Ancient Traditions

Well, results won't be in until tomorrow, but I think I did pretty well on today's exam. Kudos to our professors for writing a tough but fair test. It's amazing what a good night's sleep and not believing you failed a test miserably will do to improve one's mood. As is the custom post any big test, a bunch of students will be meeting up in our version of church ... The Cliffhanger Bar. I imagine that ever since Hippocrates asked a few of his students which herbs were poisonous they immediately congregated 'round the old wine barrel and celebrated their right answers or commiserated over their wrong ones. We are proudly upholding a sacred tradition know to all medical school students. In any case, the cliffhanger is a great spot to grab some pictures so I hope to posts some good shots later (provided the sun cooperates). The Picture above on the right is from my first semester here taken right from my barstool at the Cliffhanger. You can see why it is one of my favorite watering holes.

T-Minus 11 Hours and Counting / Why Do Doctors Carry Around all Those Little Books?

In less than 11 hours we will take the first of our pharmacology exams this semester. Students who have completed this course rate taking these tests somewhere between having a root canal and attending a Carrot Top performance. So much joy awaits! I must confess I have spent the most consecutive hours studying this subject than any other in my entire academic career. The material isn't exceptionally difficult to grasp it's just that there is an enormity of info to get through. The wild card is of course, which testing philosophy will be employed by our esteemed professors. There are basically 2 schools of thought here at AUC. First, there is the clinically minded who test relevant material that actually has a correlate in the practice of medicine. Important concepts are hammered home and there is statistical relevance between doing well on an exam and actually knowing something useful about the topic tested. We all love this type of test. Sadly, there has been less of this type than most of us would like. In its place we have seen tests that focused on minute detail that has no real relevance. I have no problem with being asked detailed questions; don't get me wrong. My objection comes when the asking of the "minutia" preempts questions that would actually assess an understanding of the material. This is harmful in 2 ways. First, it doesn't actually give honest feedback of our mastery of a particular concept, and secondly, it fosters a culture among students that focuses on memorizing our notes rather than understanding principles. Both in my opinion are a recipe for disaster.

It does occur to me that perhaps some of our test authors may never have actually met a practicing doctor. For surely they would have noticed the multitude of handbooks overflowing from their lab coat pockets. Proudly they stick out, crammed chock full of details just waiting to be looked up; dutifully agreeing to safeguard information and sparing our brains for remembering important things like: "Out with the bad air, in with the good", plumbers shouldn't bite their fingernails, and the leg bone is actually connected to the hip bone.

I'll stop whining now. Admittedly it is late, I am cranky, and my head is swimming in a torrent of polysyllabic drug names and their mechanisms. To bed. To sleep, perchance to dream......


(Editorial note: Tired and cranky = Shakespeare quotes, Drunk = posting in Latin. )
12:40am and sober

Adrenaline- Saving Lives Since Men Took Wives

As you might guess, the Island of St. Martin does not recognize Memorial day so yesterday was business as usual. A complete day of classes topped off by a Medical Psychology Lab in which we observed several children undergo developmental assessment. The ages ranged from 10 months to 8 years and although the children were quite cute and it was amusing to observe them for a while, I must say I left with a feeling of having watched paint dry for 2 hours. Don't get me wrong, despite my previous attacks on psychology as a discipline I do see a value in learning this material, I just think that I would have been better served reviewing Pharmacology for those 2 hours. We learned about the assessments in class and even saw film clips of children undergoing the testing. All I am saying is that it wasn't crucial to our education to witness it firsthand- at least in this stage of school. Someone in our class pointed out that we are scheduled for more hours per week in Med. Psych. than for pharmacology. This strikes me as odd since for 99% of us our practice of medicine will include gobs more of the latter than the former.

Speaking of pharmacology, that is what I have been holed-up doing today studying all about the drugs that effect the autonomic nervous system (all the stuff your body is busy doing behind the scenes for you because you are too busy watching "What's Happening?" reruns to pay it any mind). For example imagine the following scenario:

