Home.

I know it’s pretty obvious that my posts have been pretty absent since moving back the to States, and for those of you who followed closely, I apologize. Tonight; however, as I was walking back to my apartment after spending the afternoon with some friends and having a wonderful catch up later in the evening with another friend, I was in a reflective mood and had an inclination to write. So, here I am. J

Tonight, as I mentioned, I had an incredible time getting together with a friend whom I’ve not known for a large part of my life, but somebody who has been in the throes of medical school with me and someone who has experienced her fair share of challenges throughout the years, but remains one of the most resilient, realistic, and positive people I have ever met in my entire life. Not that I interact with many negative minded people, but it’s always so refreshing to find people who view life and the world in such a similar way. Anyway, as our conversations concluded, it was time for me to make the 15 minute walk back to my apartment and I realized, like I have on many other occasions here in Chicago and many many many more occasions whilst living in Dominica, what it means to simply live in the present. To take everything in. The sights. The sounds. The smells. Everything. As I walked, I wasn’t thinking of anything but the way the sky was so clear I could see the stars. The crispness that the air brings to Chicago in March. How happy and excited my fellow Chicagoans were to be enjoying their Saturday night. The way the streets intersect, and how things just seem to come alive at night with the business lights all on and streetlights illuminating the neighborhood. It was absolutely indescribable.

Now, some of this may be coming from the fact that I know I only have 5 weeks left to call myself a resident of Chicago, but I also know that I’ve been experiencing these feelings, despite getting caught up in the stress and chaos it can often offer, since I moved here. Admittedly, the place I feel most present is down at Lake Michigan where I walk from my apartment and just sit. Listening to the peacefulness of waves on the lake while the traffic zooms past behind me on Lakeshore Drive. Looking south at the lights of downtown and only imagining the hustle and bustle of life existing within the streets. Just taking it all in, knowing that I’m only a small part of this ginormous place, and knowing that despite its eccentricities, I’m going to miss it. Which leads me to the title of this post: Home.

What is home? For some, it’s where they have a place to sleep and prepare their food. For others, it’s where their loved ones are. And still for others, it is where they were born and spent the majority of their life. What I’ve come to realize, is that for me, home is exactly where I feel the most present. It’s where I can go to take my mind off of the stress of day to day life. The place I can walk and just appreciate the little things in life; where I can simply be. Five years ago, that place was Minneapolis, three years ago that place was Dominica, now it is Chicago, and in three months it will be Des Moines, Iowa. To say that I am grateful for having the opportunity to call Chicago home would be an understatement. The things I have learned, the people I have met, and the places I have gone have taught me more about life than I could have imagined learning in a lifetime. They are things I will take with me to my next adventure and beyond. I am so excited to move into the world of pediatrics for the next chapter of this amazing adventure, and cannot wait to experience this recurring feeling of being present (I know it was a common theme in my posts from Dominica) wherever life wants to take me. But for now, I’m going to spend the next 5 weeks taking in everything Chicago has to offer and appreciating the little moments like my walk home tonight.

Fragility.

Fragility. A word known to so many people in so many capacities, and no matter whom you ask, every single person will have a different story to tell. For those of us in the medical profession, it’s something we encounter on a daily basis, whether we want to or not. One decision, even if it’s exactly what is supposed to be done, can make or break the outcome of somebody’s care. Even if it doesn’t, every single patient we encounter is fragile. They are, in some capacity depending on us to make them better, fix their problems, and send them home. They are vulnerable. On the one hand, it’s one of the most humbling aspects of being a (future) doctor- knowing that somebody has willingly placed their well being in your hands. On the other hand, it’s absolutely terrifying; constantly questioning and wondering if the decisions you are making are, in fact, in the best interest of the patient. Today happened to be one of those days in which the fragility of medicine, and life itself, made its presence unquestionably known.

