Dominica Farewell

How do I say this......It's not you.....it's me. I take my leave of you now, Dominica. I'm going away tomorrow, and I truly can't say if we'll ever see each again. Things were a little tense between us the last few weeks - as I studied for a relentless horde of tests, and your reggae clubs pumped music across the bay long into the night, frequently disturbing my slumber. Nevertheless, I'll look back fondly upon our time together; everything's nice in hindsight, right? I'm sorry...that was a little harsh. Even as I packed my bags and ran around on errands - returning the propane tank and case of empty Kubuli bottles, picking up Dramamine for the airport ride, and giving away things I can't take with me to people I've gotten to know - I started to become a little nostalgic. I'm sure the stress of all the studying made me a little short with you, Dominica - I'm sorry for cursing about you when I couldn't concentrate; I know that it wasn't always your fault. The lowing of the cattle couldn't be helped, and the people need their midnight reggae, right? I guess it doesn't really matter - I just want to apologize for likening you to one of the lower circles of hell - I didn't really mean it. Our time together was very special to me, but it's just time for us to move on, you know? I've got to get back to the states for 5th semester and all. I mean, I tried to stay, Dominica - you know that; but the powers that be stationed me elsewhere. And what with the talk of the possible resurgence of your legendary volcanic temper, I think it's a good time for me to move on anyway, don't you? I knew that it was probably time to move on when, as I was studying for the first of the shelves, you got angry and caused a minor earthquake. I didn't tell anyone about it...I mean it was something we had to work through, right?

I will miss you - let's face it, Dominica, you're easy on the eyes; what you lack in substance and sophistication, you make up for in natural beauty. It's no wonder they call you Waitu Kubuli - "Tall is her body". Yesterday, somewhere in between packing and procrastinating, after the gym, I walked around snapping pictures of you - just for the memories, you know. If it's any consolation, I'm not going to Miami because she's prettier - it's just that she has what I need in my life right now. And before you know it, there'll be a whole new crop of first semesters, and you'll forget all about me. Really...it's for the best.

Don't be like that, Dominica - you're more than just a pretty face. I came to embrace your culture and your people. Here's a picture of Nelson's Grill house - this is where I ate every single day I was on campus, and some when I wasn't. I'd leave class for lunch, and order spicy chicken with rice and salad, and it was fantastic, Dominica. Whenever I'd come back to Nelson's after being away between semesters, it always made me realize how much I'd missed it. No, I'm not just saying that to be nice - I really loved the chicken. None of the other food really called to me. I've already shown pictures of Addison's juice stalls - that's one thing you take the prize in Dominica; you have the best juice I've tasted anywhere. See? That's something I'll never forget about you - and your sunset are always amazing - they're never the same, but I've taken so many pictures of those, and the beaches that form your body, that I just didn't feel the need to post anymore here.

I'm sorry it has to be this way, Dominica, but it's for the best, trust me. Both of us will be happier this way. If you want me to be brutally honest about it, you're a little too third-world for me. I've enjoyed your beauty, but I won't miss the cows, the lizards everywhere, the bugs - and Miami is just a little more sophisticated. She'll mentally stimulate me a little more, but I don't see Miami and I staying together forever either; you know how I am. I've set myself on this professional course, and I'm going to have to keep moving around - it wouldn't have worked out. This doesn't have to be goodbye forever though - I still haven't seen your boiling lake, or done all of the hiking I can do. So you see? At least we're leaving on a pretty good note, right? We may yet see each other again, sometime in the future (though in my heart I doubt it. Sorry.) I do want to thank you, though - you were always so relaxed and understanding - sometimes too relaxed, but I wouldn't try to change you. I'll never forget you, Dominica - as frustrated as I was at times, you'll always hold a special little place in my memories. I know I've been a little harsh in this, but I will miss you. Miami's fast paced and can be a little unrefined too - at some point, I may wish that things could have been different, but I won't change my mind on this.

As we sat out on Nicole's balcony last night, drinking rum and wine (separately, of course) and chatting about the future, Dominica, you threw a star into the sea. It was like no shooting star I'd ever seen - a faint, luminescent streak against the black silk sky - rather, this was more forceful. It burned bright white as it fell, appearing for all the world like heavy-duty fireworks flying in reverse. It then flared to a brilliant green, lighting up the night sky, and finally it burst into an angry, fiery red, before plunging behind the clouds over the sea, and disappearing into nothingness. Dominica, is that your way of saying you'll miss me too?

Sincerely,

Farley

Yeesh...

Ok....scratch that....scratch everything I said about paper patients maybe possibly being easy. Mini 3 was today, and I don't know if it was just because I was burned out from having 6 other exams over the past few weeks, but this one was a beast. I've gotten used to reading through a question and being able to recall not only which professor wrote it, but which lecture it came from, which course packet, and even which slide - I can usually recall the notes I've written on my second and third read-throughs. This time, the questions were damn near all nebulous and ambiguous. Some of them were just plain surprises. Part of me wonders, though, if, after taking hundred and hundreds of questions from the mighty NBME, I'm just dealing with a significantly lower quality of question writing. All in all, though, it wasn't absolutely terrible, and if anything, the beastliness of this exam is a prelude to the Comp and the Step.

