Taxes at Work.

Another week down. Actually, it was a fast week. We only had two classes per day, which is something of a dream around here. Unfortunately, that dream ended this morning about as abruptly as the construction next to my room began. In all fairness, it has been going on since we've arrived, but I feel as though they definitely begin earlier and earlier in the morning. I can't complain specifically if it means they will finish on time (actually, they are building a new dormitory in which I hope to live next semester, but it had an original completion date of August 2004. I think Hurricane Ivan had something to say about that.).

But, that does not mean I enjoy hearing the banging and sawing and shouting and whatnot at the exact time of the sunrise each day, which is coincidentally around 6:30 each day. The good news, of course, is that the countdowns have officially begun. I now have only 49 days remaining on the island until I get to leave and enter civilization again. OK, I'm being unfair again. They have a distinct civilization here, just not one to which I was prepared.

Let me elaborate. At our on campus restaurant, Glover's, which is complete with a full bar, among other things (I can't help harping all over that all the time), they very often will let you order and then say, "We're out." To which one often replies, "Oh," and goes back to the menu. After another few minutes, after trying to order again and hearing, "We're out of that," one begins to wonder what they actually have available. Unfortunately, no one who works there is going to volunteer that information so you have to keep ordering until you get it right, or so I used to think.

One of my friends walks up, orders, pays and then meanders off to find the rest of us and relax for a few minutes on a Friday afternoon. After ordering, you just wait until the food appears behind the bar and then you have to judge if it's yours or not, and then go ask and maybe get told, "A few more minutes." So, after fifteen minutes of waiting for his pizza, he heads back up and wonders how much longer?

The lovely woman at the register says (I'm not making this up), "We're out of small pizzas, you can only order large." My friend says, "No you're not. Use a smaller piece of dough."
- Register responds, "I said we were out."
- "And I already ordered and paid. I'll be back in ten minutes."

Lo and behold, it worked. He went back up in ten minutes and his pizza was waiting. I cannot specifically verify the cleanliness of said pizza, but it was a lesson learned for all, i.e., one can get things done around here; it just requires the proper motivation. Of course, try acting like Miss Register in the States and there would be some consequences; in Grenada, this is the norm.

Anyway, in addition to the little tiff with the Glover's staff, there was a little party called Sandblast a week ago. It was a way to blow off some steam from all of the exams that most terms had just finished. It was held on the same beach as the first party, and was in much the same manner. Except this time it was during the day and there was sponsored water activities like wake-boarding, banana boat riding, food, volleyball tournaments, etc. One of the highlights: the professors always line-up for a water-balloon toss from the students, so that was pretty funny to watch.

Another highlight, of which there is a picture above, was a small rainstorm we received in the middle of the day. This is extremely common here, i.e., a downpour for fifteen minutes, and then back to perfect weather (it supposedly doesn't happen in the dry season, read: January through July), but we are proving them wrong on all accounts.

Regardless, it began to rain, so the huge speakers needed to be covered. If one looks closely at the pictures, the phrase "USAID" can be seen, which is what the U.S. writes on anything they send to the 3rd world to help them recover from anything, and which the local medical school is using to cover its speakers during huge parties. A classic irony of which all Americans should be proud . . . and it works for us!

Happy St. Paddy's Day!

Many of you must be thinking, "Wow, two posts in one day?!?" Its true. In honor of St. Patrick's Day, I've decided to post one of my all time favorite shots. This was taken in 2000 at the beautiful Cliffs of Moher. Enjoy your Guinness, but for the love of all things Irish, do not drink any green beer.

What recovery period?

We are now 1/16^th on our way to completing medical school. How daunting a prospect is that? Since I officially passed all my midterms, I am now $10,000 smarter than when I started (and just for fun, that makes me worth about EC$26,000. I might just stay here!). And we’ve already dived deeply into the material for the next half of the semester. In fact, the very morning after what could arguably be considered the most stressful week in my educational career (as it determined whether or not I could really continue in school), I was scheduled for my first patient interview at 8.30am.

Now, some of you might be saying to yourselves, “How interesting. I didn’t know you started learning those skills so early in your schooling.” Indeed, it would have been interesting had we received any advanced preparation for this sort of thing. In fact, there was not even an announcement from my favorite department (Clinical Skills) as they simply posted a notice outside one of the lecture halls during the exams. Conveniently, I might add, not the one in which I took all my exams.