Around mid-morning, a patient who wasn’t even specifically my team’s began to decompensate rather quickly and unexpectedly. As the medical team in charge of “rapid responses” for the day, we responded to the page, treated the patient as we saw was appropriate, and moved on to continue our day. As far as everything looked, we did what we were supposed to. The patient’s mental status had returned, and they seemed to be back at their baseline level of function. We were all completing the required tasks and preparing for upcoming lectures, when this particular patient’s nurse called another rapid response not even three hours later. Again, we responded. This time; however, as we looked at the patient’s most recent labs and compared them to the previous set, we realized something much bigger was going on. The problem; however, was that we had no idea what that “something” was. Somehow this patient was losing blood internally, and fast. Despite knowing the broad cause of this patient’s quick decline, we knew that it was likely too late to turn anything around. Ultimately, we ended up having to call a “code” on the patient (aka: his heart isn’t beating and he’s not breathing on his own), and he died. Now, the fact that the patient died is hard in and of itself. If you’ve never been in somebody’s room while they’re taking their final breaths, let me tell you it’s a bizarre and indescribable experience. Even more than that; however, is wondering what you could have done to change the outcome. Now for me, the answer to that is absolutely nothing. I didn’t make any decisions nor did I personally manage any aspect of this patient’s care. I do know; however, that had I been in a position to be making those decisions I would have spent the rest of my day wondering how we could have changed the outcome of this patient’s life. As we finished the rest of our paperwork for the day, walking down the hall in the hospital, my resident asked me what I would have done differently. As somebody who was more “on the outside looking in,” what would I have done differently? This struck me for two reasons: 1. Even though my opinion carries absolutely no actual weight, I was being asked how I would have managed a patient. In my head, I was thinking, “but I’m just a medical student, how could I possibly have enough understanding to be able to make that kind of decision?” And, 2. In the grand scheme of things, I don’t know that I would have done a whole lot different than what had been done. In that instant, I got a glimpse into what it feels like to be responsible for the care of a patient who doesn’t make it.

Now, on the opposite end of that spectrum, I have another patient who presented to the emergency department about a week ago morbidly obese with a severe infection and several other medical complications. At that time, we had no idea what the source of infection was nor how it could have even possibly gotten this bad. We even thought from the get go, “this person may not make it.” Nonetheless, we admitted the patient to our service, and began doing the only thing we knew how- the best we could. Now today, a little over a week later, this patient has turned 180 degrees. Nearly recovered from the infection, labs mostly normalized, and ready to be discharged to a rehab facility where they’ll be provided dietary guidance and physical therapy to begin walking again. Today while completing our rounds, this patient even jokingly (I secretly don’t think she was) claimed that we would see them running in the Chicago marathon next year.

All of us go into medicine to “help people” in some way or another. When we make the decision that this is what we want to do, or some may say what we’re called to do, it is with the understanding that death is a part of the process. That there are situations in which no matter what we do, how worthy the patient is, or how much we want to “help,” there is nothing for us to do except accept the reality that death is a part of life. As people who sell themselves as “fixers,” it’s a harsh reality for doctors, nurses, and other caregivers to accept, but it also has shown me the importance of simply being a support for the friends and family of those for whom we can provide no fix, and continuing to believe in every single patient no matter how they present. In many cases, we are their final chance; the last option they have when everything else has failed. And to not show up 100% when they need it the most would not only be doing them a disservice, but also ourselves.

I’ll be honest and say that today was one of the hardest days I’ve had so far as a 3^rd year student, and I know it is only the first of what will be many cases in which there is no fix, but it was also one of the best reminders that life does in fact go on, and that fragility and vulnerability can be just as much of a positive as they seem to be negative.

Uncertainty.

Uncertainty. As a type- A personality who likes to feel in control, it is my worst enemy, but as an international medical student, it is something that I, as well as all of my colleagues, have become quite familiar with. Currently, I’m at my mom’s house in Minneapolis studying for STEP 1 (the first in a series of US medical licensing exams). Originally, I had planned to take it in the beginning of March, with the intent of starting my clinical rotations soon thereafter. Well, as usual, life took the reigns and gave me some pretty good indications that I needed to take a bit of a break and, instead, push my exam back to April. First, as many of you know, I arrived back to the States with an additional companion, my dog Fenway. Now, I absolutely love her to death; however, the adjustment of 1. Having a dog, and 2. Living with my mom and her dog, took some more time than I anticipated. Additionally, my brother and his girlfriend (now wife) of nearly 8 years got married in the middle of January. As much as I planned to study non-stop during the weeks leading up to the wedding, and even the weekend of, it didn’t actually happen. I was too excited and had too much to do. Throw in there a bit of: getting together with friends and family I hadn’t seen in months or years, enjoying some time to read books for fun, and exploring parts of Minneapolis and St. Paul that I hadn’t seen before, and you’ve got a lot of time spent not studying. Really long story short, I didn’t realize how much I just needed that downtime, and knew I would not be ready to take my exam in March. We’ll see how I feel once it’s over in April, but for right now, it absolutely feels like I made the right decision. It does; however, bring me back to my original point- uncertainty.

