Sunday, April 30, 2006


I worked in a hospital for over a year on the Hem/Onc floor. We were the highest Onc floor, which meant we had the most terminal patients save for the ICU just above us. The night shift was a long shift, and we would pass it at the nurses' station talking about nothing. The nurses would tell me about each patient or go through the charts with me (which might be against JCAHO, might not be) and I'd try to absorp what I could. When a patient needed to go for a CT scan, I would take him in his bed or wheelchair and sit behind the consoles watching the slices of their body on the screen.

After a year, even without any training in Anatomy, you get an idea of which cancers are the worst and what they look like on the CT. You know where each organ sits in the body and what it's supposed to look like. And more than all of that, you can tell when the CT tech is holding her breath and the physician brings his hand to his mouth that this person is in some trouble.

So it was with Anne. She was a little younger than me, a year maybe. She went to a college that I knew well. We might have known some of the same people. She came to our floor with her parents and sister. I admitted her, went through my "this is everything" speech after I took her vitals, and let her family know that I was only a call-button away. She was beautiful and healthy and trying to make the best of it.

The admitting physician called me over with a wheelchair and I took her down to CT. She asked me where I went to school, if I was a nursing student or a med student (neither at the time, but hopeful), and my age. We had a lot in common. I helped her onto the table and then went in the back with the monitors. The Tech held her breath, the doctor covered his mouth. I saw what they saw: hundreds of tumors in her liver. "Poor girl. She's so young."

Everyone was speaking less as I took her upstairs and she knew. When we were alone in the elevator, she asked me, "So. What do I have?"

I didn't say. "I'm just a tech; I can't read a CT." Again, she knew. I brought her back to her room and she said, "thank you." My shift ended a few hours later, but not before every nurse on the floor knew about this girl.

I came back the next night and I could tell that the doctors hadn't told the family. I came back the next night and off the elevator I could hear the papers moving at the secretary's desk above the sounds of the nurses' conversation. They had told her. I looked at the assignments and she was my patient that day. I rounded, got all my vitals and emptied urine and talked to families. Her room was the last. I came in ignorant and smiling because I'm not supposed to know what everyone knows. Her mother met me, told me it had been a hard day for the family, and that the nurse already got the vitals. "If you need anything, please..."

"We know. Thank you."

She became sicker, friends started to visit, and then she left for a different hospital. I never found out what happened to her.


Working in the hospital, that first week, you're obsessed with knowing everything about the patients. You write their first and last names on your record sheet, you know what they did for a living, and you look at your insensitive coworkers that don't know their patient's names until they read their wristband. They have patients 3, 4, 5, 7, 9, 10, 14, and 15 instead of Mrs. Hayes, Mrs. Bopp, etc. You tell yourself that you're going to remember the names of every person. You're an idiot.

I'm no different. I tried it and slowly they slipped away. Then I started forgetting the names of people that had been on the floor for weeks at a time. Then I couldn't remember the names of the people that had died on the floor, or the ones I had watched die. Then I couldn't remember even 10 of them.

But I've always remembered Anne. Everytime I feel the year I spent in Hem/Onc slipping away and I can't remember the nurses' and the doctors' and the patients' names, so long as I remember Anne I feel like I haven't lost it all. And I wonder how she's doing. And I worry about her often.

Friday, April 28, 2006

Bet a Beer on It

I assume you want to do well in medical school. A trick I've learned since coming to Grenada is this: talking helps. After you've read about the sympathetics and the parasympathetics, spent some time in the library committing the topic to memory and worked through a handful of practice questions you start to feel comfortable with the material. Then you find yourself in a conversation with a classmate, trying to explain the concept to him when you realize: I don't really know this. You stumble over your own explanation and a couple of excellent questions later you think about all the time your spent working on your wrong answers and you want to cry. At least I do.

That was my second week of class in Anatomy. Afterwards I started studying with the guy that asked the great questions and made sure that we talked through all the concepts every couple of days to keep each other on the ball. It shouldn't surprise anyone to know that it works like gangbusters. After that we found another person that asked great questions and he was studying with us too.

We were lucky to find each other early on, stick to our schedule for covering each course, and to end up testing well. With the confidence of doing something correctly, you start to see the game emerge between the students and teachers. You begin to read the notes and see the test questions buried inside them. You start coming to group review with questions that you've created to stump your friends. They come with questions of their own and you fire back and forth. You bet a beer that such and such will be on the test. You bet three beers and four beers. You have to get out flash cards to keep track of all the bets. And at the end of it all, exhausted from the exam, you meet at the bottom of the hill in front of the D-store to tally-up and celebrate with your class. It's intoxicating.

Remembering the thrill of learning and the excitement in the eyes of a person that "achieves understanding" of a difficult topic is what you cling to when two solid weeks of exams loom two weeks away and you're holed up in the library hating the clock as it ticks past midnight. You remember that and then you see an interesting detail in the notes that you bet your friend doesn't see. And you write it down. And you think about that beer you're going to win.

Tuesday, April 25, 2006

Phlebotomists 'R Us

I knew back in the hospital as a tech what all nurses and patients have known since time immemorial: doctors can't draw blood. They're horrible at it. Shouldn't matter, right? Doctors have other much more important things to do like Chest tubes and Lumbar Punctures and all the other things that make an aspiring med student salivate. As an underling, I was almost grateful that I could be better at just this one stupid thing. What's funny is that patients don't think that way. When a physician walks in and starts stabbing and missing, they change in the eyes of their patient and become a little less Superman and a little more Clark Kent. Too bad that it happens over some stupid blood draws.

But here's what really gets me: they get to pull ABGs! An Arterial Blood Gas is a collection of oxygenated blood from a pulsing tube in your wrist. It's deeper than a vein, harder to draw correctly, and with more serious consequences. Patients wnjoy this even less than a vein puncture. So since my first days in the hospital, I've wanted to know exactly what kind of training future MDs get in the arts of nursing. Well guess what...

OUR CLASS JUST DREW BLOOD! That's right, 300+ students that have never held a needle were shown a 10 minute instructional video explaining what happens when nothing goes wrong, and then they were given a tube, tourniquet, needle, cotton swab and bandaid! We were placing bets on how many students would pass out, vomit, or just walk out.

