Thursday, August 31, 2006

Silverback, MD

Tevin is a neat kid, maybe 12, whose mother slams his head into walls until he stops asking why she's beating him. He likes the disappearing-thumb trick that my father taught me. Mrs. K has just had her foot amputated because of uncontrolled diabetes. She doesn't understand any of this, knowing only that she has "the sugar". Jeremy has "THUG LIFE" tatooed across his chest and an icepick in his left shoulder.

It's a jungle in here.

We're finally in the hospital. Imagine us, each wearing our Grownup clothes under bright white coats, stethescope-necklaced with pens and books stuffing our little pockets. We look pretty stupid. For a lot of students, this is their first patient exposure. You can imagine the shock of all of this. Imagine how they balk at having to pull back the blankets from an 80-year-old woman and lift her sagging breast to listen to her heart sounds. Imagine their stuttering steps, their over-explainations to a patient who could not care less, and their unease with the breast-chalk that now tarnishes their previously shining virgin stethescopes. It's pretty great, actually. Really brings me back...

My first patient was a 90-year-old. She was lying, her back to me, facing her daughters. I was a few steps in the door when she said with some excitement, "I smell a man!" I did not know how to act just then, having no precedent. My last patient was Mr. H. We had a conversation about his plan to die at home and how he was preparing his children for that day (which was a month later I heard). It doesn't take long for people to break through the awkwardness of taking a sexual history or talking frankly about death. It's this amazing privilage that we have as medical professionals and I'm so EXCITED to watch my friends and classmates go through the whole thing over the next two years.

Of course, I still know nothing about how to provide care. None of us does. It's disorienting to know so little after studying so much and it's the doctor's job to make sure I stay aware of it. I'm told that in the jungles of Africa, when a Silverback gorilla spots you, they will scream and charge. If you run away, it will kill you. Instead, curl into a ball and break eye contact. The Ape will stand over you, snort, and then leave having established dominance. From then on, you're free to walk amongst the trees.

So I'm standing in a jungle of knowing nothing when along comes Silverback, MD. Jeremy's icepick had come close to this brachial plexus* so the doctor started to ask questions, slapping me around with his paws. I made the mistake of answering correctly, which is like eye-contact to them. He batted me harder, asking about all sorts of random things to throw me off any balance I pretended to have until I fell, incorrect. "Look at how small you are in my jungle! Look at it!" he was screaming, while beating his chest and snorting. Patient after patient, he kept poking at me, waiting for me to look up. Playing dead was useless: the poking would continue until I answered and the beating would continue until I was wrong. In case you were wondering, I'm pretty sure this is how they train students.

Doctors are like Silverbacks with amnesia and I've got to find this one a kitten or something to bat around so he'll stop playing with me.

If anyone needs me, I'll be in the fetal position.

*The brachial plexus is a large jumble of nerves around where your neck meets your arm and it contains every nerve to control your arm and sense the covering skin. It's what a bouncer grabs to cause crippling pain. It's where actors get shot without consequence. This is why actors can walk past bouncers unharmed.

Tuesday, August 29, 2006

Grenadian Weather

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.

Island Culture

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.

School Culture

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.

SGU students study like they party: hard. Go to the Crab Races at The Owl every Monday night at Grand Anse beach. On Wednesday, everyone heads over to Stewart’s Dock for drinks and a live band. If you like to keep going until 4am, Banana’s is the place for you. There are so many organizations on school that every weekend has at least one sponsored party at the Aquarium, Thai Beach, Kudos, etc. Take advantage while you can. Before too long you will start looking forward to the weekend because it means no more classes and you have time to study. Yes, you will be ‘that guy.’

The Day-to-Day

As a First-termer, I got up every morning around 7am and checked 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 until 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.

The Last Phone You'll Every Buy

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) Google “unlock SIM” 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.

All in All, I paid $95 (phone $50, SIM $20, Unlock $25)

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.

A Picture is Worth...

