Post Script and New Beginning's Part I

Ok. I know. Don't say it. Really, I know, and I'm sorry. I really wanted to keep up with this blog but life got so insane. Every free moment I could have used was used for something more important: a mindless activity to retain my sanity. That is until now actually. Now I have quite a bit of time on my hands, sort of. You're probably thinking "How do you have any time on your hands, you're a medical student!" Technically I'm on a leave of absence, really I'm not actually, but it's my brilliant school's fault and technically I'd think 3/4 of my class are on the same LOA if not more. This probably requires a bit of explanation. Lets go back, way back. We left off in 4th term I believe.

So 4th term ended with a fizzle academically. The second set of three exams in Path had a 61 class average. The lowest in our schools history. The department blamed us for being poor test takers. To that I say, well, I better not say it as it is quite offensive but you get the point. The first exam the class average was in the 80's. This means everyone must have taken a stupid pill the day of the second exam or the department messed up. They to this day maintain it was a fair exam. I never saw so many students cry during a fair exam though. This led to an uproar, lots of anxiety, lots of classmates dropping the class and being left behind, and shattered the image of the school has a helpful and loving entity to the few students who still had that in their minds. I didn't but I was still left shocked at the sheer audacity the department heads had when they would speak to the class about it's shortcomings. The third exam, here's where the fizzle comes in, was so easy in comparison that it was like the difference between a calculus exam and someone handing me a coloring book and saying go nuts. However the ragged few left at this point were so beaten down, exhausted, and out of fuel, me included, that A's as a class average did not happen but it was still pretty high from what I hear. I guess we stopped taking those stupid pills.

The feeling of relief that washed over me after this exam is indescribable. The minute I walked out suddenly colors were brighter, the air smelled sweeter, and it felt like my body suddenly was lighter and less strained. It was a good feeling. After this when all the exams were over and it was finally after 6 long months time to go home, we all drank like it was our last day to live and then got on our respective planes. There were a few gaps, people had different flight times and days.

That break was good and uneventful. Just relaxing.

Then 5th term came. It was a very different ballgame. There was a new common activity however between 4th and 5th term. I somehow, someway, for reasons unknown to me, became someone that a small group of lower termers would come to for advise. Asking me for advise there was in my eyes equivalent to someone asking a homeless man for smart long term investment tips. None the less I'd tell them whatever I could think of and many times it worked somehow. This led to a relationship that was formed between me and a few of them that was stronger then I would have thought. Some of them I now consider to be good friends, and excellent guys all around.

Back to 5th term. It was easier in the sense that by now anything was easier in comparison to what we had just been through. Material wise it was still hard, we still had to put in some serious time, and Step was right around the corner. We also felt close to the end. We had something for the first time in a long time that was foreign to us by now, hope. We were possibly going to make it off this island and into clinicals. We became cocky, jaded, and unimpressed with most things, exactly what seniors are supposed to be. In the end I gave away a lot of stuff to my awesome roommates (I miss you Rafi and Nate!) and the group of guys a year behind me upstairs that I affectionately referred to as my "Chitlin's". I was usually referred to as either "Papa Joe" by them or "Put it down, you've had enough". The latter nickname will not be discussed any further.

The end came, we had made it through, we partied one (or multiple) more times at the end like we were rockstars and then went our separate ways. Right here is another reason that island is so terrible. Some of these people that you have forged such a strong bond and friendship with through the hardest of times is now possibly not going to ever be a part of your life again unless they are going to be in your clinical center or nearby. So for some the goodbye's were rough. Everyone had different flight days and times as usual and Mike and I were the last ones to leave. I remember the last night on the island very clearly. We stayed in Mike and crew's house which by now was eerily empty and devoid of any trace of my friends other then the distinct smell of Yllibacca in his room. Mike and I went to his upstair's neighbors for dinner, a group of awesome vet students who took us in and fed us. After that it was a restless night for me, I kept going out on the balcony, smoking cigarettes, and staring off in complete disbelief that it was my last time ever seeing a night on that island.

Coming in Part II: Homecoming, Texas, Step I, and where I am now.