You have been out late drinking with the boys, you stumble home way later than you wife expected you, there may even be the slight aroma of a cheap perfume intermixed with even cheaper beer about your person. You slowly fumble to fit your key in the door gently turn the knob as not to disturb your lovely bride. Upon entering the house you immediately remove your shoes so that your footfalls will be silent. Ever so slowly and quietly you sneak down the hall and enter the kitchen. Having developed a powerful thirst on the way home, you decide for one last drink before turning in (on the couch. thinking to yourself you will tell her "not too late but I didn't want to wake you" when she asks in the morning what time you got home). As you go to reach for the refrigerator door suddenly the kitchen light explodes on and and a shrill, almost deafening sound erupts, seemingly from all directions at once, "WHERE THE HELL HAVE YOU BEEN MISTER?", followed by some inaudible screaming (Astute listeners may even make out some very descriptive profanity and threats to certain anatomical structures you have grown very fond of.) Now at this very moment you would invariably be standing there slack jawed, dumbstruck, and with a glazed look about you. Enter your Autonomic Nervous System. With lightning speed your brain senses danger (married men have a highly evolved Spousal Danger Detection Center) and at once triggers your adrenal glands to release a cocktail of hormones, Epinephrine(also known as Adrenaline -pictured above) and Norepinephrine, into your bloodstream. These hormones have been evolved to transform your stunned and languid self into a highly revved-up, broom ducking, plate dodging, kick avoiding, balcony leaping, and into the safety of the night, running machine! These hormones have the added benefit of dialing down some of the routine physiologic functions such as urination and defecation- sparing you further embarrassment during your avoidance of certain death.

Ain't Pharmacology fun!

Boys Night In

Poker night was a a success! Brandon, Brian, John C, Sujit, and Jersey Pete came over and it started out looking like they would be leaving with not only all my money but taking furniture with them too. Fortunately I was able to win my money back. Actually, I ended up ahead on the night as did Sujit "the shark". So next semester's tuition payment will be made as scheduled. I hope we can arrange another game in the not too distant future since I have way too much booze left over.

Surprise Baby Shower at Kissing Fish

A very special thanks to the DiCarlos and others who orchestrated an impromptu surprise baby shower for Kathy at the Kissing Fish last night. A good time was had by all, there was good food and of course good drinks (the little momma drank sparkling cider). There was even an elaborate gambling board set up where people could wager on the date our little bundle will arrive along with sex and weight- Mrs. DiCarlo was apparently a numbers runner in a former life! The pot is up to around a hundred dollars.

The party went along very well until someone decided it was time to go swimming with their clothes on (jersey Pete) this triggered pretty much everyone jumping in the pool and yep you guessed it, it wasn't long before the water charades reared its ugly head once again! Truly a phenomenon you have to experience for yourself to fully appreciate!

Tonight at casa de la McDonough, after a day of studying Pharmacology, there will be a mini Texas Hold 'em tournament. As a reminder to those coming: #24 Vista Verde, Point Piroutte (make a left just before tennis courts)

Flip Flopping...

After Kathy's Dr. appointment yesterday, we have some good news. Our little critter has rotated his/herself head down. So barring an emergency, no C-section will be done. Also we found out that in keeping in line with the Dutch side's pricing for medical care (see Health Care post below), the French hospital will only be charging 1100 EU/ day ALL INCLUSIVE! This works out to about $1400/ day after conversion. Pretty cheap! Perhaps that's why the Gynecologist asked Kathy to borrow money for lunch!

In other news, I received the results of my first Med Psychology exam and my technique seemed to work pretty well. I didn't do exactly as well as I wanted; but that was due to my missing some of the required readings of material not covered in lectures, mea culpa! I'll get em' next time coach.

I would like to thank and welcome those readers who come by my blog via Paul Kyser's blog. I am impressed with the geographical spread of people that have read my blog. Recent hits have come from Alaska, Miami, Louisiana, Dallas, and Ohio. So welcome and I hope you come back! I'll do my best to at least entertain.

If I keep taking this class I'll go blind...

So, today was our first exam of the semester. We had a Medical Psychology test and well.... While the class is interesting, I have developed a groundbreaking technique to doing well on the exams. I hope any lower semester students reading this will head my advice: Simply choose the most flowery sounding, after school special like, non-natural response as an answer.

Perhaps an example (try my method and see for yourself):

Q. An obviously disheveled, middle aged man with a swastika tattoo on is forehead bursts through the door of your primary care office carrying a blood stained double headed axe over his left shoulder. He has a wild look in his eye and what appears to be remnants of a Reuben sandwich down the front of his threadbare flannel shirt. He says to you "So you're the F*&#ing doctor huh?" The most appropriate response to this patient should be which of the following:

1. Immediately dial 911 and start praying
2. Open your desk drawer, remove your firearm, and equilibrate his interthoracic pressure with that of the atmosphere with extreme prejudice.
3. Tell th patient with an authoritative voice, "Sir, put down that axe at once!" and then schedule a CT and toxicology screen to rule out medical causes of his behavior.
4. Say in an empathetic voice,"I can see you are upset. This must be hard for you. Are there any problems in your life you would like to discuss with me today?"

