Dream came true.

This post has been a work in progress since match results came out last friday. Be warned it is lengthy!

To spare the suspense... I MATCHED and best of all, I matched at my first choice program!
Beginning July I will be an ObGyn resident :) The week of match results was exhilarating and terrifying all at the same time. I had to read that email over and over again because I could not believe my eyes. I had known how competitive my first choice program had been based on the interview day (20 candidates per spot). I don't think the news has quite sunk in yet although I am knee-deep in paperwork, contract signing, visa arrangements and apartment hunting!!

BUT let's back up to the Match process since I promised to give out my advice as best as I could for those of you getting ready for the 2016 Match.

"The Match"

I won't go through a timeline since that can be found quite easily on the NRMP website. However, there is a timeline that is important to factor in as a 4th year medical student. For ease of reading and not to make this post super long here's my advice and things I have learned from going through the process

4th year - electives:

• great way to showcase your potential and what you have to offer to a program - as well as see how good a fit the program is for you. I always thought of electives as a two-way interview because it is important for you to love the program as well. 
• Try and set up electives in the specialty you will be applying to before the September application day. This is for two reasons: 1) programs want to see a letter of recommendation from a preceptor in their given specialty 2) being in fourth year gives you much more responsibility and offers your letter writer a chance to assess you on a different level than when you were just starting clinical rotations.
• Electives/ sub-interships in your given speciality of interest are important however try and do various other electives in things you may be interested in or have some sort of connection to that specialty. Shows you are well rounded, gives you a chance to learn more and also gives you the option to applying to two specialties if one is more competitive. i.e.. ER, heme/onc and female adolescent psych are ones I did for Ob/Gyn.

application, interviews and rank list:

• Do your research on the programs you would like to apply to. There are several sources you can use. FRIEDA is great; also the dedicated specialty committees (i.e. APGO, AAFP) usually have a list of the accredited programs. 
• Decide what is important to you... location? community vs university? fellowship oriented? class size?. This will help narrow down the programs. However the most important advice I received was "be realistic" apply to all programs that have taken candidates from your school and other caribbean schools. (there's no list of these, you have to search each individual program's website). Don't narrow down your choices even before applying - you can attend the interviews and if the program is truly not for you then do not rank it. I was pleasantly surprised by a lot of the programs that didn't look great online. Also, apply to those "reach" programs - those programs where you would love to go but don't think you have a chance... you never know.
• Start your personal statement NOW! I know it's early but it's a hard one to write and it will keep changing as you go through 4th year. My advice for this one is "make it you", don't worry if it's not what you think they expect; this is what programs have to get to know you aside from your credentials and your volunteer work. Talk about what is important to you, what are your passions? what are your quirky hobbies? Why should they choose you?
• Be ready to submit the application on the day it opens. Have your USMLE Step 2CS and CK scores in before this date. Be sure everything is already uploaded on ERAS prior to that day. Select all the programs you intend to apply to before that day so all you have to do is click submit.
• Letters of Recommendation: 3 per specialty as a minimum. Some programs will not look at your application until those 3 letters are submitted. You may add a 4th along the way (say you did an important elective in August and the letter is not ready in time, once its uploaded you can send it to the desired programs as an extra)
• Be prepared to spend money. Thousands - for the application and the interview travels. You've already invested money in this journey, this is not the time to cut down. Go all in so you only need to go through the match once. (this is for the IMGs mostly - US students tend to apply to 30 or so programs. IMGs apply to 80+ programs per specialty usually). 
• The saying is that IMGs get 1 interview for every 10 or so programs they apply to. 
• A good interview number to have for IMGs is 7-10 from what I've heard. Although there is also a caveat because it really only takes one interview to make a lasting impression - with that said the more interviews I had the more confident I felt about matching.
• I had a total of 12
• Be present on interview day. What I mean with this is be observant, be yourself and ask questions! Questions show interest and also, again, this is a two-way interview. You are trying to also decide if that is the right place for you. Be aware of how the residents interact with each other, with the attending, with the ancillary support staff. Do the staff/nurses/PAs/ medical students look happy? Also pay attention to the other candidates they are interviewing...do you get along with them? would you want to work alongside them? I think the types of candidates they interview also speaks to what a program is looking for.
• This goes without saying but, just in case, prepare for the interview! There are basic questions that can be asked and you should have an idea of how your answer will be... i.e.. Why this program/city/specialty? Tell me a little about yourself? (don't be afraid to repeat things from your application. Sometimes the people interviewing you are not the same ones who looked through applications). How do you respond to stress/conflicts/disagreements?
• Remember that at the interview stage you are now on the same level as any of the other candidates. Your personality, character and the way you interact throughout the day is what is really important. They know you have the credentials, now the program wants to know if they can work with you (are you teachable?).
• Rank the programs according to YOUR preference. Disregard what you think they are ranking you. The algorithm is in favour of the candidate (here is a better explanation). Also rank only the programs that you are willing to train at because it is a binding contract. The caveat to that is to think long and hard before not ranking a program... would you rather not match at all then go train there?

I hope all that helps and answers most of your questions about the process! It is stressful and not going to lie, insane! But completely worth it to see that email in your inbox. 

