Obama = Robin Hood

I really do not like that man, but I've decided to go the less offensive route and just post the current article that is making me dislike him even further.
The article can be found here: http://money.cnn.com/2009/02/27/magazines/fortune/obama_budget_tax.fortune/index.htm

Behavioral Results...

Following up on my last post about behavioral science...I did very poorly on the past exam. I'm not sure if it was because they write non-USMLE style questions, the fact that they put questions on the test from the last block, without telling us that they'd be doing so, or some other reason. I'll admit that I didn't do a ton of studying of the exam, but I definitely did enough to perform better than I did. Fortunately, my grade from the last exam, low as it was, is still keeping me at a passing grade for the moment. Also, even more fortunately, our final exam in the class, worth 20% of the grade, is a shelf exam, meaning it is definitely USMLE style questions.

To make myself feel a little better and prove that I can answer good questions, I made a 10 question behavioral science exam on USMLEWorld. If you're not familiar with USMLEWorld, it's an online question bank that nearly everyone says is the #1 best review source for the USMLE. I got a 100% on that test. Sure, it was only 10 questions, but I set it to cover all of behavioral science, including last semester. Since I now need a passing grade on the shelf in order to pass the class, and the shelf is all USMLE-style, I'm feeling just a little better.

Need a lesson in writing bad test questions?

Ask for a copy of our behavioral exams and you'll have all you need. Who would have possibly thought that a behavioral science class would make people LESS compassionate! And no, it is not me saying this...it is what I've heard from other people.

Last block exam tomorrow!

Well, it's currently 1AM, so I guess my last block exam of med school is technically later today! But, the exam is not until 12pm, so I should be fine. I feel fine for the exam tomorrow, but unfortunately, studying for the block has given me almost no time to study for the comp! Have I mentioned that I really do not like AUC's new curriculum of having class in 5th semester? My plan was to get through biochem and micro (Kaplan) this week and start Goljan on Saturday. Well, that's definitely not going to happen. I guess it wasn't a very realistic goal to begin with though. I'll be lucky if I get through just the biochem, but it's unlikely.

Whether I do get through biochem or not, I'm starting Goljan on Sunday, at the very latest. There is not a lot of time left and at this point, Goljan is probably the highest yield thing I can do to try and pass the first comp. I really wish I had enough time to study for this first comp, but I just do not see myself passing it this time around. It's not really a big deal since I'm pretty certain I'll pass the second comp, but it would be really nice just to not have the pressure of needing to pass the second time. I guess we'll see what happens.

In the mean time, wish me luck for tomorrow...the last block exam of med school!!

Some people really love their job!

Above is a handy little chart, listing all of the possible codons for various amino acids which make up proteins. I've used the chart before, but I've always been OK with looking up the amino acids in a book or in my notes. I'm currently watching the Kaplan DVD's though and the biochem guy just suggested that you get this tattooed onto yourself. I know that he was joking, but this is definitely something that only a PhD could find funny!

No more lecture...EVER!

OK, so I will likely be sitting through various lectures throughout my clinical years and residency, but I am officially completely done with formal classes forever!! I have made it to a place that I have always thought was a lifetime away. When I started college, I couldn't imagine making it through 4 years to get my bachelors, and then another 2 years of intense class to make it through basic sciences. But, I eventually finished college (although admittedly taking more time that I would have liked) and made it to med school.

I vividly remember arriving in St. Maarten to begin med school, and walking into my first day of class. I remember looking at the 5th semester students who were on their way out, and thinking that the day I'd be there was so far away. Once I was almost there, I started counting down the days until classes were over (about 1/2 way through the 5th semester), but it still seemed like the day would never come. Today, that day has finally arrived. I still have a ton of work to do, with block exams Friday, a comp Thursday, and shelf exams the next two weeks, but man is it nice not to have to sit through another lecture tomorrow! It actually just occurred to me that today's class was not only the last of basic sciences, but the last ever!

I remember walking into Shock Trauma at the University of MD hospital a few years ago on the ambulance and seeing a med student there. I was still in college and had not even applied to med school yet. He was just finishing up preparing for his step I exam. I told him that I couldn't wait to get exactly where he was...about to start clinical years, with the worst part of med school (the classroom years) behind me. Well, aside from a few exams that I'm not particularly worried about passing, I'm at that point. I still need to study to make sure I remember everything I've learned, but I've already been taught everything that AUC's basic sciences faculty is going to teach me. It's good to be here.