When you're in hell...keep going

I have no time to be writing this. I'm behind in Pathology and Micro, I have exams in a little over a week, I should be working. I have to get this down though, because writing after the fact is to write about the memory of a feeling and memories never do the experience justice when trying to convey them in words.

I'm in hell.

No, not literally, but a personal hell. This class, Pathology, is basically for all the marbles. It's a culmination of all the prep we've gone through taking other courses. It's a majority of Step I, it's medicine. It's difficult to say the least. Conceptually it can be difficult but more than that the volume in the amount of time we're given is whats really difficult. It's like getting a month's worth of an undergrad course dumped on you weekly, and thats a conservative estimate. The number of days I've woken up and become depressed over the amount I have to accomplish that day and how much I didn't accomplish the previous day are far too many. I miss my family, I miss my girlfriend, I miss my friends, I miss New York City. In fleeting and weak moments I miss the life I had before, a job I was good at, money, and time. Those moments pass and I realize how much better what I'm working towards will be, still I think like that on occasion.

Despite all this I'm still in awe. I'm still shocked at the amount I've learned this term so far and how quickly my thought processes are evolving. My ability to look at a person with an illness and to understand what the signs of the illness mean has gone from nil to something. It's not much in comparison to an actual doctor but it's something. The vocabulary and syntax of the language of medicine is filling my head and I'm beginning to understand it, barely, but one must crawl before they can walk.

It's a catch 22, which oddly enough is the name of my Pathology lab group. You love what you learn and what you're becoming, you hate the process. None of this is special or unique though, it's called growing up and even people who don't become doctors can understand that very feeling.

There are other effects this is all having on me though and I've really noticed them more lately than before. I was always told I'm a weird mix of a person. Very mature for my age yet totally immature. I understand a lot of things from the perspective of a cynical old man which stems from some of my experiences and my upbringing yet at many times I'm impulsive, brash, direct, and childish. It all depends on the day and mood I guess. Each side of that spectrum has been amplified though, as a result of stress I suspect. I'm not sure if having this mix is good. I like to think it is, I like to think you need to have both to stop from becoming too much of one or the other. Though the only one it really matters to is me and those I care about. I know there are many people who don't know me very well who observe me on any given day and make a snap judgement one way or another and one of the biggest changes I've gone through since coming here is this: I used to care about that to an extent (A lot less than most though) and now I simply don't care. When I have to be professional and political of course I can put on a game face and no can tell who I am or what I'm thinking one way or another, I had to do that a lot when I was in undergrad and working and became very good at it.

That's my Dad in me, that's his genetics and teachings. "Never let them know what you're thinking or what you know, because when it matters you can surprise them all and that is the best advantage of all. Surprise." Thats along the lines of what he always told me. That and when it came to friends, never lie. When it comes to business, be honest to those who deserve it and can be trusted. Everyone else can turn out to be an enemy at any moment and you need to make sure they're never aware of your capabilities. Some will say that to lie and manipulate under any circumstances is wrong, these people have a very black and white view of a very gray world.

For the most part though, in general conversation and around those of little consequence to me I'm simply who I am and I make no apologies for it. For the first time in my life I've actually become comfortable in my own skin and proud of who I am. My accomplishments thus far while small in size and meaning are mine and mean the world to me because each one taught me a valuable lesson thats has helped me to survive here. Some people I know from home who are thinking of medical school are reading this, and if they're curious what these lessons are:

Work hard, and after that, try to work harder.

Relax, because if you burn out you're useless. Take time for yourself.

Plan for the worst, hope for the best.

If you say you're going to fight, then fight and put your all into it. Don't half ass things and don;t say things you have no intention of doing just to say them and sound intimidating. The way it was put to me from a young age was when my father tried to teach me that carrying a gun wasn't what made him brave or a man:

"Anyone can have a gun. Having gun isn't what determines if I'm going to live or die. It's my willingness to use it. If you pull a gun on someone in a fight because you think it'll scare them away and then they pull their own, it comes down to whose more willing to go past the line and pull that trigger. The slightest bit of doubt, hesitation, you could be dead because the other guy might not have hesitated. In other words, don't hesitate when it matters. Know what you have to do, know what you're capable of, and take the action. If you don't, someone else will."