Dream came true.

On another note since I don't begin residency until July and I am finished with medical school I will be traveling South East Asia for 5 weeks and then a 2 week stint in Ecuador! Cannot wait to roam the world for the next two months.... not that I haven't been doing that for the last 4 years, but this time it will be vacation!

A quick update!

First off, thank you so much for keeping connected!! I'm sorry I haven't posted in a while (everything is going great!) but I have tried to keep up with answering your comments and questions.

I stopped posting due to the interview/ match season that started in September. Interviews have recently wrapped for me and am currently teasing out the last of my rank order list. Then the waiting begins... which will be the hardest part I think.

For those of you unfamiliar with the process of a medical student obtaining a residency, here is the simplified version:

- finish four years of medical school
- apply to your desired specialty
- Sept-Feb: interview across the country (expenses are mostly out of pocket)
- Feb: create a list of the programs you interviewed at by preference of where you would like to train
- Match Week: basically a match up between the hospitals and the candidates (both form lists of who they would like) and the computerized algorithm "matches" you up. We find out if & where we are placed the week of March 16!

I promise to reflect on the entire process and give as much advice as possible once that Match Week is over.
Until then please feel free to post questions and other comments as I have been checking back regularly

sincerely,
IDL

PS. I have officially finished medical school rotations! Feels great to have hit such a milestone, but I think it will all sink in once I get that email in March. For now, I have decided to stick around Louisiana (where I finished my last two electives) to enjoy the culture and festivals of Mardi Gras before making the long road trip home for the last time!

Senior Status

The moving has begun, again! If it was not yet apparent, as a caribbean med student we do not have a 'home' hospital like the students that attend an american school in the US. Thus all our clerkship rotations are at school affiliated hospitals found throughout the states - mostly the east coast, the south and some central states such as Georgia, where I am currently residing for a month. The third year core clerkship rotations, those that are required by every medical school to be completed, can usually be done in one if not two places so the student can decide if and how much they would like to travel. I went between Florida and Maryland if you recall. Talking to other caribbean students this has been a common path.

The 4th year is completely different.

It is the year when you try and narrow down your interests if you have not picked a specialty already. These clerkships are called elective rotations and each individual is responsible to make up their own schedule based on their interests. For us, that usually means we move around to different hospitals depending on what they offer, their availability and scheduling... I will not get into the stress of making up that said schedule because that's besides the point. Yet, I will say that it is not an easy feat!

I will say that I finally have my 4th year scheduled!
Since my last post I have finished two one month electives, one in Michigan and one in Baltimore, MD. I am currently in Atlanta, GA doing a family medicine elective and will be heading off to New York for two months and then Louisiana for the last two months of my medical school clerkships. It seems I have so little left before I get to have that status as an MD. Looking back I can see how the process has shaped who I have become as a senior medical student. Last month I went back to Harbor hospital, where I completed the required 3 month Internal Medicine rotation last year. I worked with a Hospitalist doctor as a senior student. During my stay a new group students started their third year - including some friendly faces from Saba! I have to admit that I noticed a significant difference. By which I mean that there was a comfort level of navigating around the hospital, approaching patients, speaking up during rounds etc. For me, there was an evident difference in the level of knowledge between myself and the starting third years... Now! Let me explain myself before you jump to any conclusions. What I mean is this: I now realized how much information I have absorbed in the past year (and of course, there is a ton I still have yet to learn). It is really astounding to see the difference in which I approach certain problems, diagnoses and questions thrown at me. I find myself not overwhelmed like I first felt in third year. The knowledge seems to have become a second nature sort-of response. Anyways, ignoring my ramblings, what I mean to say is that I have surprised myself at how far I have come in just one year. The process is gruelling and pushes you to your limits but it really does work! I have no doubt those third year students will go through the same realization when they reach 4th year.

Where am I now?
Applications to residency programs are a month away! Yes, you read that correctly. One month. If you have been following my journey from the beginning, can you believe it's been 4 years?!
All the required board tests have been taken - and passed!! I am now finalizing the programs I am applying to, which has become a very time consuming task, albeit important. The personal statement is written; but it may be re-written over and over again in the next month. As a blogger and a person who enjoys writing, the personal statement has been something so difficult to be 100% pleased with because it forces me to summarize my passions, goals and direction in life in just one page. One page?! I am almost tempted to write one line: "Dear Program Director, please read my blog".

In any case, the end is in sight! Although it won't be smooth sailing until next March (when we find out to which program we matched) I can say I will try to make the most out of my travels and experiences.

Here are some pictures of Atlanta so far. Never did I expect it to be such an 'artsy' place!

Now time to go explore more of Atlanta.

sincerely,
IDL

Rewards and Frustrations

I've been thinking about my reflection on the psychiatry elective I finished over 2 months ago for a while now. In my last post I was just about to start it ...For 3 weeks I worked in the adolescent female inpatient unit and it was definitely an unexpected experience. I went there with the thought that it will be a nice break from the rigorous clerkship rotations I have been through and a nice transition from studying at home to my current trauma surgery rotation in Florida.
I was wrong and realized something about myself in the process.