More reasons not to take Heroin

Of course, there are the obvious reasons that heroin is illegal and overdose causes you to go unconscious and mostly (or completely) stop breathing. But, as all heroin addicts know, these effects can quickly be reversed by a little narcan. what may be more disturbing to heroin addicts though is that it decreases testosterone levels and increases prolactin. increasing prolactin gives you gynecomastia, aka man-boobs. I won't go so far as to say that it turns you into a woman, but the side effects definitely are not very nice for a guy!

library time

I really wish I had something more exciting to write about. I only have one hour of class left for basic sciences (not including ICM), and that's very exciting. But, I have loads of studying left to do. Unfortunately, AUC saw fit to change around the curriculum a couple of semesters ago so that now, instead of having the entire 5th semester to study for the step, we have class for much of the day, half the semester. Combined with ICM, this provides little time for additional study. So, although class is nearly over, I have had almost no time to study for the first NBME comprehensive exam, which is next Thursday. I am hoping that I can get enough done between now and then to at least pass the comp. The plan is to spend most of the rest of the week in the library. I'd like to get through Kaplan biochem and micro, along with Goljan path. If I can do that, I may just pull off a pass, which would greatly reduce my stress for the rest of the semester. So, I guess it's time for me to jump in the shower and head to the computer lab.

Hopefully, I will be able to find a computer that works for Kaplan, since apparently only about 1/3 of them work well enough to play the DVD's. Ahh...the wonders of going to school in the caribbean!

The people have spoken...Apple wins!

There are countless reasons to purchase a mac instead of a PC. I could go into them, but I just don't really feel like taking the time right now. However, this graph sums it up nicely. People are far happier with their mac computer than any other brand. Dell and HP (the companies with the largest market share) aren't even close. So, if you're in the market for a new computer, just do yourself a favor and head down to your local Apple Store!

Daily amusement

I went to The Mailbox today to pick up a book that I ordered about a week ago. I knew that it arrived in Miami last Wednesday or Thursday, so definitely would be in St. Maarten by now. When I got to The Mailbox, they told me that I did have mail, and it cost $4.50 to pick up. The following is the conversation that followed (it's worth reading...just stay with me for a minute):

Mailbox lady: Is your name Alan Levitt (she had just seen my real name on the paper)?
Me: No, it's SCOTT Levitt
Mailbox lady: OK, well we only have mail for Alan Levitt
Me: Can I see it?
Mailbox lady: [hands me the mail, one letter says Alan Levitt and is clearly not mine, the other two letters are mine]
Me: Well, these two are obviously mine, the Soap Opera Digest is definitely not, but I also have a package in the back
Mailbox lady: It says the package is for Alan Levitt
Me: I know, but I'm certain that the package is for me. Since some things were clearly mislabeled, can you please check?
Mailbox lady: The package is for Alan Levitt
Me: I understand that it says Alan Levitt on the form that you guys filled out, but can you please just check to make sure
Mailbox lady: [Returns with my package from Amazon, clearly labeled "Scott Levitt" on the shipping address, but "Alan Levitt" marked on the form that they had filled out and taped to it]
Me: Thanks for checking, that's exactly what I was waiting for
Mailbox lady: This says it is for Alan Levitt
Me: No, the slip of paper which you guys filled out says Alan Levitt, but the shipping label says "Scott Levitt," that's definitely my package
Mailbox lady: But our label says Alan Levitt, so it might not be yours
Me: Again, if you look at the shipping label, which was typed and affixed to the box by Amazon, it clearly shows that it's my package. It looks like you guys just made an error when you filled out the slip
Mailbox lady: I don't know, it says Alan Levitt


Fortunately, the owner came over when she heard this going on and quickly corrected the situation. She said that since they have no Alan Levitt in their system, they just put it under my name, which is the closest they could find. Trying to think about what must have been going through Mailbox Lady's head really just gives me a terrible headache. Sometimes, I'm not sure how people remember to breathe.