Guess what: THINGS WENT WRONG! Needles with vacutainers still attached were pulled, sucking tissue with them; veins were blown and swelling under the skin with tourniquets still tightly fastened; and hands were shaking so violently that the needle was scrapping back and forth before it had the chance to hit the target. There's a rule among phlebotomists that it takes 100 draws to get comfortable and trully competent. With that math in mind, 3 people had correct draws today. Pretty respectable, I think.

Our group faired well: three shaky hands, two blown veins, only one blood spill onto the table and a lot to laugh about. Good day all around.

P.S. If you need a summer job that pays within reason: phlebotomy is the way to go.

Monday, April 24, 2006

The House Effect

It's probably unfair to call this the "House effect" because this problem predates that show by a few decades, but I'm going to anyway.

House effect: obsession (of both teacher and student) to know (in detail) the aspects of a disease that you should never see in your entire life.

I learn that 95% of all tumors of the gallbladder are adenocarcinomas. Ok, I'm fine with that. What I'm not fine with is a page of notes then devoted to the minutiae of that remaining 5%. It's not necessary. It wasn't necessary after I learned that 90-95% of lobar pneumonias are caused by strep. pneumoniae, and it isn't necessary after I learn that 98% of all peptic ulcers occur in the antrum of the stomach and in the duodenum. You can keep your 2%; I don't want to know it.

Under the same logic, I should NEVER HAVE TO KNOW ABOUT ANTHRAX. I'm staring at two pages of Anthrax notes right now, and while I feel very prepared to hold my own against a talking head on FOX NEWS, I sure as hell know that I will never put this information to clinical use. And let's say, for argument's sake, that I did? Let's say ten years from now I see a case of anthrax: I'm calling the CDC and letting them cough up their lung (which is what everyone should do, regardless).

The logic of the last 5% is pretty simple: if you treat 100 patients you'll see it 5 times, so you need to know it. I understand and respect this. I also understand that all the truly useful things I ever learn will be on-the-job. So if during rotations my Resident decides that I really need to know the 5%, then I'll know it. But just imagine how much more useful it would be if every medical student walked out of the first two years knowing 1) the top five causes of everything or 2) the causes that cover 95% of cases. Instead, I feel like I lose sight of the forest because the people writing my tests think the ant on that piece of bark on that rare tree is too interesting to skip. So I should probably know that instead.

Sunday, April 23, 2006


So congratulations! If there's any course that signifies medical school to the undergrad, it's Human Anatomy. After this you should know every bone in the body, every muscle that moves them, and every nerve that orders them around. And I'm kidding. You will cover a fair bit of it, know some interesting clinical presentations, and be able to explain to your friends back home what "fight or flight" is all about. And isn't that the goal? To sound impressive?

This course has changed a bit since I took it. Instead of having every student slave away in the lab cleaning fat for a grade, the department now pro-sects (a professional dissection) every structure of interest and then takes you through ID, relationships to neighboring structures, and pop quiz. I think you get to dissect the first day on a space that's impossible to screw up too bad: the superficial back. Of course this didn't stop me from cutting all the way to the ribs on that day. And yes, an announcement was made to the class that I was an idiot.

If you've taken the course already and want to freshen up or are taking it for the first time and want a heads up, this site is great. It shows the dissection of the entire human body in easy-to-download quicktime movies. Another great website is the University of Michigan site. Several classes have lived and died by their practice quizzes. Get a wrong answer: it tells you why you're wrong. Most students click all the wrong answers anyway just to see what they might be missing. And for those of you with the free time to dream of overachieving, they have surgical videos as well.

Now for the books. The school gives you the combined oil paintings of Frank H. Netter, may he rest in peace, and the "Baby Moore" Clinical Anatomy book (make sure you read the Blue Boxes). For a book with a more gross approach to anatomy, the Color Atlas of Anatomy by Rohen is pretty clutch. Some students go so far as to buy Clemente's but between you and me: that's overkill. For those out there who like coloring books, they have those too.

The school produces their own Anatomy manual in binder format and all of the lectures are online as PowerPoints. Review at your leisure.

Strategy for covering all of this material? Who knows. The first week or two of classes is light, giving you every opportunity to study like an idiot and learn everything incorrectly. It happens, don't sweat it. Instead, learn about the different ways to study and make a trip to the Department of Educational Services (DES) office and have a chat with them. I did both; both helped. Another thing you'll probably due is attend too many DES sessions (tutored by students that are 4 months ahead of you), artificially boosting the confidence of said tutors until you cut back and find your rhythm. Best advice I received was 1) draw everything and 2) study with people smarter than you.

It's going to be the first hard class of medical school, you will get through it, and look at it this way: by the final you will be able to write out all 208 bones of the human body on a table napkin and not bat an eyelash, and that's what medical school is all about.

Saturday, April 22, 2006

Black Belt in Notejitsu

My friends and I laugh at ourselves when we think back to undergraduate. Somehow, we were convinced that it was hard at the time. I remember talking to classmates after a test thinking, "Wow, I studied for six hours in the library for three straight days to prepare. I'm exhausted. I feel like I earned an A." I wasn't lying.

Well welcome to medical school. A friend of mine went out on a date with a med student who had to cut the date short so he could get back to the library, and he wasn't blowing her off. I remember Uncle Neurophysiologist telling me that my life would be in a book, my weekends in a book, my nightlife in a book. I didn't believe any of this. Well the rumors were true.

Medical school is the beginning of your life-long devotion to learning. You will spend the majority of your next two years (preclinical) in the library on a Friday night learning the morphological differences between Tropical Sprue and Whipple's Disease. You will be a student of the 17th and 18th grades. And you had better be an expert at studying.

You will hear about the Cornell Method of note taking. You will flirt with concept mapping (CMap is the best program I've seen). You will swear by flash cards until the rubberband breaks sending your brain spilling across the floor. You will stick with the outline style of note-taking you learned in high school. You will see someone read the notes with a highlighter, achieve understanding, and then put it away until the test comes. You will hate that person. You will see someone that highlights too much, with too many colors, and has colored pens at the ready. You will see people with 3M sticky notes covering their cubicles, the organization making sense only to them. You will see people with too many other sources stacked around them, drowning in it.

Rarely will someone go to the student help center to learn about note taking styles and strategies. And that's a shame. You're going to study more and be tested more than any person that you know outside of this world. It makes too much sense to say that you should become an expert at what you do. So my advice to anyone in medical school or thinking about the plunge is to go to the bookstore, research studying methods, talk to an expert, and earn a black belt in note-jitsu. It's going to be a long hard fight.