I enjoyed my 6 week rotation last year which is why I decided to come back and work in another unit. Adolescent girls I thought would be a great fit - I can relate and it will help in my long term goal to work and advocate for women's health. I fit into the treatment team right away. The social workers, unit staff and my supervising attending all cared for their work and put in long hours. There was no real structure for me to follow which is great because it let me explore working with different people on the unit - from social workers holding family meetings to art and musical therapists. It was really up to me how much I wanted to invest. As I've said before, I learn best by experiencing, so I got involved as much as possible. I started getting to know the girls, their histories, their personalities, how they interact, their families … it was interesting in terms of psychiatry and applying the things we learn in books to real life situations… but also heart breaking to read about their life experiences at just 12 years old. By my second week, the attending doctor encouraged me to take time and talk to some of the girls one-on-one. I did.

I was taught how important 'active listening' is as a skill. We were told about it in my 4th semester on Saba but not until now do I really understand what our prof was trying to tell us. Daily one-on-one sessions with some of the girls were amazing. They began sharing and opening up about their past; stories that weren't even in their social work reports. I was so happy to be able to have an honest discussion … to hear them out, never judging, that's really what they were looking for...but emotionally it was hard. Very hard. The movies about street kids from broken families surrounded by drugs, abuse and prostitution; girls being bullied because of their appearance to the point of harming themselves - unfortunately they are true. These girls have experienced life's hardships at such a young age that they grew up. Fast. What did surprise me was their strength, and resilience - two things that were not obvious when I participated in the group sessions. Most of the girls seemed so different talking to me than in the group. I learnt about their dreams and aspirations and then, in a split second, heard them shutting down those ideas because "it's not possible". That was difficult to swallow. As a person, I am an optimist (if you haven't figured that out yet!); so I asked "why?, why can't you?". their answer was even harder to understand, but it was the truth… "I have no support." " No one cares."  "I have to take care of my siblings."  "I have to provide for my family." Now, I am generalizing as not all the girls were in the same situations… but these were some of the answers I did hear.

I realized how important a nurturing, supportive environment is as a child. Having a family that cares enough to ask about getting homework done, to insert those (sometimes annoying) reminders to clean.. we've experienced them, and they come from our loved ones. But that is support; support that most of these girls were missing.

This elective made my final decision to not apply to psychiatry. NOT because I didn't like it. It's actually the complete opposite. I had the hardest time separating my emotions from acting as their doctor. We are taught about professionalism in the oath we take. As doctors, we are not a patient's friend and I completely understand that. In all my other rotations it is a clear line. In psychiatry, it became very blurred for me. I emotionally invested in my one-on-one sessions. Came up with ideas and ways to talk about difficult topics… and they worked. Great! But I went home and took their stories to heart. I could not separate the medicine from myself. At the end of my rotation, the attending pulled me aside and said I would become a great psychiatrist one day.
I'm sure, in time, I'd learn how to draw that line but I don't want to go through 2, 3 or 4 years bearing all that emotional turmoil with me when I get home. This may sound selfish but I think its the best thing for my own health and my ability to treat my patients.
As medical students we've either said it or heard it: psychiatry is not 'real' medicine. There are never clear cut answers; everything meshes together to provide an emotional response. And, as students, we all have that one thing which we cannot deal with in medicine - whether it be skin rashes, broken bones, surgery or delivering babies. For me, mental health is where it becomes the hardest. I can stand in the OR for 6 hours. I can deal with stabilizing a trauma patient after they got shot. I can stay up for 30+ hours without coffee. I can look at an open abdomen and see the medical complexity and not the patient. Yet, talking to someone through their emotional turmoil, hearing about their past, yes, I can do it. Yes, I can be good at it. Yes, it's very natural for me to just listen. But it's been one of the hardest things for me to go through.

Hats off to anyone who works in the mental health system, I now partially understand the hardships you experience.

Part of a letter I received from one of the girls on my last day of the elective. It's in a safe place to always remind me of my experience and how much they taught me.  

PS. the video is a spoken word poem by Sarah Kay. I found it a great way to reach out and discuss those difficult topics. Needless to say I learnt a lot more amazing poetry slams from the girls… they were very familiar with it!

Back to the start, yet moving forward.

As I sit in yet another airport awaiting my connecting flight, I'm embarrassed to see I've only posted 7 times this year... but I will stop with the apologies and just accept it. I hope to continue my sporadic posts (and replies to comments) as I start yet another journey.

The Pediatric rotation finished! Looking back, long hours were spent with adorable, but screaming children.
After this rotation I really felt that my history taking skills have improved. Seeing 50+ patients per day gave me an opportunity to fine tune the questions I posed to parents and the patients (a technique that I'm sure I will be forever perfecting). I realized that it is such a fundamental part of any exam as it can drastically alter an assessment and treatment plan. Patients and parents tend to forget/ not divulge details if they do not think them significant and as a medical student we have the privilege to spend a fair amount of time questioning patients before the doctor sees them. The questions you ask and the flow of the interview not only sets the atmosphere of the appointment (especially in pediatrics) but it also shows the supervising doctor your train of thought. Each question should be directed in such a way that it either 'rules in' or 'rules out' a diagnosis on your continually forming mental differential diagnosis list.... and trust me that list is a long one when the answer to "what brings you in today?" is "my child has been coughing".
So, with that said, I do love kids; I like observing their different personalities and how they surface at such a young age. I like making them laugh and feel comfortable in the doctor's office. I am grateful for the opportunity to have had such a large amount of time interacting with patients during the peds rotation but my heart is with the field of obstetrics and gynecology :) ... and will make sure to enjoy the simple fact that my patients will be able to express their pain and describe it!