The "right" answer is #4. Without any knowledge of Psychology, you can arrive at the right answer using my technique!

This is why I have determined that Medical Psychology is the equivalent of ACADEMIC MASTURBATION- it may make people feel good temporarily but it wont get you anywhere.

No disrespect to Psychologists (but then again they would just attribute this to my anti-social personality disorder and really wouldn't blame me )

Next up is our first Pharmacology exam and it is touted to be fairly tough so I will get back to studying. (for those non psychologists reading this this is a clear example of self-delusion)

Life's a Beach / Panic in the Halls

Today Kathy and I decided to drive up to the French side of the island and take in the lovely weather. The sign to the right struck me as funny for 2 reasons: first Baie aux Prunes is French for Plum Beach. However, upon first sight I had a vision of a Florida beach overrun by octogenarians. Secondly, the swim at your own risk is a bit much.... looking at the next pictures the greatest risk we faced was a moderate sunburn. The water was glorious; calm, clear, and quite warm! Our time at the beach was followed up by a return to our previous home, The Summit, where we engaged in swimming and water charades with the DiCarlos.
(make sure to click on the pictures for a better view)

***********************************************
Meanwhile, a flurry of rumors have been swirling around school this weekend. The equivalent of WANTED posters were hung around campus. They showed a picture of a student along with his name and simply said anyone spotting this person was to notify security immediately.In, what is unfortunately is the latest in a series of administrative missteps, no other information was given; until today that is. This morning an email was circulated by the Dean which explained the situation (My guess: it was to quell the rumors that were abound).

Apparently, a second semester student last semester was caught after breaking in to a professor's office and stealing a copy of the final exam. He was arrested, spent 8 days in jail here, and was released yesterday. Unfortunately the school administration had neglected to notify the security guards in time and the former student(he was expelled obviously) was let onto campus. The unfortunate part of this story is that, while being placed into custody, the student, who happens to be Asian, was heard to have made terroristic threats against the school and administration going as far as saying something to the effect of "just like Virginia Tech:.

This, needless to say, stirred up a maelstrom of rumors and panic amongst some students. On an internet forum many students stated they were not going to attend tomorrow, for fear of their safety. However, a fellow blogger posted on Paul's blog that he in fact witnessed the student in question departing the island and arrive in Miami. So all again is safe here. Or, to quote an idiotic ER doc I once worked with at Abington Hospital, "Crisis Averted".

Random Kitty Pictures

Dogs Gone Wild & A Retrograde Babe

While sitting on our balcony late this afternoon, Kathy and I were witness to a real live installment of When Animals Attack! Apparently the golf course just below our balcony is the stomping grounds for a pack of Dastardly Diminutive Demon-Dogs. At last count there seems to be 4 or 5 of the feral beasts; none is bigger than about a foot and they all have moxie. As if to prove the point they attacked some poor jogger who was minding his own business enjoying an afternoon run. They sprinted across the fairway and started barking and yelping like mad. I'm sure this poor guy was thinking to himself "oh look, how cute, tiny little dogs". He was about to be very, very wrong. These mini dogs were auxiliary members of the militant golf course security team and they do not take kindly to trespassers. This unlucky jogger was nearly mauled to death (Ok maybe not but his shins were in mortal danger) His relaxing jog quickly escalated into an all-out sprint for his life. With winged foot he ran, and thankfully after about 50 yards the dogs lost interest. I must admit, I was kinda pulling for the dogs on this one. It must be the couch potato in me.

(Make sure to click on the photos to enlarge them the little dogs are tough to see here.)

In other news, Kathy and I began the 4 week countdown until the arrival of the newest McDonough, although smart money is on an early appearance. Last week at the OB/GYN visit the baby has rotated him or herself back into a breech postition. (not head down as is customary but butt down) and if the baby doesn't flip back down we will most likely opt for a Cesarean section. Our doctor is pretty conservative and tells us that the French almost invariably will deliver a breech baby by c-section especially in a first pregnancy. We just learned this week in school that France has a significantly lower infant mortality rate than we do in the United States,some 35% lower, so it may be good advice to take.