Friday, April 21, 2006

Public Speaker

In Pathology we have Clinicopathologic Cases. They're cousin to the SOAP notes of Physio were a patient on paper presents with problems that neatly fit into that weeks' lessons. In contrast to the SOAP note, the CPC is mildly terrifying. Our case this week is a 20 year old male that hit a pothole while drunk on his motorcycle and stopped at a tree, suffering serious trauma, a compound fracture with significant hemorrhage, and possible spinal injury. You're working diagnosis at this point is "idiot".

EMS arrives within the platinum ten minutes to deliver care. They get him to a hospital, work on his leg and get all of his vitals straight back to normal. He dies anyway from respiratory failure. Working diagnosis should now be "tree allergy."

Everyone in my class of 350+ has this case, and while all of us think we know why he died, none of us wants to prove it. No matter, because our professor reaches into a bag with 350+ names and pulls one unlucky bastard to the front: not me. You can smell the collective exhale of that many students while they cheer the lottery winner to the front. He rereads the packet to kill time, asnwers what he can while getting a few things wrong, and is appropriately nervous. People like him and empathize, so he gets to avoid the tough questions.

Afterward I run into a few AAA-types saying how they wish they'd been called and were thinking about volunteering for the next CPC. I hope they let you; it'll be a blood-bath.

This is what I think about when I think of doing clinicals in a year. Lay low, have the right answer if they ask you, but don't be a dick about it.

Thursday, April 20, 2006

Asthmatic Kite Runner

When I was kicking around the idea of being a doctor, my Neurophysiologist Uncle told me to read every book I ever wanted to read before going, because you wouldn't ever read for pleasure again. I scoffed as I often do at such unbelievable things. Well, the rumor was true.

Today on Graham Azon's blog (over my med body) he posted a pdf about a woman with perfect autobiographical memory for the past 26 years. I clicked it open and saw that it was 15 pages long. Well, I'll never get to know about that lady becuase I don't have 15 pages of free time.

And that's the way I look at books now. A 350pg book isn't some amazing journey through the life of such n such; it's 4 days of waste with a 3rd place ribbon on my test (C). Nope, I'll never know what it's like to fly kites in Afghanistan. Too bad. Instead I'm learning about Asthma.

Though flying a kite would hit the spot right about now.

Wednesday, April 19, 2006

The conversation with yourself

I remember the early days of first year when the work was hard and the labs were long and we had our hands in cadavers and our heads in biochemistry and we felt like some of the smartest people in the world. Everything is great, you're dating new people and forming strong friendships and then BAM. The work is too much that week, that night that day. And the pesonnext to you is getting it. And they're excited the way you used to be excited and life still feels easy to them the way you miss it. That feeling will hang around your neck as long as it needs to. It'll keep hanging there until you have a conversation with yourself.

Why am I doing this? My friends back home are starting their jobs and making money and buying new things to make their apartments look nice so the people will want to sleep with them and I'm missing all of it. This is first year. It only gets harder. Why am I doing this? I could quit. I could quit right now and I'd only have $40,000 in debt to pay for my mistake. It might just be worth it. Maybe I should quit. Maybe this was a bad move.

And of course maybe it was a bad move for you. Maybe you shouldn't be here and the smartest decision of your life would be leaving right now and cutting your losses. People stay though. They stay because they know a moron the year ahead of them, so figure it can't be that bad if THAT GUY made it. Some people stay because they don't know what else they'd do with themselves. Some people stay because as much as it sucks, they can't do anything else. The point is that the doubting doesn't have to stop because you want it to.

I'm almost half way through 2nd year and I'm having a bad week. I don't feel like I'm learning any of this Pathology and I've ignored Micro for three weeks now. It's all going to catch up with me whether or not I catch up with it. And if I don't suck it up and pull through then it's going to sting real bad when I see my test. Feeling beat up and stupid is no fun, and it's frequent enough that you often feel like quitting. But I remember exactly where I was standing on campus in first year where I had that important conversation with myself. And I remember my answer.

So I'm waiting for it to get better, plugging away while it isn't and telling my problems to a stranger. All of it helps.

Tuesday, April 18, 2006

Everyone's a Ken Doll

You'd think that at this point in our lives, as med students, that everyone would be comfortable with penises and vaginas. We are not. I remember as a first year in Anatomy lab there being seveal students that never laid a scalpel on the body and remained on the margins, their scrubs smelling just as bad as everyone else's but missing the flecks of flesh. This would be laughable if it weren't encouraged. Pick up a medical textbook and more often than not, instead of an anatomically correct drawing you get a Ken Doll, complete with nondescript genitalia and breasts that ride the border between overweight guy and underdeveloped girl.

So I was surprised today when I walked into Clinical Skills to see a video of a very curt Irish physician giving a full pelvic exam to a very hairy Jewish girl. I was more surprised than anyone, having heard so many stories about giving pelvic exams to manequins instead of prosititutes like the other medical schools get to do. I don't know where I heard that, but I did.

So after a perfectly graphic demonstration of a female pelvic/anal/breast exam was an equally graphic male example. Checking for an inguinal hernia does not look fun.

"With your right index finger grab a section of free scrotal tissue and feed it up and into the inguinal ring, following the spermatic cord, where you may appreciate the internal inguinal ring."

Now I applaud the folks that put the video together and the phsicians and patients that volunteered, but everything was still a little off. Hospital work, though repetitive and disgusting, does have a pot of gold at the end: you get comfortable. It took my around 11 months to get really comfortable to the point where I could talk to patients about their dying and regrets and family. Being able to speak frankly and honestly with a person that near death is special and should be mandatory. Imagine you're dying slowly, having the chemo-book thrown at you, and everyone's too busy being motivating and positive to say that, "Yeah, you're dying. How do you feel about that? What are your biggest concerns and what do you want accomplished in the next few months?" Sure you throw a chaplain or two at them, but they aren't part of the day to day care. That job should instead fall to the day-to-day staff: your oncologist and nurses and hell, even your techs.

My point about all this is that those physicians and patients were really off. The patients were too happy and compliant about their anuses and urethras and the physicians weren't distracted enough. Your proctologist is bored with your anus. He's seen thousands of them. Same goes for your OBGYN. The patients are not happy about your finger in their rectums. That hasn't happened to them thousands of times and they want it to be over. They certainly don't hop off the bed and shake your hand afterwards.