1000 Words

It's amazing how a few photographs taken by students can add some perspective to the place. Go to 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

Monday, August 28, 2006

Where to Live

Unless you arrive very early, it is difficult to find a place to live off of campus. You will not know which areas are safe, what prices are fair, and everyone that is coming to the island after First term has snatched up the best apartments. You will probably end up at the True Blue Campus or at Grand Anse.

The University is on the True Blue Campus. There are a number of dorms their: Superdorm #1, #2, #3, and #4. There is also upper-term housing in singles, doubles, four- and six-person suites. Your room will be very small, very cozy. It will also be very expensive. The pros to living on campus include waking up later, not having to use the bus as often, good security and being around people every hour of the day. The cons are the price, the size, campus burnout and being around people every hour of the day. It comes down to your personality.

If you grew up in the projects, you will love the dorms in Grand Anse. You will come home to crabs and lizards. Your plumbing may throw fits and your carpet may begin to smell. If you have ever been camping and like it, then this is the place for you. The pros of living in Grand Anse are the price (considerably cheaper), the location (it is on the beach and across from the Spiceland supermarket and mall), the atmosphere (people that can live happily in those conditions are generally relaxed), the food (Mr. Green Jeans and the Ladies are there to cook for you every day) and the quiet.

When it comes time to find another place to live, you can either enter the Lottery on campus or look elsewhere. I suggest moving off campus. You will be farther away so may need to rent a car and your security is window bars instead of guards, but even taking that into account it can be cheaper and nicer. You can find available apartments through word of mouth or the campus housing office, though their lists are often out of date. You can live in True Blue and this tends to be expensive for what you are getting. The advantage is being within walking distance of campus. The advantage to living in Grand Anse is being in walking distance to every store you could need. Next to Grand Anse is Mont Toute, also a thriving area with several shops. Lance Aux Epines is the Manhattan of Grenada with its paved roads and beautiful homes. Housing can be expensive here, but not as expensive as campus and you get what you pay for.

Arriving in GND

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.

If you are flying to Grenada on a connection from Puerto Rico you will probably spend your first night without all of your luggage. The reason is simple: you came to San Juan on a very big plane and left Puerto Rico on a tiny little plane with propellers. This is the type of plane where they ask the passengers to move to different seats to balance the weight (if that sentence makes you nervous, self-medicate before takeoff). A puddle-jumper like this cannot possibly hold everyone’s luggage in one flight, so expect at least one piece to be a day late. Make sure that you have some toiletries and two changes of clothes in the luggage that never leaves your sight.
The airline will give you a number to call and you will have your luggage shortly. 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.

What to Pack

I will only brush my teeth with Arm & Hammer toothpaste. I cannot stand anything else. So every time I fly down to the islands, I have all the toothpaste I’ll need for the term. A girl I knew would bring Downy drier sheets. The point is this: the shopping malls and grocery stores are sparkling clean and air-conditioned much like home but that does not mean that they are stocked the same. They will have everything you can think of needing but not necessarily your favorite brand. So if you are wedded to a certain brand of tampons or deodorant, bring enough for the term. Other than that, there is no need to worry. To the guy that brings 40 lbs. of Whey protein on the flight: we have a GNC-type store that has that. Do no waste the room and the weight. Also, you look like you work out.

You will wear shorts, shirts and flip-flops every day. Have something nice to wear if you plan on asking someone on a date or celebrating at one of the fine restaurants. Every once in a while, their will be a banquet at the Governor’s Mansion or physicians visiting from our clinical years, so have something nice to wear for those fancy people. You will never be asked to wear a jacket, but maybe a tie. Bring a few pairs of scrubs for Anatomy Lab (you can still wear sandals). We have a nice air-conditioned gym, basketball courts and a soccer (football) field so bring some athletic gear and your ‘A’ game. Things made of linen are always a smart purchase.

Binders are expensive on the island and worth the space in your luggage to bring a few. 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 for the study rooms in the library. Bring a flash drive and a modest external hard drive. Students share all of their files and useful programs with each other via flash drives or iPods. That means entire seasons of Nip/Tuck, Lost, 24, etc. Each term also has a MacDaddy program filled with old study resources like previous tests, tables, and summaries. These information juggernauts can reach 10 gigabytes; plan accordingly.