Being home meant I got to spend time with this "little" guy. :)

For the past 5 weeks I took a much needed 'break'. And the word break is in quotes because it consisted of being home and studying for the canadian equivalency exam as well as working on 4th year elective applications.
I was definitely burned out when I got home. Sleep, eating and doing nothing all day had never felt better... every now and then we all need a lazy, lounging day ( or week) spent in the confines of our home ...  Although, as I sit here waiting my plane, I am excited to be returning to my role as a medical student. I guess I missed having a structured day. I really shouldn't be surprised; I am the type of person that will choose white water rafting and camping as my vacation rather than an all-inclusive resort.

Friends supporting friends. Being in medical school doesn't mean your hobbies are put on hold. 

the never ending swarm of runners was such an amazing view.

mile 11.

I also went to support a friend running the NYC Marathon (I hope to write a short post on that alone) but I do want to encourage all of you to attend a big city marathon if you ever have the chance. It truly is an inspiring atmosphere!

So what's next?

I'm going back to the start! That is I will be returning to Sheppard Pratt for a 3 week clerkship in female adolescent psychiatry before returning to Florida for 3 months of Trauma Surgery to complete my third year.
I'm excited to return to Pratt as I will be going back changed; a more experienced medical student. With Ob/Gyn in mind, the female adolescent psych elective will be a nice complement. During my core Ob/Gyn clerkship we dealt with a surprising number of pregnancy complications related to drug addictions and mental health. I will try to keep you posted.

To end this overdue and long update I'm also happy to share I will be partaking in the Color Run in support of Global Citizen. Click on the links to find out more about them and see when they will be hosting an event near you :) It's a fun and interactive way to get everyone involved and spread awareness.


PS. Personal goal of running a marathon has been set... and now it is public which means I have to do it

On to the next one...

I wrote my last post almost a month ago - I can't seem to keep up with the blogging.

Third year seems to be becoming a blur.

As much as it is exciting to be in the hospital, you rotate through each specialty so quickly.  As I am getting comfortable and familiar with my surroundings, the rotation is over and I am thrown into another. Sometimes it seems I just need to keep my head above water long enough for my next day off to come. Working 6 days a week since February with a total of 3 weekends off has taken a toll. Might I add that the "day off" is spent guiltily sleeping in and then franticly studying for the next exam.
Needless, to say it can/has been frustrating and exhausting to feel lost most of the time - while trying to keep an external calm and having the classic "medical student enthusiasm".

I have already finished my first week of paediatrics.
Here is peds in a nut shell: adorably cute kids that are ALWAYS screaming/ crying and come in with full blown colds that get you sick (and give you headaches!). Lessons learned so far? new found respect for parenting!
... but I'd rather tell you about the last little while in florida.

I finished 6 weeks of Obstetrics and Gynaecology (Ob/Gyn) and LOVED it. I think I may have found my specialty. The rotation was mostly an inpatient experience as I only spent 2 days in the outpatient clinic, however it was my choice as I wanted to get as much hands on learning as I could. I became a sponge for wanting to learn too much in very little time. I couldn't help myself, I took two 26 hour calls that were voluntary and worked 12+ hours/day. I may have over-indulged! But I had great attendings teach and trust me to perform procedures on patients. To give you a little glimpse... I learned to actually deliver babies with my own two hands (what an incredible experience! To hold someone in their first moments of life and be part of that new family), I was taught how to close fascia and skin, admit patients on my own, read and interpret fetal and maternal monitoring strips, make first incisions, drain cysts and scrubbed in/assist on numerous surgical cases.... the list can keep going but I'm afraid I will start using too much medical lingo ... then I would lose my readers for sure.

If you can't tell that I am excited then here is a picture to prove it. This was taken on one of my last days working with a doctor that I have grown to look up to (she truly invested her time in teaching and showing me everything she could). This was taken after she had let me close fascia and skin after a c-section and perform a quick surgical procedure called marsupialization on my own (with her guidance of course!). Such a rush.

I found ob/gyn to be the perfect combination of primary care in which you can develop a relationship with your patients, hands-on work that is not too time demanding in the OR (most procedures are < 2 hours) and a specialty which I can take the skills I learn and contribute elsewhere, where maternal health resources are needed. This specialty would allow me to continue pursuing my interest in international health (and even link my undergrad genetics studies). There are so many (too many?) possibilities.

Hollywood beach boardwalk

Other than rotations I have not had much time to explore Florida, unfortunately. But I hope to do so in the coming weeks... I am however a 5 min drive to the beach and boardwalk which has become my new running route as soon as I get used to the humidity here - you'd think I would be used to it from Saba, no?

mom and I at the beach after our 17 hour road trip!
Obviously this is the first place we would go to :)

Dinner with friends before they left for their next rotation.

