Realization

Day 9

Four  hours of lecture again today was much easier after having slept well. I finally managed to tape down the edge of my window shade, a vital need because the light would shine into my room directly on my face every morning. This meant I was rudely awoken at daybreak. It didn't help that on Tuesday, Anatomy lab starts at 7:40 am. 8 am on Wednesday is not much better. I have a feeling that coffee may become an intimate part of those mornings.

In Anatomy lecture today we examined more closely the spinal cord. The cord itself runs from the brain down through the vertebral column, and ends (in most adults) at the second or third lumbar vertebrae. The sac of dura mater extends down to the first or second sacral vertebrae. This means that between L2 and S1 there is an area of cerebrospinal fluid that can easily be accessed without harming the spinal cord itself. Clinically, that is done through a lumbar puncture. The theory of this procedure at least, was the subject of this particular section of lecture.

Because we were seated in the back of the lecture hall, I was carrying on a side conversation about the correct level to perform a spinal tap on a child, which had come up the night before during my evening studying. The lecturer got our attention; saying the next piece of information was important.

He asked us to imagine that a patient came into the emergency room presenting with a headache. A spinal tap could help to assess if the patient had meningitis. However, if the patient had suffered a head injury, it was possible their pain was due to increased pressure in the cerebrospinal fluid. If we were to do a spinal tap under these circumstances, the resulting pressure change would cause the brain to be sucked downward out of the skull, thereby killing the patient.

I was momentarily floored by what he had said, not just because of how awful that sounded, but because I realized in that moment that this was unlike any class I had ever taken. In all my other classes, If I fail to remember information, I might get an F.

In this class, if I fail to remember information, someone could die.

Welcome to medical school.

My First Day

Day 7

Since I was young, I could never wake up early for anything. Today, I couldn't sleep. The light streaming through the side of the shade of my room woke me up at 6:30 AM. I tried to roll over, to cover myself with my sheet, but the insistent caribbean sun would not be denied. Drearily, I climbed out of bed and trudged to the kitchen to fill a bowl with corn flakes and milk (one of my best purchases so far.) On the way back to my bedroom, I glanced at myself in the bathroom mirror. I looked tired. I felt tired.

I gulped down my breakfast and headed out the door at 7:25, dressed in shorts and a T-shirt. My roommates (upper termers) had told me that no one wore scrubs around campus.  Upon looking around I saw that they were wrong. I couldn't run back to my room and change but that was okay; I had my surgical greens in my bag. I couldn't run back because it wasn't just any other day. It was my first day of medical school.

From when I was a child, people assumed that I would follow my parents footsteps toward medicine. It was without thinking that I set myself on that path. It took a life-changing event for me to realize that medicine was my own choice. I knew the curriculum, knew the steps I would need to trace to make it from the first year to the fourth. I knew that road was starting today.

I almost ran to the top floor of the science building for anatomy imaging lab. I ducked into a bathroom and changed into my scrubs. I was nervous.

This was my first day, and how it went might change my life's path forever. After a brief orientation, our lab groups split up into various stations. At each station was an ultrasound machine, a MD tutor, and an actor portraying a patient. Our teacher demonstrated the use of the machine on the patient. He asked for a volunteer to try the machine. My hand flew up.

As I walked to the machine, I realized that all of the agonizing over this past summer was for nothing. I introduced myself, shook the patient's hand, and got his name. I started to explain the procedure, and was interrupted with my first lesson of the day.

"Always ask the patients permission." the tutor said, In my hurry to show the group my skills I had forgotten this important step. Unflustered, I rephrased my words; "Is it okay if I examine your arm with this ultrasound machine?"

I picked up the wrong probe. It wasn't even connected to the machine. Even so, I went back to my seat elated. I had started the process of learning medicine. Not just memorizing Anatomy and Biochemistry, I was learning how to be a doctor. On my first day!

Wet lab was next. I was at first a little apprehensive about the cadavers. As soon as the exercise began that melted away. I was here to learn. We rotated through the various stations. When we reached a tray containing what looked like a large deflated black kickball, I started to prod what was obviously a pair of human lungs with the probe.

The lab instructor picked up the lungs and demonstrated some large cancerous lesions on the underside. Here, she said, after she had finished, and deposited the organ in my gloved hand.