Most students at United States medical schools have a structured time window in which they are expected to take STEP 1. Technically, I do, too; however, it’s a little different. Upon finishing our Foundations of Medicine curriculum in Dominica, we are required to sit for STEP within the next 6 months. From there, assuming we pass, we start our 3^rd and 4^th year clinical rotations. All of this seems pretty certain, right? I mean, finish in Dominica, go home (or wherever one plans to study for STEP), take the exam, complete clinical rotations, graduate, start residency, boom, you're done. If only it were that simple. You see, prior to starting rotations, we are required to complete a 6-week pre-clinical clerkship in Miami, FL. A very necessary clerkship in which we, as international students, become more acquainted with the hospital systems here in the US, work through simulated cases with our colleagues, and begin our clinical rotations in a Miami clinic. That being said, it’s only 6 weeks. Enough time to sort of get settled into an apartment, but not entirely, knowing that soon thereafter a move will be warranted. A move to where, you ask? Well, here enters the second phase of uncertainty. We don’t find out until 1-2 weeks into our time in Miami. For me, personally, based on when I will be there, I could be anywhere from Chicago to Maryland for the next two years. Toward the end of those rotations, I begin applying for residency, essentially my first job, in locations, again, scattered around the country. For those of you who have known me for a while, you know that I have moved (not necessarily cities or states) every year at least once since I graduated from high school. Granted, I know many people who are in the same boat, and I am incredibly excited to begin working with patients, but boy am I ready to just be in one place and stay there. 

Ironically, I spent the majority of my first 25 years wanting to get out and move; experience something different. I grew up in a suburb of Minneapolis, went to college at the University of Minnesota in Minneapolis, and worked for 3 years after college in a suburb of St. Paul; basically all within an hour of the Twin Cities in Minnesota. I was ready for a new adventure; you know, new scenery, new people; a fresh start. I went into my opportunity at Ross with a completely open mind and a nervous excitement that I had never before experienced. In retrospect, this attitude and approach is what made my time in Dominica as amazing as it was. You’ve all read about my experiences with various bugs, the times without water or electricity, and the constant rain, but when I look back on all of it, I can honestly say it is one of the most influential experiences of my life. Not only did I get to embrace a completely different culture, but I also had a chance to learn a lot about myself; things that I would have never known without my time there. It also taught me, as I’ve mentioned numerous times before, how much I value people and my relationships with them. When I say that I don’t intend to focus on any one or group of relationships, I mean all of them; anybody who has been a part of my life and impacted it in some way. The thing I realized while away and since I’ve returned is that most of those people are here in Minneapolis, and that, on top of many other reasons that I have re-discovered in the past couple months, makes me say for the first time, that I really don’t want to leave again. Not only that, but I want the certainty that I don’t have to. Unfortunately that’s not an option. I’ve expressed this sentiment to a few people in the last couple weeks, and every single one them reacted with, “You can’t quit. I’m not going to let you quit.” For those of you who told me that, thank you, very sincerely, but I assure you that I have absolutely no intention of quitting. Not only have I put far too much into this to throw it away, but I also love it with all of my heart. I do; however, have it in my head now that I may want to move back someday.