Rely on others, find some people you trust and when you need to don't be ashamed to lean on them. You can be the strongest man in the world but alone you are useless. Friends and family are what makes life worth living and what keep you balanced. If you have a good set, when you fall they will catch you. Mine have caught me many times, and to all of you reading this who have I am forever in debt to you and I can only hope I do the same for you. You know who you are.

Plan for the future, but worry about today. Plans will change, whats happening right now can't.

Don't go nuts about being the best. A's are wonderful and should be the goal but if you fall short don't hate yourself for it. Grades are not the sole indicator of who you are and how good you will be at something. Don't just get by either of course, just do your best and accept what you get. You have nothing to prove to anyone other than yourself and when you get to the end of medical school, residency, your career, life in general you won't care. Being the winner of the race is great but this race is so long and difficult that simply finishing it is a feat of great proportions. It's something to be proud of. I have a lot more to say about this topic in particular but some of it might be offensive, and so I'll refrain.

Doing the right thing is the hardest thing of all, but most often the most rewarding. Right and wrong are never clear though. I was rebel when it came to many things before coming here and even here to some extent. There's nothing wrong with that, just make sure you know your own right from wrong and are prepared to take the judgement of others whose differ. To quote one of my favorite songs "I don't know much but I do know this, with a golden heart comes a rebel fist." If you know it's right but those around you disagree, then fight for it at all costs and never betray yourself when it really matters. This is not something thats very big in the school aspect of medicine but it's been my experience and the experience I know who have done it for a long time that this is what truly separates a good doctor from a great one. There are those that do as they're told and there are those who will break the rules when they know in the heart of hearts it's the right thing to do. These are the trailblazers, the people who are ridiculed by their peers who blindly follow convention without questioning it and they take it because when the day is over they know what they did was right and maybe someone who would have died didn't. My father was a rebel in everything he did and he became known as the best in each field because he of it. It was hard in the beginning, but as time goes on and people see the results of your way of doing it, they respect you for having the courage to break the mold. I aspire to one day be able to do that.

Finally and most importantly:

KEEP PERSPECTIVE

Whenever it gets to be too much and you're overwhelmed just step back. Look at it from afar. Look at the big picture, the mosaic that is your life. The small piece you're focused on, is it that bad? Will it matter that much in comparison to the rest? Are the people around you in the same position? In medical school there will always be someone smarter than you, someone dumber than you, and someone right with you. Someone will always know more about one thing than you do, but you may know a lot more than they do about another topic. Never let things like this shake you. Just look around and realize a majority if not all of the people around you are just as scared and behind as you. You're never alone.

This went on longer than I expected it to but I needed to take a break and as I said in the beginning, I needed to get this down. I want to be able to re-read this later on and understand what I was thinking at that moment in time as well as possible. I want to be able to see how much I've grown, regressed, learned or forgotten.

The title of this post is a quote from Churchill which I find very apt for the place and time I'm in now. I'm not sure if he said this after that, but I figure it means that you have to keep going because when you're in hell the only way to get out of it is to get through it. The minute you stop pushing through it is the minute you get stuck there.

So just keep pushing, keep going.

D-Day + 2 Months

So I left another huge gap. See a pattern emerging? 3rd term went well for the most part. Did well, got the grades, had a great time with my friends. Since we had more free time so to speak we all got a little closer, went out a little more, and of course acquired some new stories to be told in the future.

Then 4th term started. Then our lives ended. Ok, not really, but close to it. These days are spent for the most part 18 hours a day studying or working in one form or another. The classes starting at 8 AM and labs going on till 5PM 4 days a week mean you don't get to actually sit down and study until 6PM usually and then you have to quit at a reasonable time to get sleep for the next day. The 5th day is only class on the morning and the weekend is devoted to reviewing and memorizing. It's grueling mentally, physically, and emotionally. The first set of exams were last week, Path and Micro, and the week leading up to it then the week of it were frightening to say the least. I was probably the biggest neurotic train wreck anyone had ever seen. It paid off and I got the grades I needed but I never want to have to feel like that again. I know I will at least two more times before this term is over seeing as we have two more sets of exams. It wasn't just the exams killing me either, try taking any minor personal problem you have then amplifying by 100 because of the mentality you're in from exam week. It's brutal. Again I can't say enough good things about my friends though. Without them I'd have definitely lost my mind more so than I already have. I even can say I've added a few new faces to the usual uncanny cast of characters this term.