The rest of the day seemed to fly by, group discussion, lunch with friends, and our daily four hour dose of lectures. Afterwards, I went about making a snack, and headed to the meeting of the Humanitarian Students Organization. I signed up to help paint a nursing home.

Yesterday, our White coat ceremony had an unexpected distinguished visitor. Five minutes before the event was supposed to start, one of the organizers got on stage to inform us the event would be delayed ten minutes. The Prime Minister of Grenada was on his way from a cabinet meeting. When the ceremony started he spoke to us about the history of SGU in Grenada, and our place as students. What struck me most of all was how lucky I was to be studying in such a welcoming country. I may not owe SGU more than the balance of my loans, but I feel like I owe Grenada a little community service to balance out their hospitality.

The highlight speech of the night, however came from the Dean of Medicine, an aging New Jerseyan, Dr. Jacobs. He told us stories about his own residency, when he knew he was a doctor, about honesty with patients, and the joy of saving a life. He framed our journey in a way I hadn't considered.

The doctor exists to heal bodies and minds, to support himself and his family, and to contribute to medical knowledge. Dr. Jacobs made it all real however with his closing. We were to be more than scientists and physicians. "Go," he said, "and do good."

The Worst Trip Ever

Day 2

I'm writing this at my desk in my room at St. George's School of Medicine, Grenada. I don't want to spoil anything, but I eventually made it to school, despite the best efforts of "THE Caribbean Airline." A little lesson I've now learned extremely thoroughly: Never, ever, ever fly with LIAT. It actually stands for Leeward Islands Air Transport. Most locals have some other names for it including;

Leaves Island Any Time

Languishing In Airport Terminal

Luggage in Another Terminal 

I flew American Airlines from JFK (New York) to San Juan, Puerto Rico. All this time, I had been nervous about going to St. George's but it was nothing compared to how I felt actually doing it. I felt slightly sick to my stomach the whole flight to San Juan. I arrived five minutes early, which I expected. I made my way to the LIAT terminal and managed to check my bags. Despite the website's assertion that passangers were limited to one carryon of 15lbs or less, they didn't say a word about my two bags, both of which easily weighed thirty apiece. I took this as a good sign: I had no idea how wrong I was.  I had to go through security again to get to the terminal. They made me open my carry-on bag and searched through it, but I made it through with ten minutes to spare. But in addition to my two carry-ons, I had another passenger following me that day. His name was Murphy (of Murphy's Law fame) and he would make sure that anything that could go wrong, would go wrong. Before the end of the ordeal of my trip was over, I would personally experience the reason for each one of LIAT's nicknames.

Despite the fact that the islands of the Caribbean lay in the same time zone as the Eastern United States, it feels like they are a part of an entirely different time zone: Island time. Most people move at their own pace, and schedules mean next to nothing. I ran to the LIAT departure gate, which was down a level from the rest of the airport. I realized this was because, we would not be taking a gangway, but instead would walk right out onto the tarmac to board the airport.

Boarding the LIAT plane in San Juan.

The plane was small: it could seat maybe thirty or forty people. More harrowing for me was the fact that it wasn't a jet. Unlike any other plane I had flown in, this one was kept aloft by two turboprop engines. The result of this was that the plane made a deafening noise whenever we were in flight. The other result of this was that the plane was incredibly slow. 

My flight was scheduled to leave at 3pm and arrive in Barbados at 6:05pm with one stop in Dominica. The flight crew arrived casually at 3:30pm. Onboard the flight, I was told the plane would also be stopping in Antigua, but that we wouldn't need to get off. I was worried about the additional stop, but I was assured that we would make our connection. This was my first taste of LIAT's particular brand of customer service. I have to say that all of the employees are extremely helpful and pleasant, but unfortunately, most of what they say is wrong. Partially this is because the higher ups in the airline lie to the employees (and by extension us) about everything from arrival and departure times to what planes are where. There's a reason that my iphone autocorrects "Liat" to "Liar." 

At Antigua, LIAT's headquarters, we were told we would be switching planes. We went through a mob-like line at the "In-transit desk", where they took one of our boarding receipts and directed us through security. My backpack was opened and searched. After I had made it through, they directed me to departure gate one where we lined up, showed our passports to the security officer for inspection, and walked out onto the tarmac. We were directed onto the same plane, almost two hours after we had left it. 