With all that being said, I know I’m not the only one of my colleagues who feels this way. As I mentioned in the beginning, it’s something, as international students, that we’ve grown accustomed to. We don’t have a “home-base” university that guarantees where we will spend the majority of our 4 years of medical school; we learn to adapt. Honestly, though, as scary and frustrating as it is right now, I think it will end up being one of our most valuable traits when it comes time to actually handle patients. Medicine, as a profession, is chalk full of uncertainty. Even in the most straightforward case, a curveball can come out of left field that throws the entire plan out the window. Knowing how to handle that, and what it feels like when all of the control you thought you had is completely lost, is something that I know will help me as a physician someday. As I’ve worked through these various emotions and have begun coming to terms with this next phase of my education and my life, I am taken to a particular movie called The Best Exotic Marigold Hotel. In it there is this quote, “Everything will be all right in the end... if it's not all right then it's not yet the end.” Granted, the definition of “all right” is not black and white; however, since seeing this movie a few years ago, this is a perspective I have really truly tried to adopt. Life is life; in the grand scheme of things, there are few things that we have ultimate control over. In this particular situation, yes, I could quit school to guarantee that I don’t have to leave Minneapolis, but where does that put me? I honestly don’t know, but I can say, with such a decision, a lot of other uncertainties would accompany it. So, at the end of the day, what I am learning, more than ever, is not to overlook it or try to suppress it. Experience the uncertainty along with the fear and other emotions that come along with it because you never know what will come out of those experiences that at one point were completely uncertain. After all, if I had given into my uncertainty about Dominica 17 months ago, I would have never met the people I now call friends and colleagues, nor would I have had the opportunity to learn about the kind of doctor I someday want to be. As I started doing this earlier today, allowing myself to simply feel the uncertainty, to let it be exactly as it is instead of thinking about it and trying to analyze it, the tightness in my chest went away, and a sense of peace arose in its place; knowing somehow that everything will work out, whether it’s exactly the way I want it to be/ think it should be or not, exactly as it is supposed to.

With that, I leave you, as always, with all of my love.

Tying Loose Ends.

It’s a strange feeling- knowing that there are only 33 days separating me from leaving Dominica for good and feeling like a part of me is missing. In the middle of the afternoon today, I came to the realization that part of the reason I haven’t been able to focus as much lately is because my apartment is in absolute disarray. I haven’t taken the time to organize it in ages. So, I left campus a little early tonight and came home to organize. I lit a candle, played some music and just started sorting. Now, here I am. I have a pile of articles and clothing that I plan to donate before I leave, and for the first time in a while, feel like my apartment is mine again. There’s still a lot left for me to do, but that first sweep is done. I threw a lot of things away and started thinking about how I’m actually going to pack all of this stuff up. Hard to believe.

I began writing what will now be today’s post about 3 weeks ago. Unfortunately my apartment is back in a state of semi disarray, but all those things I mentioned having to accomplish are now complete. Last week marked the last exam I will ever have to take as a part of the basic sciences curriculum here in Dominica. One week from today, I will take one more exam in the exam center here in order to get back home for good, and two days after that I will be on a plane with a dog heading north. As usual, I could write a book about all of the things that are going through my head trying to grasp that concept, but for today, I think this quote sums it up pretty well: “Maybe you had to leave in order to miss a place; maybe you had to travel to figure out how beloved your starting point was.”

Having been a guest at a banquet hosted by two of the organizations on campus last week, a lot of things ran through my mind. The excitement that comes with being done with the first two years of medical school, the anticipation that I have of coming home and being home for the holidays, sadness in leaving a place that has welcomed me with open arms for the last 16 months, appreciation for every single sunset I’ve been able to see and the clarity of the stars when not polluted by lights, and the list goes on. What I’ve come to realize, though, as I did a year ago, is that what I’m going to miss are the people. An incredibly brave person gave a speech at this banquet last week, and very clearly, without any reserve, admitted to being so incredibly overwhelmed with things going on in her life that she wanted to kill herself. What got her through; however, were a few very select people who didn’t leave her side. She called them her guardian angels. Although not everybody is in her exact situation, it really points to the fact and reality of this profession and how it affects people. It can be stressful, overwhelming, de-moralizing, and exhausting. One day you can love it, while the next day you just want to quit and never return. Basically, it can consume you if you let it. The things, though, that get you through all of it are those that you can’t put a definition or a title on. They’re the moments with people who care, the times that somebody is there before you even realize you need them to be, simply because they, too, know what you’re going through. As much as I can’t wait to come home and see all of my friends and family, continue to meet new people and advance in medicine, I know what I am leaving behind, and unlike a year ago when thinking about returning to Minneapolis, I know that even if I return here to Dominica, it won’t be the same because those people who have made this experience what it has been, both good and bad, will not be here.  