Bored and excited at once

I am currently sitting in behavioral science. As you may have garnered from my previous posts, I am not a huge fan of this class. In fact, it is my least favorite class of basic sciences. But, I am pretty excited because depending on how fast we get through things, we only have 2 or 3 days left! Equally exciting, tomorrow is our last day of pharm! So, on either Monday or Tuesday, with the exception of the ICM class in the mornings, I'll be done with basic sciences!!!

P.S. - yes, you read that right. Behavioral, possibly the lowest yield class of med school, is running longer than pharm, one of the highest yield classes of med school!

stupid mosquitos!

I have not had to fry a mosquito in my room in a few months, but today, I got two of them! I also noticed my first two mosquito bites that I've had in a long time. I don't know why they went away, or why they're back now, but I'm not happy with their return. I've managed to go nearly 5 semesters without Dengue...I'm gonna be pissed if I get it in the next 2 months!

I do not like vanilla tootsie rolls

They are the exact opposite of what a tootsie roll is supposed to be. They are unnatural. They likely cause cancer. OK, maybe not......but maybe

St. Maarten ER rotation

I had my ER rotation today at the St. Maarten hospital. It wasn't quite as interesting as the OR clinical, but that may owe a lot to the fact that I've spent years in the ER already and not much here was going to surprise me. The ER here consists of 3 rooms plus a cast room. One of the rooms is fairly large (about the size of a typical US code room), but the other two are barely larger than two hospital beds side by side. It's staffed by one doctor, two nurses, and a registration person. If they need any kind of imaging, they call someone in to do it. Apparently they don't see too many really sick people, since the doctor said she probably only intubates once a year.

Speaking of the doctor, she was very friendly and tried to teach as much as she could. There really wasn't very much coming into the ER to teach on today though. I was very impressed to find out that she speaks 6 languages! Unfortunately, this meant that for about half the time, I couldn't understand what she was saying. But, she usually translated it for me later. We also had two parents bring their child in to the ER, who had a seizure while they were on the beach. Turns out, they are on vacation from Maryland! Too bad that he had a seizure less than 24 hours after arriving on the island! My professional med student opinion is that he'll be fine in the morning.

Score one for science!

Below, I have copied the opening sentence of an article today from U.S.News:
"There's no scientific evidence that childhood vaccines such as the measles-mumps-rubella vaccine caused autism in children of parents seeking compensation from a federal fund, a U.S. court ruled Thursday."
If you're interested, here's the article: http://health.usnews.com/articles/health/healthday/2009/02/12/court-says-vaccine-not-the-cause-of-autism.html
If you did not already read my previous related blog post, I would like to remind everyone that numerous studies have shown absolutely no link between vaccines and autism. The much more likely explanation is that you get vaccines around the same time that autism is usually diagnosed. It would appear that parents want a better explanation as to why their children have autism, and this is the [nonsense] link that they have come up with. Hopefully this will end the debate, but I highly doubt that it'll be that easy. Why is it so hard to just accept what numerous large scientific studies show to be fact?

Just in case you live in a barn...

If you look up pictures of St. Maarten, you'll almost certainly come across tons of pictures like this one, with planes flying unnaturally close to the beach. The setup here is basically very small beach, followed by road which can barely be classified as one lane each way, followed by runway fence. When the larger planes that need the whole runway land, they're less than 100 feet above your head! When they take off, they position themselves on the beach side of the runway, about 150 feet from the fence (which stupid people like me stand behind). Here's a picture of an Air France jet coming in, just before I got on the fence to be nearly blown away by the outgoing jets. Aside from the 747 which comes in once a week, this is the biggest jet we get here. After my experience with the smaller USAir jet, I will not be standing behind the Air France or Corsair 747. If you've never seen it, this is what it looks like:

(This photo, and the ones below, are from Cleveland firefighter guy)

Addition:
Here is the Air France jet at the end of the runway, getting ready to go:

Here's what happens when it goes:

Sunglasses blown away by jet engine: Check!

I've been in St. Maarten for about a year and a half now, but until last weekend, I had never stood behind the airline jets on the Maho beach as they prepare to take off. Well, I finally got my chance last weekend, but it was a very expensive experience! The Cleveland firefighter guy, who I spoke of in an earlier blog, came for vacation last week with his wife, and we got the chance to meet up. He had already taken a bunch of pictures of the planes coming in, so I thought it was as good a time as ever to see what all the fuss was about.