I always feel like Dante after a semester - climbing out of Hell on Easter Morning. This time, though, I'm not just climbing out of the academic hell, but I'm leaving the island. That's not to say that Dominica is hell - far be it from me to suggest such a thing - but I'm ready to go. I've been ready to go for a while - I can't wait to be back in the states. It was a good run, I suppose; this whole island thing was good for me - I got a lot of positive things out of this. If I had the chance to do it all over again, I would - actually my answer to that question is dependent on how far back I can go. Nevertheless, I can give this soon-to-be-closed chapter of my life a thumbs-up.

Adios, Dominica. Soon.

I can almost taste the freedom!

Last night was another one of those nights in which, despite all of my good intentions, I toss and turn for hours. I don't know if it's a stress thing or what, but it's gotten to the place where I'll just keep up the studies and hope that I'm not a zombie the next day. Fortunately, I maintained a modicum of focus - the big, final test on the island is tomorrow (and I really should be reviewing skin and kidney pathology instead of posting). I can't wait to be done with this place!

So I'd been TAing anatomy for a few semesters, and, lo and behold, they pay us. I mean, I knew that - I'd just never picked up my check (one per semester). I wanted to get it all as one big lump sum before I left the island - I figured it'd be like sticking my hand into the pocket of some shorts I hadn't worn in a while, and pulling out a few hundred. Here's the funny thing, though - my wages for slaving over dead bodies amounts to something on the order of 0.4% of my total current debt. How's that for perspective?

There's a lot to square away before I head home - I've got to fill a barrel with the books I'm going to use to study and I have tons of stuff to give away to some of the locals I've gotten to know. I have to close out my Dominica account because, let's face it - if I was going to have an offshore bank account, I don't think I'd choose this island. There's some packing to do (which I abhor), and then some relaxing to squeeze in.

While walking around with Nicole running errands yesterday, I snapped a few more shots, just to make sure I represent a well-rounded view of my little spot on the island. This one was taken just in front of one of the little grocery stores close by, and if you squint your eyes, you might be able to see the sea in the background.

That picture on the left was taken on my walk home - you can really see how the buildings butt right up against the jungle. It's like this island hasn't yet realized it's supposed to be civilized, and the mountains are keeping urban development in check like unruly toddlers around the knees of kindergarten teachers.

The one on the right is of the Cabrits - the little mountain peaks I'm sure I've shown numerous times, and which look nothing like that from the air. I only added it in here so you can see my view - I've taken to studying outside, and this might be one of the few things I miss about this island. I'm literally right on the sea, and even though I haven't been to the beach since our lectures about hookworms, it's nice to have it close-by.

Speaking of hookworms...here's another one of those pieces of information I referred to in my last post. Apparently, mice with more lice had fewer allergies. Essentially, they had more relaxed immune systems. You see, your immune system is like a hyperactive little kid - it needs something to do. Over the course of human history, it evolved to deal with a whole host of parasites - worms, protozoa, crustaceans, etc. But now, in this super-clean society, we've taken away the constructive outlets for our immune systems, and, like bored little kids, they turn on us and become destructive, hence peanut allergies and the like. Since the biggest threat to early man was starvation and not germs on a counter-top, there's no way anyone would have been allergic to food - if they were, by some random mutation, they probably wouldn't live too long. It all boils down to this: when our immune systems develop in infancy, it can take one of two paths - one of those paths develops cells that fight parasitic infections, and the other develops into cells that fight infection, but can have a more detrimental affect on body systems as a whole. The thing is, even though everyone has both systems, they're fairly mutually exclusive; if you grow up in a place in which it's necessary to fight off parasites and deal with lots of pathogens, you won't be allergic to anything, because your immune system'll be too busy. So, ideally, as much as I hate to say it, if you don't want your kids to be allergic, make sure they grow up with pets.

Before I get carried away by more witty metaphors, I probably oughta get back to the books.

Get me off the rock

I'm ready to be done. This was painfully apparent last night, when I was getting ready for the ICM shelf, and suddenly fell into that "I-just-don't-give-a-damn-about-this-exam" mentality I hadn't felt since undergrad (and is surely my reason for being here in the first place). The clouds eventually passed, though, I and got back to it. Luckily, it turned out to be the second easiest shelf I've ever taken - nothing makes me happy like seeing Kaiser Fleischer rings, and wondering what they could possibly ask me about Wilson's disease. You see, at this stage in the game, it's all still cluster bridges - I've realized that the NBME (who owns my soul as much as Sallie Mae, I now realize) merely wants to see if I can put 2 and 2 together. I'm sure I've said this before, but these are paper patients, and they're relatively easy.

Hold on there...I didn't say med school was easy. I said that paper patients can be simple - if you (1) can identify the organ system (2) have read about the cluster of disorders they're talking about and (3) have memorize some descriptor of each, it's really not that bad. They aren't like real patients - who don't always read the books, and who don't always realize that symptom A is supposed to belong to Disease 637. Paper patients are simple in that, when we make mistakes, it means a wrong answer - not a dead patient.