To all of you reading this from Dominica, thank you. Thank you for your friendships, thank you for your kindness, thank you for teaching me about life, and most importantly, thank you for simply being here. You all have given me so many new perspectives and shown me what it takes to really open one’s eyes to life. To all of you who might be reading this from Minnesota, Iowa, New York, anywhere else in the world, thank you, as well. Without you all, I wouldn’t be where I am today. You all know where I started and why. Anywhere from late night phone calls, movie “dates” over FaceTime, unexpected packages and snail mail, and visits over breaks, you guys are the ones who have kept me going, reminding me every single day that everything about medicine, Dominica, and this experience is worth it, and that I can actually do it.

With that, I leave you, as always, with so much love.

Grab a Snickers (and perhaps some Kleenex).

This one will be short and sweet, both for my own sake, as well as yours. For today, I have one purpose and one purpose only- the discussion of life and death. And, as unfortunate as that purpose is, it is one that is a part of all of our lives whether we want it to be or not.

As a wonderfully wise person said so many times, you might want to grab a Snickers (and perhaps a Kleenex). For the last eight years, since my first year as a member of the University of Minnesota Marching Band (UMMB), I have been humbled to watch, albeit solely as a fly on the wall, as my band director and his family found out that his wife had metastatic breast cancer, and went on to battle the ever evolving roller coaster that goes along with it. Although nobody wants to receive this news, their approach was so positive. They started a Caring Bridge site, and from the very beginning, both expressed the utmost optimism and faith in the process, using movie quotes as “Never tell me the odds,” and “Go to the mattresses” to describe an experience too real for so many people. Over the course of my four years as a part of the UMMB, as well as the years since graduation, I have followed the updates on her Caring Bridge site, watching not only her, but also her husband and other family members cope with the ups and downs that are chemotherapy, clinical trials, radiation, remission, and recurrence- multiple times. Throughout those eight years, it was amazing not only to watch their family cope, but also how the idea of “family” extended so far beyond those related by blood. As a group of over 300 people, the band sent cards, took pictures, raised money, and a few years after I left, made a quilt. Additionally, friends, neighbors, and community members cooked meals, cleaned their home, and took care of their three boys when she just needed a break. Now, I’m not trying to get on my soap box to turn this into a plug for the UMMB or to talk about me, but to describe my appreciation and utmost respect for an organization and family that always goes above and beyond what is expected, both in the capacity that is “defined,” and more importantly, that which is undefined and completely outside the scope of their responsibility. The power and true support that comes from a group of people who have such a genuine interest in helping others in whatever capacity they can, is truly amazing.

Although I only met her once, it was so incredibly easy to see how caring, vivacious, selfless, brave, and 100% real Toni Diem was. She is somebody whom so many of us should aspire to be, and will be missed by a lot of people. As I said earlier, I am extremely humbled to have been even a small part in such an enormous chunk of this family’s life. The things I learned simply from observing expand beyond the boundaries of anything I could have learned in a classroom or from a teacher. I will take all of it with me in hopes of applying it to the many sensitive, tender, and raw situations I expect to encounter in the coming years of my career.

With that, I leave you with a few more words from that wise man I mentioned earlier, “Call home, because you just never know.” I love all of you, whether acquaintance, friend, or family, more than you’ll ever know.

I’ve included the link to her Caring Bridge here, on the off chance that any of you are interested in reading both her story, as well as the perspective of a person who loved her in a way that is seen only on the most rare occasions.

This is the time.

Quotes. As anybody who has known me since middle school knows, I thrive on quotes. You look at the space of any dorm, apartment, cubicle, office, desktop, computer, phone, etc I’ve ever owned, and you are 100% guaranteed to find quotes in some location. Do I plan my life around them? No, but I do find them both a reminder and a catalytic point of discussion. In many cases, all it takes is looking and reminding myself to see them.

I started writing this about two and half months ago. A few things have changed since.

