basically, you definitely do not want these diseases....they're no fun at all and may even permanently stop fun
9. So, the MMR vaccine is safe, rarely has serious side effects, and does not cause autism
10. Here's the kicker....there are still parents that will not have their children vaccinated, based on inaccurate information, and probably ignoring their doctor's advice.

Fortunately, in the US, you can't go to public school unless you have the MMR vaccine. Unfortunately, it is possible to get a religious waiver. Also, you do not have to vaccinate your children if you don't send them to public school. Not only are these parents putting their children at great risk, but they are putting the lives of all other unvaccinated individuals at risk. So, my question is, why in the world do we allow parents to make these decisions?

It is already illegal for parents to withhold treatment from their children for religious reasons. Clearly, a precedent has been set that while parents almost always have the right to decide for their children, they are not usually given the right to do things that are going to be dangerous to their life or well being. However, we continue to allow people to go unvaccinated, often simply because the parents are not properly educated. Should parents really continue to be given the choice to deny their children vaccinations which have been proven to be safe and effective at preventing death?

no more double pharm

Once again, after much more effort than probably should have been necessary, the pharm department has graciously decided to do away with double pharm lectures and just extend each class period by 10 minutes. We fought very hard last semester to have it changed for ICM4 before they finally agreed, so I have no idea why they changed it back for 5th semester! So, we fought it some more, only to be told that there was probably a good reason that they just didn't want to tell us, and it wasn't going to change. This was despite the fact that nearly 100% of the class voted to get rid of double pharm and also filled out course evaluations indicating the same. In any case, they mysteriously changed their mind again, and all is now well in class :)

So, although I still don't know what the issue ever was in the first place, thank you to the pharm department for allowing the students to have a voice.

One of many many reasons I hate Microsoft!

This is Microsoft's add for their new Songsmith software. It's supposed to compete with Apple's Garage Band, but I can't imagine anyone over the age of 5 actually using this program. It's mostly just sad. I don't know why Microsoft can't seem to get anything right for the past couple of years. If you haven't already switched to a mac, this commercial might just make you want to. And no, it doesn't get any better as it goes. Also, did anyone else notice that THEY'RE USING A MAC BOOK PRO, with a sticker covering the Apple Logo!!!

Deans list?

I calculated my grades today from last semester and unless AUC does something screwy, I should have finally made the dean's list! I'm going to wait until I hear it from them to get too excited though, because you never know what AUC might have up their sleeve. But, it's looking like after 3 semesters of just barely missing it, I might have finally pulled it off!

In other news, I unlocked Heath's iPhone 3G, so I am now absolutely certain that it's possible (and quick and easy). If you've got a new iPhone, or are thinking about getting one, I can help you get it unlocked and ready to go on the island. If you have an old iPhone though, really no reason to upgrade since google maps doesn't cover St. Maarten, and there is no 3G signal.

Become an OA to sell your books

OK, so there are many more reasons to be an OA (orientation advisor) than to sell you books. It's nice to be able to help incoming students adjust during their transition to the island and medical school. I've never heard anything but positive comments about the OA program, and it's good to be a part of it. BUT, it's also good to sell your first semester books and make back a little money! One of my orientees (not sure if that's a word) bought most of the books, and I had to fight off the crowds trying to buy my BRS anatomy and Rohen's atlas today, when I announced to half the first semester class that they were for sale immediately.

For now, back to studying for the ethics quiz tomorrow, where I will find out, once and for all, if I am an ethical person. At the very minimum, i'll find out if I can at least distinguish which answer among 5 would be considered the most ethical. I've always thought that ethics were a pretty subjective topic. But tomorrow, there is only one right answer.

Upside down and naked, on a ski lift!

This is certainly not something you see everyday! This poor guy botched the boarding of a ski lift in Blue Sky Basin at Vail Resort. I was a patroller for 3 years and I've been skiing most of my life, but I've definitely never seen or heard of anything similar!