My new favourite study spot.
Poolside studying can work...sometimes

One thing I find is hard to get used to is all the moving around. As much as it is exciting and amazing to have all this opportunity to travel and temporarily live in places I would never think of going, my friends and I have Skype friendships now. Sometimes we even Skype if we are in the same city doing different rotations. Everyone has such a different (and hectic) schedule that it is hard to find to maintain those friendships in person... unless we meet up for study sessions!
I look at all this moving around as travel opportunities and times of adventure... but sometimes, just sometimes, I feel like a lot of people my age are starting their life. "settling down" so to speak which seems like a comforting idea. Being away from close friends and family can be isolating. Moving from place to place with no real 'home' can also be isolating. Always studying can become lonely.

Just some thoughts.

To end off on a more positive (and super cool!) note, here is something I found today :)

If you want to follow his adventure here is the link to his blog: http://www.hankboughtabus.com

"The" one.

Choosing a specialty is like finding the one person you want to spend the rest of your life with...at least I consider it with as much importance. It will dictate your career, lifestyle and opportunities. It will send your life in a certain direction ... surgery versus family medicine will make a difference. It is not just about deciding whether to be a doctor because that was an easy decision, it is now time to really define the rest of my life.

Like I have mentioned before, the follow up question I always get to "what do you do?" is "what kind of doctor do you want to become?"

As  I have always had a passion for surgery, I have been going back and forth on it being my top choice because I am also trying to consider the lifestyle I want to lead further down the road, thatis, one of balance (traveling, keeping active, research, family etc.) Should I choose something I am truly passionate about or a path that would guarantee me more free time away from the hospital? Is there a way to do both?

In the last few days I've had the opportunity to scrub in on a short surgical procedure for one of the patients I was following on the internal medicine floor. I am enjoying the internal medicine rotation, however in the past month and a half I have spent in it I have to confess that I have never been so excited to come back to the hospital (after a full 12 hour shift, mind you) to scrub in for that procedure! It was exhilarating and inspiring...I got those butterflies in my stomach and I couldn't wipe the smile off of my face, even if it was after an 18 hour day. It made me think why not do both? Why can't it be both? I have worked hard at becoming a doctor thus far and chose to take this path with no reservations - which does come with sacrifices - so should I settle for something I would like or something I would love? I figure if I am loving what I do, I can (eventually) take charge and make time for how I want to live my life as well... it might take a while before I am able to reach that point in my career but wouldn't it be worth it?
I don't yet have the answer yet but I thought I would share my thoughts and would love to hear some feedback from you!

the new life: psychiatry in a NUTshell, IM and this new thing called a social life :)

Much has happened since the last time I wrote. I finished my review paper, got it approved, received some of my clinical rotation schedule, already finished the psychiatry rotation at Sheppard Pratt and am 2 weeks into the internal medicine rotation at Harbor hospital.

So let's start with psychiatry!

Sheppard Pratt Psychiatric Hospital

6 weeks at Sheppard Pratt psychiatric hospital flew by. It was overwhelming at first - as you can imagine we had information overload...hospital protocols, new schedule, new patients, learning not to get lost in the hospital (trust me, the last one was harder than you think!). Being in a hospital with real patients is completely different than just reading about suicidal behaviour. It was very surreal in the first week when you sit with a patient and ask about suicidal thoughts, homicidal thoughts and severe depression. I was surprised at how comfortable patients were discussing such personal issues. Overall I actually enjoyed psychiatry more than I had thought. I really liked getting to know patients, their stories and by that I mean not just their 'medical history'. Psychiatry is one of the few specialties which really relies on knowing the full picture; social aspects of a patients life is just as important as their medical symptoms of depression. Assessing and managing a patient includes psycho-social evaluations. I loved sitting down with the treatment nurse, the social worker and the psychiatrist to check-in on patients daily. Once the patient would leave everyone would say their impression of the story we had just heard, we'd call a patients family to get another perspective and include both their and the patient's request on how to manage them. Are they safe to be out in the real world? that was the golden question, the one that decided if they needed to stay in the inpatient program or can continue as outpatient treatment. The down sides to psychiatry? there was no practicing of hands-on medicine and I feel like I would miss that. Most of the management of a patient was medications and therapy... the therapy portion I liked, the medication monitoring not so much. The pros of psychiatry was definitely the amazing schedule and lifestyle it allows. It is a specialty in which you can choose to do research in your free time and that is something I will be pursuing no matter what field I end up going into.

My friend from Saba and I looking all professional
on our first day of internal medicine 

Suffice to say I liked the rotation and will most likely going back in november to do an elective in adolescent/child psychiatry :)

Internal medicine is a totally different basket of eggs! I have only started 2 weeks ago and I find myself going to take a history of present illness report from the patient and asking them more questions about their social situation than I probably should. Although it is important, IM deals with emergent cases at times (especially [and obviously!] when we are doing admissions from the emergency department!). I need to stop thinking like a psychiatrist!! haha. So far I am in the overwhelming stage of IM... long hours (12 hr shifts are the norm and we have night call as well as long call 7am-9pm. Oh, did I mention we work 6 of the 7 days a week?). So yes, still adjusting to the schedule and the early start time! But all in all I like the patient interaction and the fact that we get to use our physical exam skills everyday. Something about hearing the patient talk about their symptoms and then confirming it with palpation or auscultation is very thrilling! :)

6:30am sunrise from the Harbor hospital parking lot.