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. Unfortunately, the campus bookstore may not carry them or will sell out early. Check each Class Section for suggested books.

Depending on your airline, you can take up to 155lbs to the island. That’s two suitcases at 50lbs each and a 40lb carry-on. You’re also allowed a personal item that can weigh up to 15lbs. I suggest putting your computer and books into your backpack as a “personal item.” That easily covers 30lbs, freeing up more weight for your checked luggage. Play it cool, though. If they see you slumping under the weight, they’ll get suspicious and make you check the bag which will cost you some money.

Friday, August 25, 2006

Why go to Medical School: La Soufriere

I am five years old and running, my arms out by my sides like a banking airplane, around the lip of La Soufriere, St. Vincent's volcano. We're 3,800 ft above sea level and too close to the edge. I have to throw three stones before one goes far enough to hit the bottom of the crater. 10 seconds. That's how long you'd fall and tumble it you made a wrong move. It's easier than you'd think since I'm inside a cloud right now and can't see in any direction.

I wanted to be first. The hike is in three stages with 40ft bamboo reeds bending overhead and hundred-foot drops on either side. We walk into and out of clouds, past rivers of bubble-rock from the previous lava flows, and up loose stones and ash as the summit comes in sight and the pitch increases. We've kept together for the most part, but with the end so close it's each man to his ability. I'm in the middle of the pack and decide to start running. My legs are burning and I'm blowing off huge volumes of CO2. I know I'm among my people when Alexander asks, "Where'd you get the extra ATP?" I start using my hands; it's that steep. I've passed 60 yards at 20 degrees and have the lead by a yard or two. No one else wants to pass me as much as I want to be in front, so it's just a matter of pacing now. But screw it: I start to run again. My legs are shaking and burning and I would feel miserable if it didn't feel great. I summit and it's flat and I start sprinting to the lip.

As a kid I remember being awed by heights. Standing at an edge where a fall meant death, I would let me toes hang over just to know that I could. I was trying to prove to myself that I wasn't afraid. Still am. I sat on the lip with my bag and swung my legs over to lean forward and look straight down. It's never stopped being exhilirating.

Over the lip you can see a massive mound in the crater. It looks like someone tried to plug the volcano. 20 years ago, it wasn't there, but the constant pressure of gas underneath has caused it to bubble out and displace the lake that used to be. Along the side, even 100 meters up, you can smell the sulfur and feel the heat from the center. I'm told that there's a rope that leads down from the lip. I'm too tired today, but next week I'll give it a try.

I am so glad that I go to school in the Caribbean.

Tuesday, August 22, 2006

Why go to Medical School? We're both crazy.

Walking out the doors of the Anatomy Lab a man is standing in front of me. His hands are busy around his waste, shuffling his penis back into his pants, smoothing the creases of his underwear and now pulling his pants up from his thighs. He's looking at me like we're both crazy.

"Yes?" was all I could offer, waiting for the punch-line.
"This wear de keep de bodies?" he asked.
"Say that again?"
"The dead bodies in there?" I'm racing through the reasons that he would ask this and why I would answer him. That's when I see the name tag. This man is one of our volunteer patients at the Clinical Skills Lab. Since we don't do genital exams this term I still can't explain why he was undressed and half-across campus, but this is Grenada and I'll have to let all of that slide. He's probably harmless.
"Yes, this is where we keep the cadavers. Can I help you?" Turns out that he came over to find out how he could donate his body to the school once he died. His pants fall down again as I usher him into the Secretary's office. I watch her eye's bug and offer no explanation; I wouldn't want to ruin it for her.
* * *

Going to school in the Caribbean is fantastic if you've got the right head on your shoulders. If you go to a restaurant and read the menu, you can't 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. If you need a blown tire fixed, you can open up the Grenadian yellow pages (which might as well say, "no we don't do that, call this guy" on every page) or you can go to the roundabout by Lance Aux Epines and look for a guy with a grey beard and a sock on his head named "Vincent." Vincent, you are told, is a good guy.

