Subaqua Sternal Rubs

Still have water. But now the fridge is getting awfully warm. After reflection, we noticed it really hasn't been making any noise for days. Freezer seems to be working fine though. Weird. Called the landlord, but 6 hours later, no response. Good thing I really don't have anything super-perishable in there…

After days without power (ok, really it was a few hours on a couple of days, but you really get addicted to that air-conditioner), there is now little or no water. Since there hasn't been more than 10 seconds of rain per week in the last 3 months, the country is experiencing a bit of a drought. To combat the problem, the National Water and Sewerage Authority (NaWaSA) has shut off water supply to the entire nation from 8am - 4pm daily for this week, and possibly longer. Tomorrow it's rumored to be "all day." I'm not sweating it though — I've been through a hurricane where I had no water and didn't shower for a week. (Guess that's getting back to my European roots - wait, actually, that's only the French that don't shower.) Anyways, for some reason (gravity, etc.) we have had water even when it is technically "shut off." Not a lot of pressure (must be whatever is leftover in the pipes), but it works. People living elsewhere aren't so lucky, and actually do run out of water. Hopefully, our luck continues, otherwise it could get a little smelly.

19 more days!!!

Had my OSCE yesterday. And not to further antagonize the worry-worts, but I did rather well without doing much studying (maybe an hour and a half in total).

The OSCE is the final practical exam for Advanced Clinical Skills/Physical Diagnosis. It consists of 7 stations - 4 patient history and/or physical in 7 minutes or less stations, as well as 3 ancillary stations (EKG, X-Ray and Prescription Writing). My patients included a "frozen shoulder" after playing tennis, an HIV+ flight attendant having diarrhea for two weeks, a middle-aged male with angina, and a female with monthly abdominal "bloating." The "standardized patients" were very good - they were flown in from Grenada, so we had seen a couple of them before (like my oil-down woman), but that was cool. I missed a couple of points on the abdominal exam, because the tutor thought I should do every abdominal exam in the book, even if they weren't consistent with the patient's symptoms. Oh well. All the patients complimented me on my bedside manner, thoroughness, and style. Nice to hear just before going into clinical rotations. (I think this is half the point of the OSCE…)

For my X-Ray interpretation, I had an IVP which showed unilateral hydronephrosis (backing up of urine into the bladder). A couple of people were complaining that the x-ray was unfair because it didn't have the little clock on it to show how long after the injection of the dye the x-ray was taken. Come on people, really. What they really should have been complaining about was the EKG station - the quality of the copy was so poor that the leads weren't labeled, and it was hard to count boxes for heart rate, etc., since they didn't come out either. Though it really didn't matter that much, since the tracing was pretty obvious with the P-R interval shortening, the peaked bimodal QRS's, and possibly some T-wave inversions (but I couldn't tell which leads since they weren't labeled…) I finally diagnosed a case of Wolfe-Parkinson-White syndrome. For my prescription I got a patient with angina again, so I prescribed sublingual nitroglycerin as needed for pain. Actually, I used some medical abbreviations like PRN, SL, q5, call 911, etc. In retrospect, maybe I should have spelled it out. Hopefully, they use the same abbreviations in Scotland where the Clinical Skills Chairman is from!

With that exam down, only two more to go: final exams in Pathophysiology and Pharmacology in two weeks. Ahh! Better start studying.

Per the score report on ANGEL, I managed to pass the BSCE II without studying (not that I am surprised by this, as indicated by the number of exclamation marks in the title.) And not that I don't have a long way to go for USMLE Step I studying, but at least I know a least a little bit of the material presented over the last two years stayed in long-term memory… Anyways, no time for celebration — time to study for my OSCE tomorrow…

When the power cut out yesterday around noon-time and came back on six hours later, I was slightly surprised (as it was the first power outage I've experienced in St. Vincent), but not overly alarmed (as this happened in Grenada around once a month). However, when the power cut out today for the same six-hour block, I became slightly suspicious. Turns out these are planned outages that I had no idea about, and don't adhere at all to the planned times. Oh well, Caribbean time, I guess… Anyways, looks like we have two more power outages the next two days to look forward to.

In other news, yesterday I noticed all the major potholes on the highway were marked with spray paint. Today, believe it or not, all the rim-busting potholes were actually filled in. Too bad that was a few months too late…

Sorry for the leave of absence, but I've been dealing with lots of stupidity lately. First my own stupidity: Last week, for the first time in the ~10 years that I've had one, I lost my ATM card. In a foreign country no less. So I call up my bank to cancel the card and get a replacement, but after wading through the endless computer voice menu, I always get "Transferring your call. I am sorry your call could not be completed at this time." Grrr. So I go online, and try and contact the bank through their secure messaging feature. I get an email back that they can't help me, I need to call to verify information. After explaining that I've already wasted $15 trying to get through, and get hung up on by the computer every time, they finally give me the secret back door number. When I finally get to talk to a human, I get my card canceled without a problem, but getting the replacement proved to be a bit tougher. Since I am in a foreign country, they have to send the card via DHL/Fedex/etc. The problem with this is that the express carriers "don't deliver to PO Boxes." However, no one in St. Vincent has a physical address. All mail gets routed to PO Boxes, where people go pick it up. The supervisor didn't believe me, so it took a bit to convince her to send the card. I mean I have gotten stuff Fedex'ed to me before, trust me, it works, even with a PO box… So hopefully I should get the replacement card soon.