I met three SGU veterinary students on the flight, upper termers who mostly spoke amongst themselves in rapid-fire spanish I couldn't follow. We flew to Dominica and after a brief stopover where they luckily didn't make us leave the plane, we flew on to Barbados. By this time it was almost 8:30pm, so I asked the flight attendant if there would be a flight to Grenada waiting for us. She spoke to the station over the phone, and reported back to us that the last flight to Grenada was waiting for our arrival. Once at Barbados, we hurried through the modern airport to the LIAT departure gate. The woman at the desk told us the plane had not waited. She told us that the next flight was at 7am the next morning, and that it was probably cancelled. 

They put us up in a hotel for the night; It was comfortable, and they paid for our dinner. They awoke us at 5am and we were driven back to the airport where we rechecked our bags. I was polite to the clerk at the desk, and she didn't say anything about my clearly overweight carryon bags or the fact that my checked luggage was 5lbs overweight. 

We hurried to the departure gate, where we were told that the 7am flight was delayed until 8am. At 8am we were told that our flight was delayed until 9am. At 9am, they called our flight number and asked we assemble near the boarding gate. The supervisor of the desk staff came over and told us that our flight was going to be a little late. It would be arriving at 5pm. We were stuck in the terminal for the rest of the day. The monotony was relieved only by the wifi in the terminal. They gave us breakfast, which I skipped, and lunch which I didn't. Things in Barbados are expensive; my meal, which consisted of a fish sandwich, fries and a small drink cost 25 barbados dollars ($12.50US). 

While we sat in the terminal, these planes sat doing nothing for hours, and then were given to people whose flights were scheduled after ours. 

Around 12:30pm we were told our flight was cancelled. The news was followed up by a small piece of good news: that another flight, 687 had been cancelled as well, and that the plane would instead bring us to Grenada at 5:40pm. 

Around one, a small aircraft crash landed on the run way. Though it looked like the fire was quickly put out, the only runway at the airport was closed for more than two hours. It reopened close to three thirty, and flights started to go in and out. 

Finally, after hours of waiting, our flight number was called at 5:30pm. I squeezed to the front of the line. I was the fifth person to walk out onto the tarmac. I was directed to the first of two LIAT planes waiting. I got onboard. It was flight 727, the stewardess said, but would also go to Grenada. One of the veterinary students got on the plane as well. In all about eight people were put on the already packed plane. I sat next to a woman with a baby on her lap, which was screaming and kicking and grabbing at my arm. I didn't care. 23 hours after I was supposed to leave Barbados, I was finally about to leave.

A relieved selfie. 

We flew into Grenada. There's very little time difference between "starting to get dark" and "night" in the Caribbean. By the time we arrived 45 minutes later, it was pitch black out. We made it into the terminal, where I found out my luggage had not arrived. I asked it it might have been put in the next plane, thinking they must be right behind us. I was told that plane had not left Barbados, and would probably be cancelled. 

I made it through customs very quickly and was taken by cab to my room at St. George's. While much of the island (at least what I could see from the taxi) looks slightly run down, the campus of SGU is extremely nice. My roommates were home. Both were fourth termers in the school of medicine and spent the entirety of my first night studying. 

I grabbed some subway (located at the student center) and watched TV until it was time to fall asleep. My first night in Grenada was complete, and it felt like there was no way I could possibly adjust. As with most things you think exhaustively after two days of stressful travel, there was no way to tell if I would be wrong or not. 

The Homestretch

3 Days to Go

My Facebook page is blowing up with people who are already in Grenada. I'm on what is probably the latest flight possible.: I'm arriving at 9pm the night before orientation. I'm excited and a little jealous to hear what a good time people are already having on the island, but I'm sure ill catch up. 

Speaking of catching up, I downloaded the Nike+running app for my brand new iPhone! So far I've only run five and a half miles, but my goal is to run 1000 miles in Grenada over the next two years. I've been trying to get in better shape because I don't want to feel like a hypocrite when, as a doctor, I tell people to eat right and exercise to be healthy. Plus, I want to look good in a bathing suit! 

So here it is: just three more days before my life changes forever. The homestretch; but really a starting block. This whole summer, really my whole life has been a warmup lap. It's time to start for real. Three days to go.