I'm not asking for much, just a doctor who'd prefer to do a quick exam and say your fine and a patient who can't wait to hear it so that she can leave. They were all just too happy and it reminded me of the embarassed students in anatomy lab that didn't want to see what a body really looked like, just like the video wasn't showing us what a rectal exam is really like. I don't blame the actors; I blame the director.

Soon, I hope, medical school will stop presenting the "Ken Doll" version of things and let Barbie know what she's really in for.

Shake Hands

I'm a Caribbean medical student. Like most people I tried to get into medicine in the states and was rejected for perfectly good reasons. Chief among them were:

1) immaturity
2) poor scholastic performance in spite of the tools to excel
3) horrible recommendations from teachers aware of points 1 and 2.

Despite those failings, I was done with mediocrity and standing still in life. After graduating I tried to find work in the medical field for a better shot at a second application cycle. The job that I eventually landed was a Patient Care Tech. in a very fancy hospital. The requirements were that you have:

1) GED / High school diploma
2) no drugs in your urine
3) no criminal history
4) no better options

I didn't even get this job cleanly, but instead with an inside man who knew my family and thought I was a good enough guy. It was one of those great times when someone in the position to help sees a little of himself in you. I was glad for it. I worked that job alongside full-time nursing students, grizzled nurses, and a revolving door of people that weren't rejected early enough.

My life consisted of 12 to 16 hour shifts at night on a Hem/Onc ward. In case your curious, the nicest hospital floors are usually on top, except in the Onc building, where everyone is trying to work there way from the ICU on floor 9 to terminal Onc on 8 down to the lobby where people are smiling because they get to go home. I spent 13 months there learning to love patients and hate patients and become used to the worst juices of the body. Like most people seeing that world with fresh eyes, I have several anecdotes about life in Term Onc and I'll write about them in time, whenever I have a slow day in the present. But we're just getting introduced now.

After 13 months of working the same job on the same schedule with the same part of your brain asleep for all of it, you learn a better answer to any admissions question:

Interviewer: "Why do you want to be a doctor?"
You predictably answer: "I feel like each of us owes something to those most in need. I enjoy helping those that are sick and knowing that I have made a difference in their life."
Interviewer: "F minus."

Now let's see what happens after hospital grizzling...
Interviewer: "Why do you want to be a doctor?"
You answer: "I used to think it was to help people, and that's part of it, but if that's all I wanted to do I'd be a nurse or a tech. I'm a smart person and I work well with stress and prefer it, and if I don't end up in a field where I am being pushed to the point of a panic attack, then I just don't want to do it. I am not going to end up as a computer being used as a doorstop. I had 13 months of that already and I just about lost my mind. I want to help people, but the best help I can give them is to go get some amazing training, study my ass off, and return a more capable physician. I'm not going to die happy having done anything less than that."

After it all I was a better applicant with better recommendations but I still didn't have the grades. Schools like to see trends. Straight Bs with straight As your last term is not a trend; it's the picture perfect of someone who could have gotten As the whole time but has horrible foresight. Every school was right to pass again. I prepared for that to happen and had a few applications out to Caribbean schools. They all accepted and so I went with the "Harvard of the Caribbean."

That' where I am now. I'm a second year student so Anatomy, Biochem, Histo, Embryo, Parasit, Bioethics, Jurisprudence, Immunology, Genetics, and a few others are all behind me. I plan on saying a little here and there about them as I move forward, but trying to tackle all of that right now is a sure-fire way to fail at the rest of life.

So that's our introduction. Nice to meet you.

Saturday, April 01, 2006

Welcome to Grenada

Welcome to Grenada.

First off, you probably do not know how lucky you are. The surprise for each new student is how beautiful Grenada is and how anyone could keep their sanity studying in any other place. What follows is a guide to your classes and a glimpse into what your life is going to be like in Grenada. A small disclaimer: I am a white American male twenty-something who had never left the US before coming to Grenada. It is very possible that certain aspects of Grenadian life specific to women are undereported. I apologize. Now let us get started.


It is GrenEHda, not GrenAHda. Pronouncing it correctly is a big deal. Grenada was described to me as a third world country before I came and this will not be your experience. Your time on campus will be indistinguishable from any university in the US; your dorm life will be no different than your undergraduate experience. Everyone uses the bus or drives a car. You will have your Subway, your TCBY Treats, movie theaters, malls, grocery stores, hardware stores, school supplies, bars and clubs. You probably will not be able to find the laundry detergent you like or fresh milk, but these are small things. Anyone who says you will be "roughing it" is lying to you.

***That being said, a few people each year have a hard time adjusting. Some have dietary concerns (it is not hard to be a vegetarian; it is hard to be a vegan). Some get very homesick or cannot adjust to Grenada's culture. The pace here is very slow. ***

The very first mistake people make when traveling to Grenada is NOT taking a layover. Often times the airlines will overbook a connecting flight from Puerto Rico to Grenada and ask that passengers volunteer to take a later flight, often the next day. TAKE IT! You will be put up in a hotel, given miles for a flight in the future, and have a chance to enjoy another island carefree.

Many students have questions about how much their luggage can weigh. American Airlines (in my experience) will tell you to bring no more than two pieces of luggage weighing 50 lbs. each and one carry-on weighing no more than 40 lbs. The problem is that your connecting flight to Grenada may only allow ONE 50 lb. piece of checked luggage and will charge you an arm and a leg to bring the other, or flatly refuse. Call ahead and make absolutely certain with an airline official that your luggage will make it to Grenada, and then get that persons' phone number.

You will likely spend your first night in Grenada without your entire luggage. This is not a big deal. The airline will give you a number to call and you will have your luggage within a day or two. Try to come to the island early so you can take full advantage of Orientation week. It is nice to have that time for settling in, to speak nothing of all of the trips around the island that are provided.

Grenada’s weather has two settings: downpour and blindingly sunny, so come to the island wearing a rain jacket over a bathing suit. Grenada is likely hotter than you are used to. During those first few days, you will break a sweat from standing, lose weight, and drink water like breathing air. You will see students going to class wearing jeans and long sleeved shirts and wonder what is wrong with them. Just know that your body is getting used to the island; it takes about a month.


It's amazing how a few photographs taken by students can add some perspective to the place. Go to Flickr and search for SGU. It says something that the students love the school enough to put all of this together themselves. My favortite albums are shot by Josh and Felix.