Not everyone that comes to Saint George's University can take all of this. Sure it seems like a series of little things, but that's what death by a thousand cuts is all about. I can't imagine what it would be like working in any medical setting (or other high pressure situation) with the girl that stomps her feet when her luggage doesn't arrive on time or the guy that loses his mind whenever we have a Grenadian Traffic Jam.* It's nice knowing that in my future professional life, seeing "SGU" on a resume will mean that they couldn't have made it through while holding on to those attitudes.

The person that does come here, takes everything in stride, and thrives is just the type of person I want by my side if things fall apart.

*Grenadian Traffic Jam: In Grenada, people often stop their cars in the middle of a two lane road to open the trunk and begin selling lemonade. Drivers then weave by to stop, chat and buy a drink. You're going to be late, wherever you were going. Honking doesn't help.

Sunday, August 20, 2006

Foreign warning

I don't write about this but it is an important thing to remember whenever you are going to medical school. Whether it is more common in the US or abroad, I can't know. Mexican Medical Student reminds me:

"Folks, regardless of medical school, there are those who shouldn’t try to become physicians–this path isn’t for everyone. A warning to those American students struggling to get into US programs considering a foreign medical school: a foreign school *is* a viable alternative, but since you aren’t dealing with the “cream of the crop,” (witness the profound statements above), expect to deal with a lot of behaviors from people that you’d think you would have left behind in high school. Add to that, the culture clash of the country in which you go to school, and it’s can make for a stressful mix–all of which, unfortunately, detracts from studying and applying yourself to your task at hand. Be prepared."

Thursday, August 17, 2006

Severed Vacation

I do not enjoy vacation. Studying medicine makes me feel so useful that I go into withdrawal. Reading Atlas Shrugged with all my spare time doesn't help matters any. I try everything I can. I cut my vacation short by starting a week late, electing to stay in Grenada to dissect cadavers for research. I cut another week by going to Milwaukee for the Annual Congress of Clinical Anatomists. I lost a week to a Michigan trip with my family, and I left that early to spend a week at the University of Alabama at Birmingham (UAB). Why? To dissect for research, of course.

My first time in the South and it's everything with fresh eyes. Southerners chew gum lazily. Without wind, you're under a heavy hot blanket. Walking for coffee in scrubs, everyone says, "Good morning, Doctor." It's pleasant.

I was at the UAB with other members of my group to finish projects between the classes of their first year students. We had complete access to 35 bodies and we all felt like kids in the dead people store. Each of us had come a long way from those first heady days of Anatomy Lab. After all, we had chosen to be here without threat of a grade.

We're cutting into people? I don't want to; I'll just watch. I'm glad they put bags over their heads. Should we name her? That's disrespectful! No it's not. I'm naming her 'mittens'. Should we say a prayer first? Oh, god. Give me the goddamn scalpel, Amen. How's that?

For all the posturing, it was a special thing to watch my hand cut into someone for the first time. It was my hand that did it, by the way. I had nothing to do with it. After so many bodies, it losses its specialness. When it's time to work, you approach, address the body, and then dive in for cleaning and measurement. A few minutes later you zip up your work and it's time for the next one.

Most of us have been the ones quick through the door when it came to cutting, the ones that call for the scalpels. But here at UAB, it was a little different. Their cadavers where fresher, fixed with less formalin, smelling less, more robust. It felt like walking into a house so clean that you kick of your shoes even though that's never been your custom.

Most of the students that flew down could give a few days or a week. We would have stayed longer but our classes were starting. Still, some of us decided to start our classes late, this being such a great opportunity for work. Two days before my flight and I make my morning call,

"Marios, what am I dissecting this morning?"
"Severed head."
Choking, "What was that?"
"Ask Vince to show you the severed head. Skeletonize the Facial nerve and clean away all fat and fascia." Hearing my held breath, "Tophy, you okay?"
"Fine Marios. Just fine."
"Congratulations. It'll be fun. You'll do fine."

I find Vince. He takes me into the cooler where they keep the fresh cadavers. These people died a few days ago or a few weeks ago and have donated their bodies to the university. At UAB, there is abundance. I wheel a small bin into the prosection room and remove the lid. Thomas is staring straight at me.