The story and more pictures can be found on thesmokinggun.com

First day of 5th

Today was not a terribly exciting start to my last semester. Unsurprisingly, the teachers all jumped right back into it, although much of it was review from other semesters. The first two weeks of the semester is ethics, instead of ICM 5. I thought I would hate it, but I think I might wind up enjoying it. For the first day, we watched a video on the Teri Schiavo case. I'm sure we'll discuss it tomorrow, but it sounds like the teacher agrees with me that they should have just let her die in peace. I do have some pretty strong views on things though (as you may be aware), so this will probably be an interesting experience...both for me and the class.

I wish I could say that Behavioral and pharm were interesting, but they weren't, at all. I really can't wait until February 25th, when those two classes are over. It's nice this semester, that our classes don't start until 9:30, but it really sucks that we have two half-classes for the first half of the semester, that keep us there from 12-2. And, since the pharm chairman refuses to budge on his position that we should have double classes (a position which fully 100% of the class disagrees with), on Wednesdays, we have class from 12-3 (after ICM from 9:30-11:30). Somehow, we're supposed to also find time to study for the step. We'll see how that goes.

One more day in civilization...

Tomorrow, I've got an 8:55AM flight back to the island, for my final semester!! If you were not aware, every flight into St. Maarten is a morning flight. American is the only airline that keeps a plane at the airport overnight, and I think it's only one plane, and not every night. So, the way it works is that airlines arrive in St. Maarten in the morning or early afternoon, clean up the plane, and then fly back in the afternoon or early evening. It's predictable, but not always ideal (I hate waking up early).

In any case, this is the last time I'll have to fly to the island until Graduation. By that time, I'll probably be very glad to be going back (mostly just because I want my degree). I suppose St. Maarten is technically civilization, but it's just nothing like the US, and I like what I like. While on break, I've had amazing food that is either not available on the island (Chipotle, just about any nice chain restaurant you can think of) or is extremely overpriced on the island (like sushi).

I've also spent a decent amount of time at the firehouse, keeping up my paramedic skills. Unfortunately, I didn't really get any good calls (which is good for the community, since a good call for me is a very bad call for the patient), but I did get ample time to use my patient centered interviewing skills. The people I rode with said I was nicer and more tolerant of the patients than I used to be, so I guess those ICM classes are paying off. Either that, or I've been away from the ambulance for long enough that I'm no longer burnt out, and I enjoy riding it again. I also try to keep in mind that even though I know that the patient isn't really sick and doesn't need to go to the hospital, they don't necessarily know that, and especially if they're older, they're probably pretty scared. Keeping that in the back of your head is always a good idea and makes things better for everyone.

Finally, it's always fun to find out how much I've actually learned in medical school. While on the ambulance, I found a systolic murmur in a patient and actually knew what it meant, and how it related to her other conditions and her medications. I would not have found the murmur a year and a half ago, and I definitely would not have known what it meant. I also saw my first Wolff-Parkinson-White Syndrome on the EKG strip, and again, actually knew how it got there! I'm not exactly sure if it's just so rare that I've never seen it before, or I just didn't know what I was looking at, but I found it this time.

Bye bye to drug rep toys :(

First off...NO, I have not stopped blogging forever, I have just given it a rest while I enjoyed my winter holidays vacation. As 5th semester is about to start up, the blogging will start up, as well. As long as I continue to have visitors, I will continue to blog. Maybe my New Year's resolution will be to blog more often from now on. I used to be very good at blogging every day, but got pretty behind at times last semester.

Anyway, starting yesterday, the pharmaceutical companies have agreed to stop handing out all of their free little toys, which I think is a real shame. If you want to get a great idea of all the neat things they handed out, I'd recommend you visit drugreptoys.blogspot.com. Among the freebies were the usual tons and tons of pens and prescription pads, but also EKG calipers, Mag Light flashlights, pen lights, reflex hammers, first aid kits, reference books, mouse pads, and even USB flash drives!

I think it's just awful that these things are going away before I even make it to clinicals! The biggest argument against them is that people think that physicians were letting their drug choices be influenced by the swag. I'd really hope that physicians had a little more sense than to prescribe based on what pen they were currently using, but maybe some didn't. Fortunately, the free dinners and lunches will not stop, although that's probably only a matter of time too. RIP, drug rep pens.