No one gets a landline and you should not bring a cordless phone with you. So that means you are buying a cell phone. Since you are now going to travel from the mainland to Grenada and St. Vincent's (and possibly Prague) you probably want a phone that can work in all areas. For this, you need to buy a Quad-Band GSM phone. There are two main companies that offer GSM service in the USA. AT&T and Cingular are now merged into one company, and the second company is T-Mobile. So here's what you do:

1) buy a Quad-Band GSM phone from one of these companies
2) make sure that it is a pay-as-you-go phone with a SIM card
3) go to this website and pay for your phone to be unlocked

I'll explain all of that:

There are four major broadcasting systems used throughout the world. So a Quad-Band phone means that you'll never have to buy a new phone for travel. The SIM card is a chip that contains your phone number and your contacts. Put another way, it does not matter from what phone you call: if you put your SIM card in any phone the person you are calling will see that it is you. So if you buy a SIM Quad-Band phone at home, you will have a SIM card with your home's area code. When you come to Grenada, you will buy another SIM card with a Grenadian number. At this point, you can simply switch the SIM cards while you're one the islands and then switch them back when you return home. Taping them into your passport is a nice way to keep track of them when not in use.

The reason you have to "unlock" your phone is so that your T-Mobile phone (for example) will operate with a Digicel SIM card from Grenada (for example). Pay-as-you-go means that if you want to talk for ten minutes, you buy ten minutes. If you talk over that, the phone simply cuts off (after a warning of course). This means that you cannot possibly suffer overage charges and you don't get roped into a contract. And why do you have to pay to unlock your phone? Because T-mobile doesn't want you to buy there phone and then use it with an AT&T SIM card. T-mobile wants your money. Typically, these companies will unlock your phone for free if you've owned it for three months, but if you're reading this now that's a bit of late notice. So pay to have it unlocked from a separate code vendor and you should be set.

Some students make use of internet phones as well. There are several programs that allow you to make phone calls over the internet for pennies a minute to anywhere in the world. Skype, Netphone, and PCPhone are popular programs and only require a headset with microphone.


For the next few years you will be using Eastern Caribbean currency, or ECs. The conversion rate is easy.

$100 = 260 EC. (exact ratio is 1/2.67, but we will keep the math easy and lose the pennies)
100 EC = $40.
I have $25 in my pocket. 25 x 2 = 50. 25 x 0.6 = 15. 50 + 15 = 65 EC
A three ring binder is 35 EC. 35 x 4 = 150. 150 / 10 = $15 (binders ARE this expensive)

There are banks on the island and no need to ever use them. You can pull EC from your US account at any ATM on the island with a VISA/MasterCard debit card (sorry American Express and Discover). Some credit card companies charge a higher rate for foreign conversions, so check yours. The ATM charge is $1.50 and the conversion rate is standard. If you have a refund check coming to you, I suggest having the school send it home and having family/friends deposit it. You will need to leave deposit slips back home. Do not forget to leave deposit slips back home. However, if you want to pay for things by check, you will have to open an account with a local bank or have traveler's checks at the ready.

How much EC will you spend a day?

Depends. EC is pretty, looks like Monopoly money and you will spend it as such. Breakfast of eggs and toast is 7 EC, lunch is around 15 EC, and dinner can be up to 20 EC. That comes to 42 EC/$17 a day, eating out every meal. It sounds expensive but few people can pull off three meals a day. Most have one full meal and fill the rest with coffee and snacks. You will find your own happy middle. Remember that if you cook and buy your own groceries, you will save quite a bit.

If you drink anything other than water, you are in for a shock. Name brands like Coke, Starbucks and Arizona drinks cost three to four times what they do in the states. That being said, some people still manage to spend a great deal of money on water. Bottled water is sold everywhere on the island and is more expensive than beer. Some students buy a bottle every day. Others (and I recommend doing this) buy one bottle and refill it at dinking fountains on campus. All of the water on campus is filtered; this is not the case elsewhere on the island. I for one have had the same bottle for a month now and may have saved as much as one million dollars. Cigarettes are no more expensive than you are used to, but you should quit anyway.


I get up every morning around 7am and check the class schedule. Typically only two courses are taught a day with each getting two hours of lecture time. On some days you will have Anatomy lab that can begin at 8 or 9am and lasts for three hours, or you have Histology lab at 8 or 10am that lasts for two hours. Lectures begin at 1pm each day and last till 5pm. You do not need to bring much to campus. I usually put my laptop, water bottle, two three ring binders and two textbooks into my backpack and grab the bus.

Eating on campus is not hard though students do complain about the selection. At the top of the hill (you will know it well) there are vendors selling fresh fruits and the Patels selling homemade Indian food. Halfway down campus is the Student’s Center which has two restaurants (Glover’s and Pearl’s) along with a convenience store. At the base of campus is the Sugar Shack. You will not go hungry.

Time before and after lecture is often spent in the library. The library has wireless internet and so should your computer (the “Computing at SGU” section of the SGU website does a good job of preparing you). During peak hours it can be difficult to get a strong connection (bringing an Ethernet cable is a bad move, as many of the plugs on campus work sporadically). The wireless network extends throughout campus into the lecture halls (you can follow lectures online or check email during breaks), across to the bus stop and down to the Student Area (where the gym and restaurants are located). Some students are able to get a connection in their rooms as well. If you live off campus in Grand Anse dorms there is a study room with a wireless connection. High-speed internet is available in off-campus apartments through a contract with Cable & Wireless.


During your first two weeks here you have carte blanche to introduce yourself to as many people as you wish. Your class will probably go out each night that first week and I recommend you go each time. The first week does not contain difficult material and you will not have another chance like it. After this grace period the classes pick up a bit, people fall into routines and your opportunities to meet every member of your class will start to drop off.

SGU operates by four-month-long terms. This tricks you into thinking that each term is a year long and that people in second, third and fourth term are somehow separated from you. This is of course nonsense. The uppertermers will have advice for you on every class and most of it should be ignored. Instead, find a good DES tutor, give yourself a few weeks, and then start making judgments on how to handle your course load. Everyone should go to the Department of Educational Services (DES) office and take a look at all of their handouts on studying, test-taking strategies, and review sessions. It is a goldmine of helpful information.

***I am aware of the irony that, as an uppertermer, I am writing this letter of advice.***


English is the language spoken in Grenada. In the school guide, they describe it as a “slightly lilting Caribbean accent”. I disagree. Those Grenadians that work with the university, or in another position that requires constant exposure to tourists and students, are easy to understand. Those that have very little exposure to foreigners can be near unintelligible, but once you have an idea for what someone is trying to say, everything seems much clearer. It is not unlike listening to lyrics from a difficult song after you have already read them in the CD jacket.