1.     I am 1 week into my last semester in Dominica.

2.     A tropical storm decided to attack the beautiful, gentle, and generous country that I have called home for the last year.

3.     My hair is a few shades darker.

4.     My plan to buy at dog as a Christmas present to myself is actually coming to fruition.

5.     I actually have a plan for the rest of my life.

What hasn't changed; however, is that constant reminder to just stop and take it all in. 

You may be asking, “Why today? What made her sit down and write today? It’s been months, so why now?” Well, to be perfectly honest, I’ve been meaning to add more to my previous accounts of this crazy, once in a lifetime experience that I am lucky enough to experience, but that all elusive property of time always seemed to limit my ability. As I took a break from studying today to check my personal email, I noticed there was an updated blog post on a website that my aunt has started in the last couple months to keep an account of all her experiences both as a successful, working professional and as a mother, and also to give other women who are trying to find the same work-life balance a place to relate and share their experiences (shameless plug: http://www.happytogetherlife.com/). The post she added today was titled  “The Beginning of What I Imagine Will Be an Emotional Roller Coaster As a Mom,” and though I am nowhere near being in that phase of my life, it struck me from a different direction- the fact that this semester will be my last. The last days that I will spend waking up to the Caribbean out my front window. The last weeks I will see a new cleaning lady on Tuesday mornings, wondering if my actual cleaning lady, Mavis, will ever return. The last hours I will spend studying next to some of the most incredible, intelligent, passionate, compassionate, and supportive human beings I’ve ever met. Granted, I still have a little over 90 days until I will actually have all of these last moments, but based on how the last year has gone, I know these days will go by before I can even blink. As I reflect on my time here in Dominica, and how the experiences I’ve had have changed me, both professionally and personally, I wonder what if? What if I had waited another year to go to school? What if I had decided that medicine wasn’t actually where my passion lies? What if I had stayed in Minnesota? What if? The me from one year ago would have taken those “What if’s?” and sat on them. Thinking of them incessantly; constantly wondering how my life would be different, and in some ways why I needed to take this particular path. What I have learned throughout various avenues while being here in Dominica is how important it is to simply be present. Not only to not get stuck on the “would haves,” “should haves,” or “could haves,” but also not to be in the tomorrows, next weeks, and next years; to purely and simply be here and now.

As an aspiring professional in a field that constantly requires extensive planning and preparation, being in the present can be difficult. We’re always thinking about the next exam or the next clinical visit we have- wondering if we’re going to be prepared or not. Planning out the next two years in an attempt to have a semblance of an idea of where I will be most successful. What hospitals have the residency program that I’m interested in? Will my STEP score be good enough? How do I make sure that I make the right contacts along the way? Anyway, I think you get my point. The thing that is so easy to forget; however, is WHY most of us decided to go the medical school and become doctors- we have some underlying desire to help people. It’s as a simple as that. In order to do this and do it well, we have to be completely present. Would you, as a patient, want your doctor to be thinking about 5 years into the future while you’re trying to express your concerns? I know I wouldn’t. Therefore, for the last few months, as much as I’ve wanted to sit down as write (believe me, there were many a late night studying that all I wanted was to put the books away and write), I tried to remain present in what I was studying and why. And you know what? It was fantastic. For the first time, I didn’t feel like I was rushing through my material. Instead of trying to get through reviewing as many lectures in a day as I could, just to check them off my list, I took my time and tried to dissect them. Not only was the learning process much more fulfilling, it was also more successful. Despite having heard that last semester was the most difficult of the first two years of medical school, it was my favorite. Perhaps it had to do with the fact that we had finally gotten into pathology and the things that go awry in various disease states, or that we had more one on one patient encounters than any other semester. I don’t know. Whatever it was, it was amazing. Was the material always what I wanted to study? Not for a long shot; but, it finally clicked. I was finally able to begin doing what I imagined I wanted to do- sit down with a concerned patient, extract the necessary important information, and start developing several hypotheses regarding what might be going wrong. Many of you, I’m sure, have experienced similar things in various times of your life. That moment when all the work you’ve put into learning a new skill or trying to understand a new concept finally comes together and clicks. It’s really indescribable.