As far as I am in my clinical rotations I can say one thing for sure: people are truly sick. I know this is such a general statement but when you read about stage III kidney failure, or about pancreatitis, or about anaphylactic shock it doest not sink in until YOU see it. I am starting to link all my book knowledge with the corresponding patient and it is a great way to build information. I find that I am learning so much more, so much faster than at Saba!

Oh and for those of you reading this and are preparing to start rotations, get ready to feel like you do not know anything all over again! We are once again merely medical students trying to stay afloat and catch our breath... its going to be a great ride.

A Good Start :)

The holiday season wraps up and 2013 begins...

Oh how I have missed spending time with family and being able to fully relax. I wrote the USMLE Step 1 a month ago, received my mark last week ( I PASSED :) ) and then proceeded to sleep 16 hours straight! I didn't realize how anxious and stressed I was until I had finally got the much anticipated email. The studying paid off and I am happy to have started 2013 on such a good note! 

I am currently working on a research paper (one of Saba's new requirements before starting clinical rotations) - the only thing standing in the way of me being in the hospital.

Being home is great, seeing family was wonderful but I noticed everyone has the same question for me "what type of doctor do you want to be?". Such a hard question to answer. If you asked me this 2 years ago I would've said one of two things: Surgeon or ophthalmologist. It was an easy answer. Now? not so much. Ophthalmology is ridiculously competitive, and I'm trying to be realistic. Surgery still sounds appealing - except for those dreaded hours and the fact that I would be spending the rest of my life in the hospital. The one thing I realized about myself in the last two years living on Saba was that I love to live a balanced life. I love to be outdoors, to hike, to go diving, to enjoy a nice meal. I love to always be active. I was never happy when I had to study 24/7 and never leave my house. Of course, there is always a trade off and there are times where you need to do it. I was alway more productive after a workout. So to sum up my ramblings... I don't know if the surgery lifestyle would fit with what I know makes me happy. I'm still going to keep an open mind to surgery because I think I will still like it but I think I will also be interested in Obsetrics/gynecology and paediatrics. 

My friend found a medical specialty aptitude test from Virginia School of Medicine (click here to try it).  It's based off of 130 questions relating to your personality. Below are my top 20 ... I think there was something wrong with the 1st choice. Radiology? me? No thanks, I like being around people. Other than that the choices were interesting :)

Hope everyone had a great christmas and new year celebration! Good luck to those going back/starting Saba! Looking forward to being an active blogger once again with the upcoming excitement of clinical rotations.

Rumors

I haven't been back online in a while because of studying for Step 1 but I do continue to follow the activity on the blog as best as I can. Unfortunately, recent comments on this blog seem to be focused more on Saba's credibility rather than responses to my journey. This has led me to make the decision to monitor comments. I've been trying to let this space be an open forum and not delete any comments received however, this blog is supposed to be about sharing my experiences on going to medical school in the caribbean and hopefully help those who are in the same predicament I was two years ago. I do not want to be spending my time debating which rumors are true or how good of a school Saba really is.
I have decided that I will be deleting any comments regarding the credibility of Saba University or of any rumors going around... Everyone has their own opinion and experience. Sometimes a caribbean medical school is the only option you have left. And if that is the only way to do what you have dreamt of doing all your life, then that is the road you will have to take.

So, please, for any discussions on credibility, rumors, attrition rates etc go to medical school forums like valuemd.

I will still be happily answering questions about Saba, if they are appropriate. I'm sorry that it has come to this but I hope those of you who have been following my adventure continue to do so.

To end on a more positive note, here is a little inspiration for the rest of the week...

Conversations with myself.

How do you keep studying when all you have been doing for the past month is study 14hrs a day?

I find that by the time I get home I am exhausted. Drained of energy; my brain forgets the simplest things. I know it is time for a break. But how do I take a break without feeling guilty? without staring at the clock, without realizing I could have just read another 5 pages in the last 20 minutes I spent eating and catching up with the world around me. It becomes a viscous cycle. I want to study. No, I need to study. I must reach my goal. What happens if I don't? Have I failed? failed what? myself? I am not sure.  I know putting this much pressure isn't healthy. After-all it's JUST a test, but then I am reminded by my subconscious: it's THE test. If I don't get the score I want on the test would all my sacrifices count for nothing? All the energy spent, money consumed, shutting out my friends (and sometimes my family - I am sorry.)... All this for what?

A dream.
Is it worth it? ...Yes. It will be.

-----------------

I felt like sharing this self-battle as I hope I am not the only one whose felt so strongly about something, someone, a dream....or anything. It's not supposed to be a pessimistic post, just a glimpse of reality.


PS. Thank you to everyone who has been endlessly supporting me with this crazy dream without questioning it - especially my family.