Stupid Congress Tricks and Why I Drink

On this day in history in 1918, congress passed The Sedition Act. It was designed to beat down opposition to the United states' involvement in World War I. This nifty piece of legislation made it illegal for pacifists, anti-war protesters, or any other scum-of-the-earth types to engage in the following: "making false statements that interfered with the prosecution of the war; insulting or abusing the U.S. government, the flag, the Constitution or the military; agitating against the production of necessary war materials; or advocating, teaching or defending any of these acts."
The more astute among you are scratching your head incredulously, and are assuming I am making this up. A law making it illegal to insult the government???? What the hell did stand up comedians, political cartoonists, and uncle Bob do for god's sake? These were dark times indeed.

This was not the first , or dare I say the last, in MONUMENTAL BONEHEAD moves our beloved congress has made throughout history. To name a few, Prohibition, The USA PATRIOT Act, and Declaring a National M.C. Hammer day! Although admittedly I may have hallucinated that last one while on a week long bender in the early 90's. (Damn, I miss my parachute pants)

Fortunately it only took congress 3 years to repeal The Sedition Act; meanwhile, alcohol spent 14 years hiding its glorious 2-carboned head in shame. Vindication for booze wouldn't come until 1933! Oh, the humanity!

My favorite Frank Sinatra quote: "I feel sorry for people who don't drink. They wake up in the morning and that's the best they're gonna feel all day." Amen Francis Albert, amen.

Bunny Surgery , Tired Hamsters, and Depressed Rats

In an effort to modernize the practice of surgery and save on the costs of cadavers, our beloved school has developed an online surgery simulator. This technology represents a significant improvement over the recently replaced Operation game by Milton-Bradley which students before my class have used with only moderate success. 32% of the class had failed Funny Bone Removal 101. To try the simulator click here: SAVE MY BUNNY

Hopefully the money saved will go toward the purchase of younger more robust hamsters. It seems that the hamsters that our school uses to turn the big electricity generator wheel have become "shagged out" thus leading to several power outages on campus.

Other than occasional darkness, school is going pretty well this semester. In Pharmacology we are reviewing the nervous system and learning neuropharmacology it's pretty riveting stuff. We learned about the effects of Riserpine; a drug that blocks a blah blah blah .... but we did hear about a rat who was given this drug and sat very still, was depressed, and shat excessively. I'll take "Things I never thought I hear about in Medical School for $400, Alex"
(I suspect if reincarnation exists, that most of those lab rats held Doctor of Jurisprudence degrees in a former life)

The joys of medical school never end!

Pretty Lazy Weekend

Happy Mother's day!

The White Coat afterparty at Bamboo Bernie's was fun as usual, however I didn't get any post-worthy pictures. It was nice to see many of my classmates there to show their support to new new incoming students. (read: excuse to party, here)

Yesterday was spent lounging around (recovering) and watching the Mayweather - De la Hoya fight that I missed last weekend.

Tonight we are headed over to a classmate, "Jersey" Pete's house for some home cooked Italian dinner. Pete is a former actor from north Jersey and is already being voted as most likely to visit a patient at home... for collections: "Whaddya mean you aint got my friggin copay? Don't you know going to the doctors is a dangerous business, I would hate to see you have an accident"

I am kidding obviously, and in all reality Pete is a sweetheart of a guy and quite a character. (in case he's reading this, I like my kneecaps exactly where they are!)

Another classmate of mine, John DiCarlo and his lovely wife Geri will be there as well so it promises to be pretty good time.

Nikola Tesla, where are you when we need you?

Many of my classmates are currently (no pun) in the throes of a black-out.
It affected our school this morning as well but they managed to switch to a backup generator by 9:30. For some this ordeal will continue throughout the weekend as the work ethic here is, well , laid back to put it mildly. We are lucky- where we live seems to have been spared.

Tonight is the semesterly [yeah, I just made that word up] White Coat Ceremony for the incoming 1st semester students. This is a symbolic event where students don the traditional white lab coat and officially embark upon their journey to memorize names of enzymes, branches of arteries, and the intricacies of the JAK/STAT pathway. White coat ceremonies are pretty common to all medical schools; ours however enjoys the added bonus of allowing its participants to wear flip-flops to complete their ensemble. So, we got that going for us.

The actual ceremony is long and boring, but it is followed by a night of "restrained debauchery" complete with buffet and dancing hosted at a pretty cool restaurant called Bamboo Bernies. (screams medical school hang-out doesn't it?) It is usually a fun outing so the bride and I will head (in her case waddle...just kidding dear) over there this evening. I LOVE having a designated driver! I may get some pictures to post here tomorrow.