Consequently, I found out on Monday evening, after several beers, that I had to be ready to speak to a patient at 8.30am, and was expected to know what to ask and how to review the systems (cardiac, nervous, pulmonary, etc.), and would be graded on this experience.

I found myself feeling rather lucky then, at 8.30am, that I had worked at St. Mike’s for so long. Working with the trifecta affords me the opportunity to literally assist with hundreds a patients each day, learning little bits and pieces of information about what questions are most pertinent to each situation (although, realistically, I am often teaching them, with such nuggets as “point 5 alive!”. I’ll never forget that as long as I live.)

(I’d like to take this moment to welcome the newest addition to the trifecta. You know who you are, and don’t think I haven’t heard about admitting patients to critical care from the NUC.)

Of course, what gets me miffed about the whole situation is the fact that it was 8.30am, basically unannounced, the morning after midterms. I mean, did they realistically expect people not to enjoy themselves a little more liberally that night as there was no new information being presented for the next 24 hours? Get serious, it’s Grenada. I’ve seen more bars here than in Madison. (OK, that’s obviously not true.)

I suppose, as a medical student, I am expected to undergo certain difficulties in order to “prove my worth” or “live through residency”; however, I might point out to those people who take this line that I am not, in fact, a resident, nor am I being judged on my ability to get up at 8.30am, yet. Nonetheless, I guessed correctly. Our patient, a lovely middle-aged woman with abdominal pain, played her part well. As it was our first attempt, it was funny to see us dance around the really painful issues, i.e., her recent sexual history, in order to arrive at the final conclusion of gonorrhea, but we all survived and are just that much better for being in class that morning.

What really bothers me about the whole thing is the fact that they gave us the lecture on patient interviews that afternoon, and then blamed half the class for not showing up (since only about half of us made it to the sessions) on not hearing an announcement, without acknowledging that there was not an announcement in the first place. As they say, you can’t win ‘em all.

Derelict Duties

It has recently come to my attention that I have not been diligently updating my current situation. This is a result of many factors, not the least of which is my midterm examinations of which I am currently in the middle. To date, sadly, I have not had many exciting experiences, although I did receive an awesome package from members of the trifecta. As we had our biochemistry exam today (I personally believe that is the definition of starting out with a bang), and I got an 'A' (I can't believe that A's are attainable in biochemistry, much less by myself, but I'm intensely proud of it and wanted to share), I thought I would take a little break to talk about the trifecta and how it might affect life at St. Michael.

To start, the trifecta is a collection (oft disputed) of characters on the 2nd shift (or PMs). It usually only presents itself on Mondays, which coincidentally is, anecdotally, the busiest day of the week. Oftentimes, beginning PMs at 3.00pm is not a terrible thing. Day shift has usually done a stellar job stocking the rooms are preparing us for the thousands of patients that will come strolling through the door from 4.00-5.00pm.

This is approximately the same time the trifecta kicks into action. Normally, the charge nurse will take a call from 'Paramedic Base'. Paramedic base is located at Froedtert, and coordinates the pick-up and transport of critically ill patients from their 911 call to what is usually the closest hospital. Since only RN's are allowed to take this call, I will often stand over the shoulder (much to the supreme annoyance, no doubt) of this charge nurse, who will be writing information regarding the incoming patient.

The trifecta affect is official once the charge nurse writes the letters 'PNB' on the paper. This stands for Pulse-less, Non-Breathing, and means CPR/intubation and a 'code'. To complete the trifecta action, the patient will be sent to a room on the side with by far the most admissions, the newest RNs and me (This is rarely anything other than the B-side, and especially Trauma 5). In fact, on one occasion, I was the most senior personnel involved in a trifecta incident. (That is not to say the most knowledgeable, just had the longest employment at St. Michael.)

Possibly the greatest all-time trifecta moment occurred during CPR:
- "Do we have a pulse??"
- "I don't know, but we've got a hernia."

Now, I'm not aware of further developments of the trifecta since having left, but I can say that I'm sure it’s not the same. I know that certain RNs will readily fill the vacancy I have left behind (and I think it would be safe to say that certain people are their own trifectas, and you know who you are). But, to make an incredibly long-story pertinent, in the package I recently received, there was a t-shirt. Written in block letters across the front is the phrase, "Trouble Finds Me."

And finally, because everyone should learn something new everyday, here is an interesting piece of trivia: Rouleaux - A French word meaning "stack", e.g., The erythrocytes form stacks called rouleaux which settle faster (impress your friends!).