If you have a healthy sense of humor, the stressful things about Grenada can be hilarious. First off, if you go to a restaurant and read the menu, do not kid yourself and think that what is on the menu is available. The menu is instead a list of things that were once available and may be available in the future. This is due either to a lack of ingredients, the staff is too busy to make your order, or the staff does not care to make your order. So order something else with a smile.

Second, if you order a drink at a US bar and it takes more than a few moments, it is often because the place is very busy and the bar is understaffed. If you order a drink in a Grenadian bar on a dead night when you are the only customer, it will take even longer. This is not because the bartender is trying to piss you off or ruin your whole day as some dramatics will say, it is instead because the island is a slow place and you need to get used to it. That Grenadian bartender could turn to you and ask, “What’s your hurry anyway?” Try to remember that there is no hurry and life will be a lot easier on you.


SGU has a healthy intramural sports program. Basketball and Football (soccer to some) are the major sports (bring cleats and guards, balls are provided). Hockey is also big (played on the basketball courts, sticks and nets provided). Rounding out the selection we have Ultimate Frisbee, Dance Classes, Yoga, and Dodgeball. I have yet to see a single person play tennis (I have not even seen courts) or cricket.


The wet season is very wet and runs from August to December. It can rain for days on end. If you bring an umbrella, make sure it is the type that opens to form a complete sphere around you, because the rain falls sideways. Honestly, go to a camping store and get a waterproof cover for your backpack, a light waterproof jacket and a shamie. You will be the envy of everyone. Another thing to consider is the mosquitoes. The breeding ground for mosquitoes is standing water, and there will be a lot of it. Invest in a mesh tent for your bed and screens for your windows (only applicable if living off campus). Want to know a fun trick? Instead of a mesh net, get a standing oscillating fan. If you go to sleep with it by your head, the mosquitos get sucked into the back of it and murdered. You get to wake up the next morning with a pile of them on the ground. Good times.

There is little rain in the dry season which runs from January till June. It is the best time to be on the island and enjoy everything that it has to offer. Go to the beach, learn to kite surf, bring your surf board, or rent a jet ski. Head to the capital and learn how to haggle in the market. Most of all, remember to get a tan so that people believe you when you say that you go to school on a tropical island.


1. If you are buying a computer for school, make sure that it is light, portable and has a long-lasting battery.
2. Do not get a car your first term. You first term will be spent in campus housing and the bus schedule is more than adequate. A car is a luxury.
3. Sometimes the buses can get crowded. I suggest you say goodbye to personal space.
4. About a month into the term, Prof. Goodmurphy of the Anatomy Dept. will give a note-taking lecture that is invaluable and will change the way you and your class study. Do not miss it.
5. I have yet to use a single battery.
6. You can talk to prospective and current SGU students at Most posts receive a prompt reply.
7. If you get onto a Reggae bus and want to get out at your stop, tap the metal ceiling.


***This is not meant to be comprehensive by any means, but instead a few things that really would have helped me. ***

Binders are expensive on the island and worth the space in your luggage to bring a few. Anatomy gives you a binder so you should only need to bring three of your own. Multicolored highlighters are invaluable when reading biochemistry and hard to find on the island. I wish I had brought more. I also wish I had brought dry erase markers. Do not bring floppy disks and blank CDs, hardly anyone uses them. Instead BRING A FLASH DRIVE. Students share all of their files and useful programs with each other via flash drives or iPods. With exception to the iPod Mini and iPod Shuffle, iPods are actually much better than flash drives. They can play music, store 20+ Gigabytes of information in any form, and are far and away worth your investment.
As for your course books, the school supplies you with them the first week you are here. They are stored at the base of campus and are heavy. I would recommend picking them up in an empty piece of wheeled-luggage. Opinion varies in the upper terms as to which textbooks are useful and which never left their shrink wrap. Take advantage of your Footsteps Buddy and try to figure out which books will be most helpful for you. That said, there are some books that most people wish they had. Check the First-termer section.

First term classes

Your first term classes:

You are given a binder that contains, in order, every lecture for the term. This is useful for both following lecture and adding your own notes in the margin. You are given an Anatomy Atlas by Netter that contains oil paintings of every structure in the body with labels. You also receive Essential Clinical Anatomy by Moore which is the closest thing you will have to a text book. How helpful people found these texts is based more on individual learning styles than the actual content of the book. There are two books which nearly everyone found helpful that the campus bookstore does not always carry:

The Color Atlas of Anatomy by Rohen (ISBN# 0683304925)
An invaluable companion to the lab portion of your class, this book contains pictures of perfectly dissected cadavers to help in your ability to identify structures both in lab and on exams. This is best used in conjunction with your Netter Atlas.

Gross Anatomy by Chung (ISBN# 0683307274)
Part of the Board Review Series (BRS) collection, this book covers the material stressed on the USMLE Step 1, offers tables and clinical explanations that can save you hours in the library, and has hundreds of clinical questions that help you to prepare for your exams.

To date, the biochemistry department gives lecture handouts to the class two to three days before each specific lecture. These handouts reflect the stress and focus that each professor will give to the material. To fill in any gaps and round out your understanding, two textbooks are given. Lipincott’s Illustrated Biochemistry is an excellent textbook that closely follows the scope of the class. The other text, Mark’s Basic Medical Biochemistry, aims to tie everything that you will earn into clinical vignettes with patients like Al Martini the alcoholic.
You will kick yourself if you do not also purchase the Biochemistry BRS book (ISBN# 0683304917). It is written by, get this, Dr. Mark’s wife: Dr. Mark. She goes through her husband’s text, pulls the pertinent illustrations, and puts all of the information into a bare-bones linear style that makes learning the material laughably simple. Because of this, you could make the case that you do not need the full Marks text if you are going to buy the BRS book. Once again, the school bookstore does not always carry this title, so I suggest bringing it to the island.

The Histology faculty has the best companion of all of your classes. It is so comprehensive as to be considered its own textbook. You will also have access to a free program called HistoTime. HistoTime consists of short histology lessons followed by hundreds of slides to help you recognize each specific tissue type. This program along with the companion is all that you need to do well in the course and walk away with an understanding of histology. That said, some students found the two textbooks required for the class (Color Atlas of Histology by Gartner and Basic Histology by Junqueira) to be helpful.