Change

a little change in scenery on my new running route; at least the sunsets are still beautiful... although I don't know how I feel about running in the colder weather. I already miss not having to worry about what to wear when I go outside. The caribbean weather was always predictable: 30 degrees, sunny with scattered showers.

In other news my intense study schedule seems to be getting the best of me. It's been hard to be so focused all day, all the time - especially when I'm trying to fight off this cold that seems to be going around. Wish I could just take a day off to recuperate, read and not think/ feel guilty about not studying. Alright, I think I'm done venting, for now.  Ugh, back to work...

PS. Grey's Anatomy is back tonight. I'm a little excited even though I know thats not what real world 'doctor life' is like. At least I can make myself think that I am being somewhat productive since the show is about medicine; I'm sure I can learn something useful from it.

A little studying pick me up :)

Great song on a thursday evening! From one friend's blog to another...

Can't take credit for it, but its awesome. Hope you enjoy it too

If you like this, check out my friend's blog for more - she's just amazing when it comes to finding new music... I may be a little bit biased :)

Goodbye Saba, hello Step 1.

I haven't posted in a while. The last month has been a whirl wind. We studied like crazy for the final comprehensive exam, wrote it AND, most importantly, passed it!!!! I have officially graduated from the basic sciences program :)

Currently sitting in St. Maarten airport one last time awaiting my flight home. I have spent the last week on St. Maarten as a mini-vacation with my parents who came to visit Saba and attend my graduation. I am ready to go home... Even though I am typing this I don't think I have realized that I will not be returning to Saba. I have gotten so used to leaving the island, going home, and coming back. This time, there's no coming back. weird. Leaving Saba was bittersweet mostly because I will not be seeing some of my close friends for a while - being hopeful to  bump into them during the clinical rotations. The island is beautiful but it was time to move on.

__________________________

Aaannd that was proof that I attempted to post like 3 weeks ago.
I now have finished my vacation, moved to Hamilton and began studying for the USMLE step 1 for the next 2 months.

the fun begins.

long days of hours of studying once again... just the library and weather has changed. Not sure I like the weather change but I sure like the library! we are even allowed to have coffee and non-smelly food at our desk - makes studying so much easier when you have caffeine and sugar by your side. Oh and of course some healthy snacks...kinda. By the way, did you know there is now caffeinated chocolate bars to help you stay awake? Best of both worlds.

My study schedule is a little bit insane. I realized today that I will need to tweak it and add some nights off because I am already tired. I will definitely burn out if I study 12+ hours a day.

for those of you interested how I am studying here is a quick breakdown of my day...
7am - run (the reason why I am excited to wake up; I found a nice trail in hamilton :) )
9am - arrive at library
10am - finish 46 set of Uworld questions
10-7 - Doctors in Training course or pathoma. Lunch is somewhere in here...
7-8 - go home, make dinner, eat
8 - review the material covered that day
10-12 - review answers to question set from that morning.

sleep. wake up. repeat.
I am hoping to write by early November so keep your fingers crossed it all works out! ( I would also love to hear from those readers who have taken the Step 1. Any advice? how did you study?)

apologies for falling off the face of blogworld. I am back and have promised myself to post weekly - or at least not at 2 month intervals.

PS. September is childhood cancer awareness month. Dr. David made a great quick post - see it here and make sure you watch the video!

Last!

today is the start of the end.

the last weekend I will be studying for block exams!
the countdown until the final exit comprehensive exam has begun.
34 days!! how's that for an update?

We are officially done learning new material in a classroom. I can't believe that I am finally in the spot where I can say that :).  It's so exciting (and a bunch of other mixed feelings - but I am only focusing on the excitement). I cannot wait until monday after exams!!

so here we go, one last time. studying for block exams....

Just add water.

Saba definitely has its own unique living experiences. Some of my friends deal with flying cockroaches and some of them with small gecko lizards in their clothes' drawer (happened to a close friend... put on PJ pants without knowing, sat down and felt something crawling on her leg. I think you can imagine the rest of the story). I am having to learn how to live without water for days at a time. The water system on Saba is based on electrical pumps, and mine has a tendency of breaking ( + the 'nearby' construction is affecting the cistern under our house).

(...and by 'nearby' I mean right outside my front door.)

I am a pretty easy going person. When I volunteered in Honduras for 3 months we took bucket showers every day and lived with the bare essentials - it was completely doable, and makes you appreciate the things you have at home a little more. I think having that experience in Honduras is really helping me cope with the water situation here; especially because it happens more than once a semester. When you combine a stressed out, hard working medical student who looks forward to going home to shower to feel refreshed after a 12hour day of studying in the caribbean SUMMER (it's 30+ degrees here everyday) with the lack of water  =   :(

It happened again this weekend. And as I was sitting in my living room/dining/kitchen area and surfing the web as a study break, one of the sites I check regulary is MSF. There it was, front headline: a story about the hardships of fleeing, finding food, getting health care and seeking shelter in the Eastern DRC...