Perhaps it's the redundancy that's got me feeling this way. Our final test on the island is on Thursday, and I'm reviewing things for the third and fourth time now. I feel like King Solomon - "There's nothing new under the sun" - but without all the wisdom and women. And perhaps it's good that I'm feeling this way; it may mean that I've actually learned and understood something. It's gotten to the place where some "new" piece of medical evidence will be published, and my response is a very articulate "Duh...." coupled with an eye-roll, as I mentally run through the pathophysiological explanation why what they've said makes sense.

And somehow, I'm still aware that as far as the practice of medicine goes, I don't know squat.

Breather

I'm knee deep in the festering muck of shelf exams. I always approach them with a little bit of apprehension - they're supposed to be an external measure of (1) how well and comprehensively they're teaching us and (2) how diligently and aptly we're learning. That being the case, there tend to be a whole lot of things I've never heard of - not things I forgot to study, or just plain forgot - things I've never heard of. So, I split my studying between reviewing high-yield course information, and reviewing 1st Aid for the USMLE. Quite honestly, I haven't given that book enough credit - it wasn't particularly useful when I bought it first semester, but I've made some notes here and there. It was far more pertinent when we began looking at organ systems, and I wish I'd added more notes - it was invaluable for the microbiology review. Not so much for path.

Micro Shelf: The First One. I thought it went alright; one never can really tell with these things.
Pathology lab Final: I love these lab practicals - it's like playing a matching game, only with disease.
Pathology Shelf Exam: You know, as much as I enjoy pathology and as well as I tend to do, I wasn't overly thrilled walking into this one - maybe that's because it was only 19 hours after the last one.
Pharmacology Shelf: Even 1st Aid didn't help too much here; some things I knew without reading the rest of the stem, some things I had to sit and think through, and some things I'd never heard of. I wish I'd reviewed diabetic drugs a bit more, and I should have paid a bit more attention to antipsychotics, but oh well - what's done is done.

Next up we have the ICM (introduction to clinical medicine) shelf, and then MINI III (and then I'm leaving Dominica forever!).

The shelves this time around carried a bit more weight in my mind - whereas the shelf exams after the second semester (physiology, histology, anatomy, neuroscience, and biochemistry) felt somewhat arbitrary, this last round of NBME (National Board of Medical Examiners) Shelf exams is more geared to the the kinds of things we'll see on the USMLE Step 1. Sure, it'll all be covered, but there's a hell of a lot more path than histo - tons more pharmacology than biochem. That being the case, it really puts my learning thus far into perspective. Am I on the right track? Have I learned things well, or just "learned'n'purged"? There was definitely some of the latter, let me tell you - a month ago, I knew those diabetic drugs.


I guess we'll see. I'm anticipating 5th semester in Miami - whereas my colleagues are daydreaming about the reliability of hot water, and the complete absence of cows on the road, my thoughts are a bit more direct; since my building has a gym, I'll be able to work out every day - and I'll be able to do thousands of practice USMLE questions. In the words of one of the rednecks who lives in the backwoods of my mind, "I'm gonna whup that puppy."

Nothing left but hurdles

It's a little humbling to think that, since classes are over, I'm officially supposed to know everything I need to know for the USMLE STEP 1 - humbling and a little bit nerve-wracking. My last few days on this island will essentially suck big time, because they'll consist of an obscene information binge.

I realized some time ago that I'd gotten used to a certain amount of reliable transition in my life. I went to the same grade school for 6 years, but then all of my friends dispersed to different high-schools. After 2 years, I moved to Texas. After 2 years, I went off to college. Once there, I pro ceded to shuffle around my friend-group every year-and-a-half or so. There were of course some constants in there - some folks I'll do my best to stay in touch with - but the change was always welcome. After that I lived at home and worked for a year, and then the time came for that to end too. Now that I've been here on this island for almost 16 months, I think I'm getting ready for a change.

I was told that this wanderlust-like friendliness with change is something unique to military kids and other folks who've moved around quite a bit. The military really didn't shuffle us around too much - I moved when I was 2, 7, and 16 - but that last one was the most significant. All of the moves have been positive - but I find myself wondering what happens when I have to settle down and stick around for more than a few years at any given place. I bore easily and am in constant need of stimulation - I guess that means I'll have to (1) do my residency in a huge city, offering endless diversions, and (2) work as a wandering locum for the rest of my medical career.

There's still the possibility that I'll end up as a teleradiologist, reading scans at home on my giant, wall-sized plasma screen TV - in my underwear - but that still just one pipe-dream among many.

I digress. You know, just because someone teaches at a med school, it doesn't mean they can teach - not even if they've got all sorts of fancy letters after their name and are old enough to remember the Mayflower. Don't get me wrong, the vast majority of the professor here have me in complete awe of their ability to simplify and condense boatloads of information - but a few have me in just as much awe of their precise knack for doing the exact opposite. So now I have to read the kidneys all over again. Gee, thanks.

21 days and 7 tests left on this island. There is nothing left to do but study and pack.