I reach down to pick him up and can't at first. Not expecting the extra weight, I give my arms a moment to recruit more fibers before he moves. It feels like descending the stairs in the dark and going one step into the ground. I hold him in the air while another student helps me clamp the vise grips into either side of his head. Of his head. I adjust the lights, pull up a stool, and grab my scalpel.

I can't do it.

I push his cheek and it moves. I try to draw the backhand of the blade against his scalp to mark my incision and I scratch some of his skin off. Before, I thought that cutting a fixed cadaver was the great big leap, and I was wrong. I stare at Thomas some more. If you're going to be a surgeon, you have to do this. How many people get to work on a fresh cadaver? What opportunity are you wasting?! Do it, topher. DO IT!

I let the blade sink in and I begin to draw the curve of his hairline down to the front of his ear, then drop to the bend of his jaw and forward to the point of his chin. I pull the line upwards and around the mouth, into the sweep of his cheek where tears would have slid and then around his socket and up, until I meet again at the widow's peak. He's bleeding, not in force, but in an ooze that marks each position of a superficial vessel. It's creeping me out.


His face flap is in the bucket. It took an hour to do, pulling up a corner and separating it from all the anchors of fascia. The beauty of dissecting is that you're only as fast as your mind. I was trying to save every vessel and nerve fiber early on, terrified of doing harm, until I remembered that the Facial nerve has no cutaneous branches. At that point it became snip, snip. Finding the target nerves leaving the parotid gland was magic. Pulling against the fat to see all of the brilliant colors of muscle, nerve, artery and vein is something that my fixed cadavers could never do for me. I'm no longer bothered by how real this all is; I'm too busy being hypnotized. The nerves branch and split, branch and split until they are thinner than hairs and I can't believe that I haven't destroyed them yet. They're so strong and wet and alive.

Gross, messy, scary, morbid.

Say what you want about dissecting the face of a man that died days ago. Just don't leave these out:

Amazing, glistening, beautiful, perfect.

Saturday, August 12, 2006

Cracked lips

If someone were to ask me, "What's the stupidest thing you've ever done?", I'd answer with this: trying to be in control.

Working on the terminal onc ward is pretty stressful if you're emotive. People came to our floor because they were going to die. A lot of them were there for a week to receive the next chemo cycle before heading back home. Some of them stayed for longer, months even. But no one ever got so healthy that they left for good. Thankfully, I'm not as emotive as most.

You start to get a feel (or think that you do) for how people are doing. Some are feeling so well that they start thinking their cancer may be going away. Others are holding steady with their treatments, walking up the down-escalator. Some are doing horribly but are stably horrible. Those are the ones that are just agonizing to serve. I remember starting on the floor and taking care of the same women for three months. Every two hours, adjust position in bed. Clean as necessary. It was always necessary.

I remember a frail patient of mine that was in her seventies. Her family knew that things were worsening and that this weekend would be her last. Everyone from out of town was coming in and spending the full day with her. As a tech, it was always a strange experience entering the room to take vitals or perform a blood sugar test. The family members would watch me so intently and then each advance their chins to me, awaiting the result. "Her blood sugar is 136." When there is no control, there must be control. Keeping track of BP, HR, and sugar are all our best attempts at control of some kind.

The family left for the night. I had ten patients for my census and checked in on her as much as possible. She was heading downhill and her breathing was becoming more and more labored until she started using her accessory muscles to pull in the air. They call this "agonal breathing" which just about hits it on the nose. I stood by her side and waited for the nurse to respond to my page. I didn't see her do it, but the woman reached out and grabbed my wrist. It was unexpected and cold and it gave me a start. I reflexively pulled away and then felt a heavy embarrassment and sadness for her. I think I reached out to hold her hand. The nurse came in and the two made eye contact. She had such fear and the nurse looked at her and said that it was okay. You're dying. It wasn't cruel or improper, but somehow perfect for that moment. She relaxed.