Next up in the endless parade of exams (ok, not really, it just feels that way) is the OSCE. It is occurring all week, but I have mine scheduled on Saturday, since the rest of the week I will be recertifying 300+ students in CPR. (And they might actually need to learn it this time, since there is a slight chance they might be performing CPR over the next two years in clinicals.) I am not too worried about the OSCE - from what I have heard almost no one ever fails, and last term the entire class got grades between 82.1% and 89.7%. (So really, what's the point, if everyone is getting a B?) Anyways, can't be too tough, considering we never had a class on one of the exam stations (prescription writing - I mean why are we getting tested on that anyways, as we won't actually be writing prescriptions for a few years…), and there was all of one hour on another exam station (EKG reading, and since I've been reading them for years, I've got a slight advantage, I guess…). Oh and there's the station where we have to do a complete history and physical exam in 7 minutes, including reporting results. They really can't be expecting anything but something completely superficial. (On a side note, isn't this close to the average length of doctor's appointments in the US?)

Since the brilliant people that devised the 6th term calendar scheduled TEAM (basically a "lite" version of ATLS for medical students and allied health workers) the exact same time that half of the students are supposed to be at the hospital on rotation. So my group rescheduled and did our final rotation (yay!!) at the "Walk-In Family Clinic" today. Unlike the Urgent Care Clinics at home, this one actually seemed to treat patients, rather than just dialing 9-1-1 for a taxi ride to a real hospital. Our patient was a 13-yo male who complained of constant pain in his left thigh since yesterday, with no other associated symptoms. No trauma. Any guesses, anyone? Well considering the latitude, Sickle Cell Disease would be a good guess. And mostly correct, too. This patient didn't actually have full-blown disease, but Sickle Cell Trait (heterozygous) instead, which is protective against malaria (hence the comment about the latitude). I was very impressed with this patient — he had a better grasp of his medical history than all of the other patients we have seen here. After quickly taking the history (getting better at that - times are down by 78%) and physical, we chatted for a little bit with the attending physician on the etiology, pathogenesis, management, etc. of sickle cell disease, and got our last signature, all in under an hour. Reflecting back, I must say that all the tutors and clinical experiences were really excellent (save one), and I enjoyed them. Though I am kinda getting sick of the observing, time to start doing!

To study or not to study, that is the question. On Monday, the 6th Term class is scheduled to take the Basic Sciences Comprehensive Examination (BSCE), Part II. It is a standardized 400-question multiple choice exam given over 8 hours. It is scored such that 1/3 of the class automatically fails based on the class mean. Though the school claims that it is not meant to be an emulation of the USMLE Step I (since it uses question types not found on Step I), basically it is designed to gauge one's readiness to sit for Step I. The thing is that I, and most of the class, don't need to pass the exam. One only needs to pass the exam if one's GPA is below 2.5, so that the school will certify one to be able to take Step I. Since I am already certified based on GPA > 2.5, (and my exam is already scheduled), I don't need to pass, and I am wondering if I should waste time studying at this juncture. People have already said that they will fill in all "C's" on their Scantron to get out of there in 10 minutes, and there were sufficient rumors of people just not showing up for the exam at all to prompt an email from the administration reminding us that we still do have to show up and put *something* on the Scantron.

Well, since my Pharm and Pathophys exams aren't for another month, maybe I can take a break from that and spend a weekend brushing up on my Biochem. Uck. Well, I'll have to start looking at it soon enough anyway for Step I review.

Update: One of my housemates managed to split the radiator hose, so our car is OOS. Luckily for us, our landlord/rental car agent offered to drive us to the exam in the morning, though half-an-hour earlier than we need to be there. In the meantime, he will be replacing the hose and dropping the car off so we have it in time for the 12:30-1:30 lunch break. Not the best of omens…

I was weak. I had made it through 26-week Terms before, but during this, my 6th Term, (which is only 18 weeks long), I took a short sabbatical and went home for a week. It was right after passing (and getting a better than average score) on my second exams when everyone I know was either 1) going on vacation to another beach (not interested - gets kinda old after being in the Caribbean for 2 years), or 2) going on a scuba diving vacation to another island (which I can't as a result my little accident). So for about the same amount of money others were spending on a weekend away, I spent a whole week at home seeing family and friends (or at least the ones that were working either at the ambulance or hospital when I was.)

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