The embryology course is changing faculty so I cannot guarantee that anything I am about to type is accurate. Embryology operates from a single textbook and a course companion. Some students complain that the course companion is hard to follow and is poorly written. While this is not altogether untrue, it is more accurate to say that Embryology is a difficult course of study in the first place and there are few things that could make it easy to follow and understand. One text that does a fair job of making the course manageable is the Embryology BRS book (ISBN #0683302728). Once again, the school bookstore may not carry this title, and I would suggest bringing it with you to the island.


This test is given a day or two after your last exam of 2nd term. It tests your retention up to that point with questions that are both external to the university (USMLE type) and internal (you've probably seen these questions on previous tests). It's a 200 question brute over 4 hours. Everyone feels like blowing this test off because a) failing it doesn't stop you from doing anything and b) passing it doesn't help you do anything.

I disagree. Your score on this exam ranks you against your class. You'll get a letter in the mail telling you your rank, your Z score, the mean and a breakdown of how you did in every section on external and internal questions. If you're serious about doing well on the USMLE, I don't know why you wouldn't take advantage of this test. Normally you have to pay Kaplan to tell you your weaknesses; the school is offering it for free. The school maintains that your rank is kept in house and does not make it onto your transcript. I haven't graduated yet so can't verify this. Students maintain that part of the decision-making when it comes to your hospital placement in 3rd and 4th year has to do with your rank, everything else being equal.

Moral of the story: doing well can't possibly hurt you, and doing poorly can't possibly help you. I for one was open to the possibilities, so tried to do my best. The best way you could possibly prepare (for the BSCE or USMLE) is to teach it. If you pulled a B or better in Anatomy, Biochem, Histo or Embryo then tutor the class. It takes two hours out of your week every week and it's a great review that your classmates aren't getting. And don't let fourth term scare you too much: my roommate and I team-taught Physio and Neuro and it was fine. We even had fun doing it.

So good luck and enjoy your summer.

Prague 2

My last free weekend in Europe was a week ago and I had yet to travel anywhere. So the night before, I found a like-minded student, Adam, and we took off for the Brewery tour of the Czech Republic. We caught a bus to Pilzen, home of the only true Pilsner beer, Prazdroj. We arrived in this town, unable to speak Czech or find someone who mluveetee anglitsky (speaks english), so we decided to take random buses in random directions. We ended up taking a bus past an enourmous complex with PILSNER URQUELL written over and over on the wall followed on the end with a sign that said GAMBRINUS. Now, Gambrinus is a competing beer made in the Czech Republic. That, along with this bus stop being called "gambrinus", made us feel justified in riding further. We were such idiots.

After the Pilzen tour we caught a train for Ceske Budejovice, home of BUDVAR! We had about an hour until our bus into Cesky Krumlov was scheduled to leave, so we wandered a bit. I have to say that one of my favorite things about Europe is their town squares. Anytime a town devotes two square blocks to an open cobblestoned square with nothing in it but a central fountain, I am a fan.

A half hour later and we are in Cesky Krumlov, touted as one of the most beautiful cities in Europe. The place belongs in a snow globe complete with waterfall and wheel, aqeduct, palace, ornately decorated spire, and a lazy river that wraps around to define the borders of the city. Of course, I took no pictures.

The next morning we went back to Cesky Budejovice to take the brewery tour. Too bad it was Sunday. We made the best of it by sitting in the Budvar restaurant and drinking 5L of delicious Budvar each. I also managed to spend 1000 Krowns on a Budvar tie, tie clip, bottle openers, and a Budvar towel. I do like Budvar. I also have 6 Budvar coasters that tell the story of some demon that sneeks into the Brewery, tampers with the beer, and is then stoned with corn-on-the-cob.

And the winner of these priceless coasters and Budvar bottle opener? Uncle Neurophysiologist, for his advice on traveling in Europe:

"Look at your luggage and divide by 2; then look at your wallet and multiply by 2."

Returning to Prague, I have gone Euro. "Going Euro" is wearing the tight jeans, the tight shirts, the green sneakers, the button down shirt open with belly proudly leading on a hot day, the guy with no shirt in the middle of the classy bar, the girl and the guy making out so hard you think one is trying to eat the other (this drawing no stares). Going Euro happens in pockets instead of on a gradient. You don't have people that are half punk, half model, or half naked; everything is all out. It wasn't till the end of the trip that I realized how much I was ignoring, but Prague is a twilight zone of crazy.

In Prague, I have finally hit "survive" on the scale of Czech fluency. I can come and go, order and pay, ask and understand directions, and tell a Czech women that she is beautiful. But more than all of this, the ability to say "buzz off" in Czech without accent has been the most useful when dodging vendors and prostitutes on the tourist-choked streets.

Traveler's note: if a woman walks up to you asking for "sexy?" and you refuse, she will try to run after you and hug you. She IS NOT trying to change your mind; she is trying to pick your pocket. Channel Ron Burgandy, and you'll know what to do.

Landing back in the US was disorienting. First, everyone is speaking English while I'm still on Czech autopilot with my Dyekui's (thanks) and my Dobry Den's (hello). The faces in the airport are softer, without all the dramatic angles that hallmark the euros.

So that was it. My own advice for those traveling to Europe:

"Learn their language."

Cheers And Nastravi! (Nicedriveway)

Prague 1

Where to begin. Having a bit of writer's block. I'm sitting off the balcony of my new room in a Hostel downtown. This is so much better than living in Kobylisy 8 with 7 other people in a room with four beds touching. I've been in Prague for seven days now. There are so many different types of faces and haircuts. The mullet is king, with every third person from the UK sporting one. The Scottish are terrifying. Every one of them looks like an extra from Braveheart that kept the costume. So scary. Nobody wears matching clothing, colour or decade.

Everything is different. Their toilet paper is thinner and has that recycled-paper look. I am still terrified of bedais (sp?). Men with capris are king; runner up is the tapered pant leg. The escalators are very steep and seems like the most popular place to stare at people. I haven't figured out if this is a staring society or if I'm getting the tourist treatment. Either way, I'm staring back.

It seems that only 3/4 of Prague is Czech, the rest ex-pat and vacationing. Opening up your head to all of the different languages ruins your ability to eavesdrop on your own, I've learned. I've learned about 50 czech words that I can't pronounce. Nerozemum = I don't know = most useful word. "krk"= throat. "Cheers!" sounds like "nice drive way" slurred. Beer is "pivo".