There was nothing I could do for her. She was dying in front of me and I would be there for her final new and final final experience. I saw that her lips were cracked. I got some lip balm, held it out, and between gasping breaths she pursed her lips so that I could apply it. That was my stupid attempt at control. I can't remember if I held her shoulder, or hand, or just stood there doing none of those things. She was staring straight ahead, bracing. And then she stopped.

We called the family. They came up the elevators crying at 4 in the morning. They stayed with her until 6 and, before my shift ended at 7:30, I walked into the room. After taking off her gown, I tied her feet together. I tied her wrists together. And just as I had turned her side to side so many times before, I managed her into the big white plastic bag. I wrote her name on a tag and looped it into the zipper. Security came and wheeled her away.

Alive, I could do something for this woman. Dead, I could do something for this woman. But dying? They didn't cover that in training and it seems like something impossible to get entirely right. Even so, when the best you can do is stand in the room and treat cracked lips, it seems especially futile. A new patient with a new cancer and a new family was in the room within the hour.

Two years later and I still feel the pang of failing her that day with my stupid attempt at control. Worse, I know that it was one of her last memories.


The way that I came to St. George's University in Grenada is funny to me.

My father enjoys playing frisbee golf. Chances are, you've never heard of it. Each player walks around with a backpack filled with different types of frisbees: long and short drivers, mid-range, putters, rollers, frisbees that cut an "S" in the air, and so on. They throw these things around trees and through clearings toward a metal basket and they LOVE their sport.

My father is a friendly guy with a laugh that makes others want to laugh. He makes easy friends. The summer after graduating from college I was wallowing at a part-time job, hoping for anything medical that could help me gain an apartment of my own. I watched the Graduate and thought about going into plastics. Friendly guy that he is, my father met a nurse named Rob N. that figured the apple couldn't have fallen to far from the tree. He arranged an interview at Big Hospital and I had my job as a tech.

I did all sorts of things at this job and learned that the worst of what I had to do didn't bother me that much. This was supposed to be the litmus test of medicine, akin to seeing a girl without makeup, hungover, vomiting. Still love her? Then go marry her. In my mind, I was ready to go to medical school.

I applied to several schools, was interviewed, wait-listed and rejected. It was from the physicians that I had come to know on the hospital floors that I learned of SGU in the Caribbean. I did some research, was impressed with their board pass rates and residency placements, and decided to apply. A month later I was interviewing and received the first acceptance letter in a long time.

Down in hurricane-wrecked Grenada began the baptism of fire that is Biochem, Anatomy, Histology, Embryology and Clinical Skills in the space of 4 months. I loved it. Socially, academically, and melanin-wise I was thriving.

The next term I had the brilliant idea that I would tutor Anatomy and Biochem. I discovered that in the captive and competitive audience that is a medical class, women find brains as attractive as anything else, giving rise to the phenomenon known as "nerd hot." To boot, my best friend was the most sought after guy on campus. I invited him to tutor with me.

During the meeting of the Anatomy tutors, a knew professor was introduced to us. Stolen from a nearby school, Dr. Loukas said that he was interested in anatomical research and would like to start a research group at SGU. He had our full attention. Meetings were arranged and a club was formed. We were the founding executives.

One year later, our research has continued with few pauses. We put together our projects and headed for Milwaukee for the Annual Congress of Clinical Anatomists to present. I gave my first terrifying speech. Their, we met another professor interested in anatomical research that Dr. Loukas had come to know quite well.

Two weeks later, at the end of what remains of our summer vacation, we are in Birmingham, Alabama dissecting 8-10 projects in 35 cadavers. We begin dissecting each day at 7am and work till 12:30 when the M1's come in to learn about the brachial plexus. We're off till 3pm but can't go many places with the stink of formalin that we wear like capes. Instead we nap and read. I finish The Tipping Point and start to wonder at all the forks in the road that have brought me here.

I fly home. Tomorrow I fly off to the Caribbean to finish the last part of my second year. Tonight, funny enough, is the going away party for the guy that started it all. Rob N. It's the only day I could have been home to see him and say thanks and the last time I'll see him for a while.

Funny though, that it all happened at all.

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