Now I'm back in the driver's seat again, on the road to getting the hell out of here. Back to 18 hour days most of which are spent in Taylor. Some new complications have arisen as they usually do, occupying my mind every hour or so for a minute. Even that though isn't too bad and I guess it's getting better as the days pass.

This term absolutely does change you as a person. Not an enormous amount, it's subtle. I can see it for sure though. It pushes you past what you thought you were capable of, makes you do things to survive you never thought you or would do. It changes the way you think not only about survival and academics but also how you look at people, it's slowly making me look at things clinically. It replaces some of those old habits in your head with ones you'd more associate with, dare I say it, a doctor. It's terrible and awesome all at once, like a lot of things I suppose.

Back to work for me, who knows when I'm going to have time to update this again.

"Proud of my life and the things that I have done

Proud of myself and the loner I’ve become
You’re free to whine, it will not get you far
I do just fine, my car and my..
Guitar, guitar go!

I drift, drift, drift, drift, drift, yeah
I drift, drift, drift, drift, drift, yeah oh

And I am done with this
I wanna taste the breeze of every great city
My car and my guitar
My car and my guitar
So you'll come to be, made of these urges unfulfilled
Oh no, no, no, no, no
When I'm dead I'll rest"

-Say Anything Admit it!!

Resurrection

Yes, I'm still alive. I was a bad blogger yet again. I left the blog defunct over break but with good reason. It's such a short break and I was enjoying myself as much as possible before being shipped back to the "Rock".

The end to second term was largely uneventful. I did pretty well on finals and was generally pleased with the outcome of the whole term. I even got on campus housing again which is a huge relief for me. Moving out of the large house we were in last term was slightly eventful. Long story short my hand wound up going through the rental car window right before I got on a flight off the island. Not too big of a deal though at the time I was not pleased. Second term was interesting for the fact that at the end of it, you really start to feel like you're learning what you came here for. As you get a good hold on the physiology and neuroscience it feels like you actually have a clear picture of whats going on inside the body. Now that MS1 is over we know in general terms whats going on inside the body during normal conditions. Now MS2 is spent primarily learning what happens when the things go wrong.

I have now entered term 3/4. Term 3 is 6 weeks and consists of behavioral science, biostats, ethics, and medical law. The hard part begins in Term 4 after that. Pathology, communication and physical diagnosis, clinical microbiology are the classes that fill term 4. Now there are alot of things I could say about this. Those who have gone through it before me have mountains of evidence both hard and circumstantial that point to what some may consider a "Stacked Deck". Like everything else I've found here though, you can't rely on the rumors you can only comment on your own experience as you go through it so while I won't be able to update the blog everyday I plan on keeping a daily journal, of at least a page a night, as soon as 4th term begins.

This will also be the longest amount of time spent on the island in one shot. Six months straight, January to June. Last term toward the end due to the isolation of my houses location I noticed myself becoming slightly depressed at times and increasingly paranoid. Being on campus was definitely necessary for a term this long and supposedly stressful. Last term I kept no records of what I was feeling when but 4th term I'd like to keep some kind of consistent record so that when I return home again I can review it and see what exactly the effects of this kind of stress and distance have on me personally as well as what coping mechanisms or lack there of I employ. Maybe it would be the kind of thing to help the next person to come through, maybe it'll be me re-reading alot of whining and complaining, either way it's a non-time consuming and constructive hobby to have on the side to clear my head when things are so busy I can barely stop to catch a breath.

Will I actually be able to keep something like that up? Knowing myself and from the looks of this blog I doubt it. I'll try though.

So this is the beginning again, year two is starting of slow but I'm sure it won't be long before the speed is almost too much to handle.

The Knife and Gun Club

If you don't recognize the title of this post you will understand it by the time I finish. First off, I forgot to blog. Ok, so you can't really blame me, I had alot to do. It's hard to find time for little luxuries like this but it's even harder to remember that it's even on your list of things to do when the list is twenty pages long and single spaced daily.