© Emily Lynch/MSF

"I left my village with my family at the beginning of the fighting. On Wednesday, having no food, I returned with some friends to my field to harvest vegetables. We heard weapons fire, and during the shooting  a bullet lodged in my left arm. I returned with my friends who were not wounded to the village where they made a stretcher out of branches to carry me to the main road where we then able to find a motorcycle to the next town. We waited until the next day to come to the hospital because we did not want to travel at night."

- Man (28) with 3 children, North Kivu, May 2012 

read the rest of the story here.

... and there I was complaining about lack of water. It's funny how everything was put into perspective. We take water for granted and forget it is a bare necessity. 

When I came home from my volunteer work in Honduras I had a hard time adjusting back into the 'modern' society I was previously accustomed to; I became more aware/ careful of everything around me. 

Not sure where I wanted to go with this post... but I guess it is about raising awareness. Stop and think. It's unbelievable that such simple hardships still exist in 2012 - even on an island like Saba.

how do I...

How do I get out of my mind? over-thinking, over-doubting...

I've been saving to write a post until after our first block of exams were over. I've been back at school for 3 weeks and it's gone by incredibly fast.  The final semester. Let me repeat that, I'm in the final semester of basic sciences. I honestly still can't believe it. It doesn't feel any different from the other semesters... new classroom with some new professors and a longer class schedule but its still the same: school, home, study, sleep. Not much changed, but everyone came back with their "A game". My whole class is working like never before. Besides having 2 full courses we are also taking the Kaplan course for 2 hours per day to prepare for the big Step 1 exam. Needless to say it's  A LOT of material to keep up with.

I'm not going to lie and say that I wasn't nervous for this set of exams. It's the last semester which brings on even more pressure to do well and obviously pass the exit comprehensive exam in August. I've been more motivated to study and found myself focused all the time. Deep down there was this question of can I do it? I got to this point but can I actually pass? be a doctor?

How do I get rid of these doubts? When will I start believing I can do this?

I think I will always have this doubt. But it pushes me to work harder, so maybe it's a good thing? Not sure if I am the only one feeling like this, nevertheless it worked :) I got a great start to semester 5 and it looks like I won't be going anywhere but home in August (if I keep it up).

comments are more than welcome. Have you ever experienced something like this?

PS. looking forward to some down time this weekend... possibly going snorkelling :)

footsteps & a beating heart.

"Burnt out"

These are words well known in the vocabulary of Saba students. It usually happens after the 3rd set of exams. Your body starts shutting down; your brain is not switched on anymore. You are in a daze all the time, just staring at the professor with that dumbfounded look. All you want to do is sleep. All you can think of is sleep. Sleep.

Instead of sleeping after these past exams I pushed myself to go for a run. I was so tired coming out of the exam centre but I knew I felt too jittery to sleep. Residual agitation and stress kept my body wired. As tired as I was, I couldn't sleep. Does that even make sense? Too tired to sleep? Is that even possible?
So I told myself that a short run will help me clear my mind, make me physically tired and allow "the crash". It was bound to happen. Crashing (aka very long naps and blankly watching tv shows) had to happen for me to be able to go to class the next day. I didn't even take my ipod on my run since it was going to be short...

I started running my usual route. Went up the massive hill, took a few minutes to take in the view of the sunset over the water. It was so quite; nothing around. All you could hear were the leaves blowing in a soft wind with that fresh water smell - you know, that smell you get in the spring when everything is in bloom after a long winter? it was THAT kind of fresh smell. Invigorating. I headed  back down the hill  at a steady speed, reached the last hill before entering back into the village of 'the bottom' and going home...and I find myself turning around and going back up the hill. My mind was clear and all my body wanted to do was run. No music, just me, my footsteps and heart beat. It was then I remember why I loved running so much. (I haven't stopped running, but it definitely has been cut out of my schedule much more than I wanted to... sacrifices for studying were needed). I ended up running double my usual distance. I didn't even know I had it in me (probably around 5km... with hills it seems much longer).  That last hill was in sight for the second time I felt like I could do another lap but decided I should stop - I hadn't had much to eat and after 3 exams I knew I must be exhausted. As I got home and took a nap I kept wondering what had kept me going for such a long distance... all I could come up with was stress. Running was my outlet, letting go of all the anxiety of exams: did I study enough? did I study the right way? will I do well? All these questions rush through your head as you enter that exam centre. There's no way of stopping the flood of nerves through your body.


Running is my outlet, what is yours?

How badly do you want to succeed?

I know I haven't been keeping up with my blogging for a while but studying pathology is taking over all my time! Thought it'd be nice to post this motivational video... his speech has kept me going during a couple of long nights of studying. Guess what? it's better than caffeine. So watch it till the end - its worth it.

Maybe it will help someone else too :)

Okay, back to another long weekend of studying for tuesday's exams. Can't believe we are already on block 3. Time is flying by this semester... next thing I know I will be coming back to Saba for the last time to finish 5th semester. Weird.

Block weekend once again...

I don't have much time tonight but I thought I'd share some pictures of Kim (my physical diagnosis partner) and I, smiling happily, after doing very well on our second clinical skill assessment exams (CSAs)!  This semester we get to 'play doctor' and learn some basic examination skills on actual people :) 

By far my favourite class.

Alright back to studying... long weekend ahead. wish me luck on tuesday!