The first plane I stood behind was a JetBlue jet, which is really not that big. It made a good deal of wind, but that was about it. The next jet was American Airlines. This one was a lot bigger than JetBlue, but still not enormous. It made a lot more wind and actually kicked a bunch of crap up at me. The final jet though was a USAir plane. I'm not sure what kind of jet it was, but it was pretty damn big! Not as big as the 747 that flies in on sundays, but plenty big enough. I was purposely making sure I didn't turn my head, so I didn't lose my sunglasses. But, I was not prepared for the shit storm that the USAir jet was about to unleash on me. When it brought the engines up to power, they were not screwing around. The jetblast was hot and felt like it was blowing a portion of the runway back at me. Keep in mind, I was standing about 150 feet or so from the jet engine exhaust of a very big plane.

Well, along with having the power to blow the waves crashing onto the beach back into the ocean (and blow half the beach with it), it had the power to life my sunglasses right off my head and send them into the ocean also. They were gone before I could even realize what happened. At this moment, they are likely being worn by some very lucky shark. I looked for them for a minute or two, but it was clear that they were long gone by the time the jet was in the air. Unfortunately, I couldn't really turn my head right away to look for them, due to the small rocks that were being thrown at me.

It was an experience that I'm glad I've had (it's kinda the thing to do here), but I do not know why anyone would be dumb enough to stand behind the 747 when it leaves. I cannot even imagine what those things must kick up at you. Below are two pictures. The first is when I had my sunglasses on. The second is after they had been taken away, and I was trying to shield my eyes from the rocks. The guy next to me (closest to the camera) also had his glasses blown into the ocean, fyi. If you ever choose to experience this, do not wear sunglasses (I'd recommend safety glasses instead).

Yes, people like this really do exist

I wish I could copy the text of this onto the blog, but unfortunately, it's a picture. So, you're just gonna have to follow the link: http://i43.tinypic.com/2cpokyr.jpg. Hope you enjoy it as much as I did!

Trying to stay awake with the people who put you to sleep

Today, I had my first rotation at the St. Maarten hospital. We can choose pretty much whatever we want, so I chose anesthesiology to be sure that I'd see the OR! I had one heck of a time trying to stay awake though! The rotation was actually a lot of fun and very educational, but I am just not used to waking up at 6:30 AM! I've been a little spoiled lately, never having class earlier than 9:30 this semester. I know I'm going to have to adjust to a much earlier schedule for clinicals in a couple months, but I'm just not on that schedule yet, at all!

The first part of the morning was spent learning how to do a spinal block and insert an epidural catheter. Unfortunately, they don't really let you do anything on the hospital rotations here, but it's still interesting to watch. Then, we had about a half hour of downtime before the surgery. So, the anesthesiologist sat down with me and went through a ton of different nerve blocks. He also took me into the OR before surgery to show me the intricacies of the anesthesiology cart. Much to my surprise, they actually have a brand new, very high-tech looking setup in there! The outside of the hospital certainly looks nothing like a US hospital (or at least not any I've been in), but the ORs are modern.

The surgery today in my OR was a hip replacement on a woman who had just fallen and broken the head of her femur. The orthopedic surgeon was a guy from Curacao and seemed very good (although I might not have known otherwise). Even though I was rotating with anesthesiology, I spent most of the time by him and he did a reasonable amount of teaching also. Once the patient was asleep, there really wasn't a whole heck of a lot for anesthesia to show me, until it was time to wake her back up. This rotation definitely helped confirm that I want to be a surgeon. Mostly because I look good in scrubs. In any case, we can now sign up for another rotation if we want and I"m pretty sure I'll be signing up for another day with a surgeon. I just wish surgery didn't start until the early afternoon!

Toppers by the Sea!

Toppers, one of my favorite restaurants on the island, has opened up a new location, Toppers by the Sea! The menu is exactly the same as the original Toppers, but they have breakfast until 11am! I went there with Heather today, and it was delicious! I got grilled snapper and eggs for $14, which I thought was very reasonable. The location, right on the beach around Pelican, can't be beat either. I really don't understand all the noise about Zee-Best having the best breakfast, but I think that they've been handily beaten by Toppers by the Sea. They may not have all the french pastries (which are mostly gone by the time I wake up anyway), but the view is better, it's less crowded, and I thought the actual breakfast was at least as good. They also have fried Oreos, which I'll definitely have to try before I leave the island on April 15th!! If I could pick only one cookie to survive into the future, it would definitely be Oreos; they are as close to cookie perfection as you can get.