There are no ranch homes in Prague. You can buy a shirt that says "Czech me out!" but not one that says "Czech, please?" which disappoints me. Everywhere I walk has art. If not paintings on walls then reliefs over doorways or statues on state buildings. There is a statue of Lenin hanging from one arm four stories off the ground and out my window. There is a statue of Superman proudly face-planting into the ground.

My legs are oak dipped in steel. I'm averaging 8 miles a day on foot. There is something to look at or do every single step. There are so many restaurants that you marvel at how they can all stay in business. There just can't be that many hungry people. I have been living like a king, eating out every meal, sitting in beautiful restaurants that could fetch $100 plate prices back home but cost only $7. The dollar trades with the krown at 1/25. I feel like I am stealing from these people. There are so many places to eat that you are forced to have the appetizer, course and desert at three different locations with drinks at a fourth, fifth, ad infinitum.

I'm in Prague to study. A course through SGU places me on rounds with doctors from different fields, one per week. I lucked out with heart, brain and bone. Some poor saps got lungs, guts and kids. I have two more days of heart, where I get to watch a doctor push and pull a tube through someone's chest via a hole in their leg. We watch all of this on live x-ray monitors and ponder the weight of our full body lead vests. For the vest alone, I do not want to be a cardiologist.

Things to do:
1) walk across all seven bridges in Prague (maybe two people laugh at this)
2) buy uncle a gift for telling me about Budvar, the best thing since life itself
3) Get out of Prague for a while

Taking a nap and walking somewhere.

Go to Prague

Go to Prague! As a January student, I went after my first term and knew nothing. Enjoyed the hell out of it. If you start in January and wait till the end of 4th term (2nd year) to go, you'll be squeezing the dates a little close together. I recommend as a freshman. If you're an August student, you get one crack at it: after 2nd term. This is probably the perfect time to go.

Get your friends together and rent a cheap apartment or stay in a 4-bed hostel suite. You chose your own level of grit. If you're a vegetarian, eat a face. If you're a recovering alcoholic, relapse. Prague is beer and meat and beautiful people and you shouldn't miss any of it.

Before you head over, go online and buy the DK Publishing Top 10 Eyewitness Guide to Prague. I lived by this book and it did not disappoint. Useful Czech phrases in the back. Also, don't ever call it "Czechoslovakia." The Czech Republic and Slovakia are quite separate now.

The set up of your selective is simple: Once a week you meet as a class with Dr. Stransky (the guy throwing this party) above Club N11. Besides being a big deal in Prague, he said one of my favorite things: "In life, it's good to be best, but it's better to be first." He owns the club N11 and will host a part there pretty early into the selective. As I remember, the first day you meet Dr. Stransky, learn about the program and what your rotations are going to be. Wear professional clothes. For guys this means shirt and tie. Do not be the guy with tennis shoes, an untucked shirt and a poorly-knotted tie. Ladies, wear comfortable shoes and a nice dress or skirt. Once you have your assignment, you meet in front of the N11 club with a bunch of other students, and someone working for Dr. Stransky takes your group onto the metro system for your destination. Remember it, because you'll have to do it yourself every day after. Your destination will change every week, so you'll repeat this process every Monday morning. Some people start rotations at 8:00am, some at 9:30. Everyone checks out by 5:00.

Each rotation at each hospital is different. For example, my Neuro rotation consisted of locking us in a room and letting a tape play (half the time), talking with Czech medical students so that they could practice their English (1/4th the time) and seeing a bunch of really interesting cases for the rest of it. If you understand 1 and 1/2 syndrome and the workings of nystagmus, you're golden. My Cardio rotation consisted of puting on a heavy-ass vest and standing in the room while the doctors snaked line up everyone's femoral artery into the heart. We watched all of it on angiogram. It was great, except for the vest and the revolving door nature of it all. My Orthopedic surgery rotation was my favorite. The doctors and nurses do not care what you do, so long as you don't hurt anybody. You change into their scrubs and gowns (their locker room) and just pick a surgery. Axilla surgery in room 1, hip replacement in room 2, and so on. I went to see a hip replacement and got blood all over me, which was AWESOME! Loved that rotation. At the end of the week you meet up above N11 with Dr. Stransky, see a patient, and talk about the week. Wash Rinse Repeat.

You're in Europe, the center of it, so you'll want to travel. I know people that made it out of Prague to go to Germany, Italy, what have you. It's hard though. You have to be at the hospitals on Monday and Friday. Once you factor in the time of transit to and from another country, you are really cutting things close to say nothing of a slow train or a broken one. To get the credit for the class, you have to have perfect attendance. That said, some of the doctors will sign your sheet for the week regardless of your attendance and I don't know of anyone that did the selective and didn't get credit. So who knows. Travel at your own peril I guess.

The weather in Prague swings. Bringing nothing but summer clothes with something nice for the hospital is not going to cut it. Bring a sweater, a jacket, something. Also, it rains in Prague. Don't be that wet guy without a raincoat.

Speaking of clothing, you should probably buy the greatest pair of shoes on the planet before getting on that plane. Everyone wonders why the people in Europe are so skinny? Not me. They walk everywhere, never stopping, always walking. So if you buy a pair of shoes that pinches your toe or drags on your heal ever so slightly, that'll be a gapping hole bleeding through your socks by the end of the third day. And since you're walking everywhere all the time, it will NEVER have a chance to heal. So just avoid that whole mess and buy yourself something nice.

The nightlife is great. Try to avoid the comfort of your two favorite clubs every night and see as much as you can. Joe's Cafe was a great one, and no trip to Prague can possibly be complete without a few trips to the Duplex. Enjoy the dancers and the air horn.

All in all, I hope you really enjoy Prague. Their subway system is larger than anything I've ever seen, and you'll have a great time getting lost even though their are only three subway lines. Every set of directions you'll ever give will be in terms of Tesco. It will take you a week to discover Andel. You'll buy a bottle of water, take one sip and spit it out, and forever after ask for "Voda, neperlive." (Voh-dah, nay-per-leh-veh) Make sure you're friends with someone who takes a lot of pictures; you'd be surprised how quickly you forget how great it was.

I wrote home when I was there, and I've included those posts. If you have any questions, please post them and I'll add where it's empty.

First Letter back home.
Last Weekend

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