Right now we're in a post-midterm slow down so I have a few minutes to sit down and collect my thoughts. Speaking of midterms, this time as opposed to last term I'm very pleased with my performance, far more on par of what I expect of myself. It was to say the least, a confidence booster. It also reaffirmed a fact that I desperately needed to prove to myself, that I do in face belong here and in this profession. I have what it takes to make it through and even do well. In MS1 (Med School Year 1) that fact is critical for one's mental health. It's a very unsure time, it's like an odd limbo, another test to see if you have what it takes. Especially here in a foreign med school where the drop out rate is far higher than in the states. The school I'm in takes in X number of students and expects Y number of students to fail or drop out by the time we reach clinicals and the number of clinical spots they reserve yearly reflects this fact, as it does not nearly equal the number of students in the first term class. X-Y= The number of able students who will more or less become MD's. This is a business, income insuring model. A U.S. school has much smaller class sizes and makes sure that 99% of that class makes it through to clinicals and residency. So out here, if you do bad in MS1, chances are you might not make it through MS2.

I can attribute alot to my upswing. I study harder and more efficiently, I have good routines down, I don't waste much time (I do waste time though, everyone has to) and while those are the most major factors that shoved me forward there are two others that were significant in my opinion. A loving, supporting family who is always there and a set of friends that are both supportive but also studious. My friends would actually make me feel guilty for slacking off when they would spout out some random need to know fact that I had never heard. I would now remember a new fact and then study even harder to make sure I was on level with my friends so as to not, and this may seem childish, feel stupid around them. Though they will tell you I'm a few cards short of a deck if you ever asked them, and if you ever asked me I'd tell you they were a bunch of slackers that played way too much ping pong.

Lessons I've learned in med school that will follow me throughout life:

-No man is an island and if he is he most likely is miserable. When it comes to tough times, there's nothing like going through them with a good set of comrades by your side.

-Ants can get into everything, no matter how well you seal something or how much poison you spray.

-BOP, a local insecticide used in the home is in fact illegal in the U.S. and both carcinogenic and mutagenic. I had breathed in alot of it before finding that out.

-Medicine is alot of science when you're in school, alot of technique when you're in clinicals, and an art when in practice.

-Don't leave a bag of clothes in a friends apartment if you think they might do something to them, like put them in the freezer.

-Shaving in public restrooms gets you some odd looks.

-The age old idea that hard work and determination will in the end yield excellent results holds true today, but most people try to bypass it in this new age of immediate gratification.

You were probably expecting me to say a bunch of random medical facts or tests but chances are I'll forget half of what I learn in my classroom years as most doctors do.

Another first happened this term, the girlfriend came to visit. She finally got to meet my friends, see how I live, and see where I spend most of my time (Taylor Study Hall). It was a blast having her here after midterms for a few days. A mini-tropical vacation with my girlfriend that ended way too soon.

As a follow up to my previous post after living in a replacement villa for a few days me and my roommates were moved back into our original place. All the fire damage had been fixed and so far it's been an awesome place to live minus the distance. I got back on campus for housing next term seeing as it's the most intense term of the two years here and the easiest most convenient place to live really is on campus.

"The Knife and Gun Club" is a photo essay written by Eugene Richards. It chronicles Denver General Hospital's ER and Paramedic services for several months in the 80's during a time of extremely high violent crime. My father owned it and it was definitely one of the first glimpses I ever had into the world of ER's and medicine. It's what originally interested me in the idea of becoming a doctor and later working in an actual ER for several years during undergrad. When this term is over in a month and a half MS1 will be over and I will be one step closer to hopefully returning to "The Knife and Gun Club" and being a physician in it.

Where There's Smoke

The vignettes are coming, don't worry, but my first week back in Grenada must be discussed first because it has been by far one of the worst weeks I've had in a long time. Despite a 6 AM wake up (An hour earlier than I would if I was on campus) the new place off campus was amazing. A 5 bedroom villa with a pool and all. It had everything we could need and was only slightly more than living on campus.

The amazing place only lasted so long. On my third day there I woke up at noon to the sound of pounding on the door and people yelling. As I reached the door after getting an electric shock from my computer I noticed something was off, an odd smell. When I opened the door to my bedroom the room quickly filled with black smoke, the living room was in fact on fire. I hit the floor and crawled out the back door in my bedroom to the backyard. Apparently the islands power grid was having issues, in that 24 hours several fires broke out including on campus due to powerful surges. The cable box in my living room blew and set the TV on fire, creating a high intensity electrical fire.