Thursday Pics Redux- Mullet bay at sunset

Thursday Pics

This picture was taken yesterday from the balcony at school. We have a pretty terrific view of the Caribbean!

This is of my current mode of transportation to and from
school-MY HOG. Manly, ain't it?

The Rising Cost of Health Care

A classmate of mine had an unfortunate accident while affirming to himself that his talents lie in medicine and NOT in locksmithing.(don't ask) The mishap resulted in a laceration to his finger that required a few stitches. The interesting part of this story is how much the Emergency Room visit and treatment cost. He paid $50.00* and is now medical bill-free!

How on earth can these poor people down here make a living, practically giving health care away? Don't their 4x4's(gauze pads) cost $19.00 each just like ours?

Seriously, it does give one pause and makes you think that if you walked into any ER in America and told them, "I have a laceration that needs suturing and only $50.00. What can I get?"

The most common answer I suspect would be : "Directions to another hospital!"

My friend Art and I have a running joke about Universal Health Care and the (I can barely type it) Socialization of medicine in America. He takes the side that it should become a reality, and I tell him to "let's just wait until I get my first paycheck as a full fledged Physician ." (look at me alliterate!)

While I haven't yet adopted the conservative republican view, given my pending tax bracket, I do believe that wholesale socialized medicine isn't the answer. I am more in favor of reforming the system as it is. I posted some thoughts on the subject on a forum. You can read them here.

For those of you that are too lazy to click here, I'll summarize, I would like to see:

1. medical malpractice tort reform
2. Fixing the Health Care Spending Account
3. Overhaul and reduction of bureaucracy in the Medicare / Medicaid programs

I was much more eloquent in my post, you could find it here if you were looking that is hehehe.

*Disclaimer:
In the intrest of full disclosure, he did recieve the sutures without benefit of local anesthetic. But unless the cost of Lidocaine has gone up a million fold then my point is still valid. Besides my guess is the doc on duty was a Rambo fan.

Two Quick Pictures

Per special request here are a couple of quick pictures from our apartment balcony. The top one was taken around sunset and as you can see we live adjacent to a golf course. The bottom photo shows our school across the lagoon - it is the peach colored building with the red roof.
I promise better pictures to come.

The National Foundation for What

My lovely wife Kathy is 8 months pregnant and is due in early June. Many of you already know my wife is suffering from a temporary, albeit horrible condition known as Placenta Brain. This is a tragic, and I am told not so uncommon condition, that renders her short term memory ...frankly ..nonexistent. Personality changes are also seen by many in this tragic disease.

We have conversations that only minutes later she doesn't remember (she staunchly defends this point of view). While straightening up around our apartment she puts things away that now I have filed as having the same fate as Jimmy Hoffa, Amelia Earhart, and the Dodo bird. Another wonderful trait she has developed during her pregnancy is a bellicose nature that Genghis Khan would envy! Whenever I say things like, "Good morning honey" or "Where is my [insert object here]" if you are very quiet you can just make out Michal Buffer's voice in the background saying :"Let's get ready to rummmmmble".

Needless to say, I anxiously await the birth of our child. I miss my normally intelligent and affable wife. In the meantime, I am actively seeking a celebrity spokesperson to head up my new charity: F.A.M.W.B.M.I.A.A.D.P

Fathers Against Mothers Who Become Mentally Impaired And Abusive During Pregnancy

Perhaps I'll work on the name a bit.

Inaugural Post

After reading and enjoying a classmate's Blog, I finally decided to write my own. Many thanks to Paul Kyser for his countless entertaining posts and inspiration to write this one. See his blog by clicking on the link to the left.
Hopefully this blog will be mildly amusing to those that know me; and a brief window into a slightly warped mind to those who may not.

Well here I am, beginning my 4th semester of medical school -the penultimate one here on the island of St. Maarten. Time sure has flown, it's been a year already! This semester's fare includes Medical Psychology, Pathology II, Pharmacology, and Medical Ethics. Today in Medical Psychology we had our weekly lab/workshop. This is where we role play the parts of physicians and patients and learn things such as empathy, non-verbal communication, open-ended questioning and facilitation . Oh yeah, apparently laughing at, yelling and poking with sharp IV needles are NOT the way you are supposed to deal with Psychiatric patients. I had previously trained under an alternative school of thought on this topic in my former life as an ER nurse and Paramedic. Mea maxima culpa.