Genital exams!!

Depending on who you are, you get to spend 4 semesters of medical school either looking forward to, or dreading the day in 5th semester that you do your genital exams! Personally, I had mixed feelings about them. On the one hand, it's a sign that you're a 5th semester student, doing exams that lower semesters definitely are not allowed to do. On the other (more prominent, in my case) hand, you have to do a genital exam!

My first exam was with a female professional patient (there are three women that fly to the island for the occasion). We have to interview the patient, do a breast exam, and then a genital exam. We learned how to use a speculum and do the exam the morning of the actual exam, and then did it on a real person in the afternoon. The patient we had was actually extremely helpful and showed us exactly what we were supposed to be doing. If we were unsure of something or weren't doing something exactly right, she let us know and then showed us the right way. I hope I don't have to do another pelvic exam for some time, but at least I know how to do one when the time comes, which I have no doubt it will.

The next day, we had our male exam, which was a breast, genital, and rectal / prostate exam. The guy we had for this exam was also very helpful and did a lot of teaching. He showed us exactly what we were supposed to be seeing, put our fingers exactly where they were supposed to be, and again, made me feel comfortable that I could do it again, when I have to. He spent much of the time smiling and making jokes, but he clearly did not enjoy the rectal exam portion, which was by far the shortest. When we got there, he made it clear that we were not to be smiling, laughing, or making jokes. Of course, this was not something I'd want anyone making jokes about either, so serious it was.

Apparently, the guys get about $30 per student to be a professional patient. I'm not sure what the females get. They also get a free vacation out of the deal. Is $30 enough to allow a student access to certain areas of my anatomy? I'd have to say definitely not. But, in the end (no pun intended), it's probably not a terrible gig for some people. The patients seem to really enjoy the job, overall, although they clearly like some parts more than others.

3/4 done pharm, also

Pharm doesn't really bother me, so I guess that's why I didn't mention it yesterday. Turns out, I did very well on that exam, but my grades were approximately equal to the amount of studying I did in each class. I studied enough in pharm to deserve an A, and I got it. Really, passing behavioral was probably more than I deserved. I actually kind of like pharm, which is good because it's one of the more important classes and definitely relevant to clinical practice. I particularly liked the last section on cardio though.

Of all the sections we've had, cardio is the one that most related to my experience as a paramedic (since a good number of our drugs are cardiac drugs). Antibiotics are important for physicians, but paramedics don't give antibiotics. However, in cardiac pharm, there were a ton of times that I found myself saying, "oh, so that's why I did (or didn't) do that!" I also finally realized that when on-line medical control turns paramedics down for drugs, they're not always just being jerks. Sometimes they definitely are, but not always.

3/4 done Behavioral Science!

There is no class that I will be more excited to have finished than behavioral science. It's one of the easier classes (I'd only count it as a half class, as far as difficulty goes), but it's just a really annoying class. I do not like questions with subjective answers! Particularly when the correct answer is something that I would not actually ever say to a patient. For example, I would never encourage a patient to see an "empacho" doctor. In my humble opinion, there are some things that may be both culturally sensitive, but medically dangerous. Steve Jobs is the perfect example of this.

I do not believe in any religion, but I do believe in Apple. In fact, my occasionally blind love of all things Apple could almost be considered religious. So, if Apple were my religion, Steve Jobs would be God. But, even Steve Jobs proved that he is not perfect. When he was diagnosed with pancreatic cancer, he decided that he did not need traditional treatment (surgery, chemo, etc.) and wanted to do things the natural way. Not surprisingly, that did not work too well for him and a few months later, surgery happened. If he would have followed the doctors advice, he could have avoided a couple months worth of cancer growth. If I can keep my patients away from their "empacho doctor," I can probably help them avoid a few extra days or weeks of GI problems. Isn't it kind of the job of a physician to help people avoid pain and sickness?

P.S. - despite my disdain for the class, I still managed to pass ;)