With the help of some great friends here, namely Youssef, John, and Mike, and my landlord who set me up in another property of his I had a place to live within an hour. This place though has shotty internet, two broken AC's, and just simply isn't my place. Me and my roommates can't actually settle in anywhere and feel like we're home until we're back in the other place when the repairs are over in a few weeks.

This on top of a few other minor problems just keep compounding things and stressing me out quite a bit, none the less, the show must go on. I'm still going to class, putting in the hours on campus, studying, and gearing up to dive into this term.

Summer

This is my summer post, since I leave this evening heading back to the rock. I know I'm a bit late but between studying, seeing friends, seeing the girl, shadowing, and so on my schedule was a bit hectic and blogging hit the bottom of the pile.

Returning home was a shock to the system the first week. After months of intense discipline is studying and the constant fear of not doing enough, coming home and not having those things dangling over my head like a two ton weight held up by a thin thread felt odd. I quickly got into the swing of things though and learned how to relax and be plenty lazy again though and it was a welcome relief.

Real television, fast internet, the city, my car, friends, family, and good food were the things that I missed most and having them at fingertips again was revitalizing. Upon closer examination of the differences between living there and here I came to a surprising conclusion. My biggest problem being there and what causes me the most anxiety is the fact that over years of living in NYC, between family and friends, I have built a network. Not just emotional support but so called "tactical support". The importance of having anything I need at a moments notice, from speedy entrance through an Emergency Department at a local hospital for a friend to last minute reservations at a nice restaurant, through my connections from family and friends I can have any of those things with several phone calls. Here I'm a "somebody". A very small somebody however when you get down to it I could accomplish a lot in a pinch. I've spent several years building up a small network of people I trust and without them in a strange land with few friends I'm on my own. The only weight I can throw around is my own, anything I need I have to take for myself and that's not something I'm used to. It's not worth it to spend time gaining new "contacts" so to speak because in a year and a half they're useless. Here even in a room filled with my enemies (politically or otherwise) my name and the things I know protect me, sometimes thats enough to keep you out of someone's crosshair's. My reputation keeps people on their toes. When I'm in Grenada I'm out in the cold. The only thing you can do there is keep your head down, stay off the radar, and accomplish your goals. Staying off the radar and not trying to right wrongs I see is admittedly something I wasn't very good at. I stick my nose in places it doesn't belong, I open my mouth, I fight until what I see broken gets fixed. I did it in High School, I did it in College, and now I can't do it. So learning that trick is keeping me busy on top of my studies.

Seeing my friends was great, they're growing quickly into themselves. I like what they're becoming for the most part and still consider myself lucky to have them despite some differences in opinions. Learning what I missed, seeing the new dynamics in the social circles I knew, and examining life progressing without me around was weird but educational, I guess.

Cecilla got a job which is great, she's miserable and ecstatic at the same time. She got a job in the closed and difficult field she studied for, and now the real world suddenly isn't as nice as she thought it would be. She's keeping up though and making proud, she's becoming a little fighter where she works, not letting people step over her to get what they want, I think I may have rubbed off on her a little. I know I'm quite a bit more reserved than I used to be which I think is partially thanks to her.

The family is good, my sister is taking the LSAT's in October which is great. I think she's going to do great. My father is doing the same thing in school that he did as a detective and an ER nurse, kicking ass and taking names. I expected nothing less. My mother is doing well and actually starting her own little business venture. If anyone needs Avon products let me know, I'll give you her number. For the most part, some small hiccups excluded, I think the pieces are really beginning to fall into place for my family. I'm of course weary, because we all know what they say about the best laid plans of mice and men.

Speaking of plans, packing and planning return trips is a nerve wracking thing. There's a saying in the military "Even the best battle plans rarely survive contact with the enemy." So I pack like the world might end while there, prepare for the worst, and hope for the best.

I'll post a few more times in the coming week with vignettes from experiences I had this summer.

So dear readers to quote Shakespeare instead of a punk band this time
"Once more unto the breach, dear friends, once more."