Of course, as important as school is in encouraging us all to continue taking things one day at a time, there’s nothing like a tropical storm to take that reminder to an entirely new level. As some of you may have heard, several parts of Dominica were hit extremely hard 2 weeks ago by Tropical Storm Erika. The detail that may be a bit surprising to some of you is that very little wind was involved. I know when I think of an area being damaged by a tropical storm or hurricane, I think of the combination of wind, rain, and perhaps a bit of lightening and thunder. In this case, it was about 12-13 inches of consistent, torrential rain over the course of about the same time frame. Now, in the United States, that would be a problem. There would be flash flood warnings all over the place. People would be at the banks of rivers with sandbags ferociously trying to create temporary dams in an attempt to keep the water contained. What we so easily forget; however, is that many of these systems are in place because somebody put them there. Infrastructure. Organization. Planning. As a country located in the Caribbean, there were certainly plans and procedures in place in the event of such a natural disaster; however, as we all know from seeing what a major hurricane did to New Orleans, these plans aren’t always sufficient for what Mother Nature throws. As the Prime Minister has toured the island to evaluate the damage, he estimates the country has been set back by at least 20 years. For those of you who don’t know, that’s huge for Dominica. The progress they have made in the last 20 years is substantial. So many people’s livelihoods depend on the land and its ability to yield food, as well as the roads. A large portion of the island south of my campus was severely damaged, and at this moment, transport into the capital city is nearly impossible. In several cases, the overflow of rivers washed out bridges and large portions of the roads. In attempts to temporarily repair those roadways and restore transport, large rocks were placed across the rivers. Notices were placed throughout the country and delivered to me from the US Embassy in Barbados stating that most of these roads could only be traversed if one was in a 4x4 vehicle. It now saddens me to say, that over the last 3 or 4 days we have gotten even more rain as a tropical depression passed and additional rain clouds continue to head our way from the Atlantic. As I said earlier, it’s not completely unexpected- we’re in the middle of hurricane season and I do recall my first semester last year being quite rainy, but it still doesn’t bode well for those communities that are already in severe distress. As of today, the Prime Minister closed all primary and secondary schools throughout the island and requested that all public officials remain in their homes. When events such as this occur, I am reminded of how, one year ago, I was settling into the notion of not having hot water at my beck and call (or at all in the kitchen for that matter), the electricity going out on random occasions for no reason with no clear timeframe for returning, and paying more for electricity than I have ever paid in my entire life. Now, one year and a tropical storm later, I find the humor and incredible opportunity to adapt in such events. Many of my colleagues and myself have been without water at all on several occasions in the last week and have needed to adapt. Take a shower at the gym instead of at home. Fill your water jugs on campus and store them. Download all your lectures for the week while you have Internet just in case the Internet goes out. All of these things we were told when we arrived, but honestly never thought would actually be an issue. I guess, now we know. So, with that in mind, I’m not usually one to readily ask for prayers, support, money, etc., but in this case, please keep the friends who have become my family in your thoughts as they continue to try to rebuild their lives and move forward. Them being some of the most resilient people I have ever met, I have no doubt that they will, but an extra thought or two never hurts.  

Now, on a more personal level, the tropical storm did affect everybody’s travels back to the island following this last break. Instead of our normal flight into the airport and a 45-minute bus ride to campus, we were flown into Guadeloupe and then took a 2-hour ferry ride into Dominica. Was it the most ideal way to travel? For most, not even close. Several people became ill on the ferry ride, and other people had been stuck on other islands- Puerto Rico, Barbados, Antigua, to name a few, for several days before they even know what the plan was. That being said, we all made it back to school in one piece, as a group, and on a travel itinerary that was completely paid for. The faculty and staff at our school did everything that they could to make sure that we were taken care of, and I couldn’t be more grateful. I can’t imagine having to transport that many people on such short notice with such strict limitations. It’s another experience to add to the books, and who doesn’t want another stamp in their passport?!

In terms of my actual break- it was glorious. I ate (almost) all the food I missed, saw most of my friends and family, and even managed to make it to the Great Minnesota Get-Together (aka: the state fair). I wasn’t quite ready to come back, but knowing that it would be the last time traveling back to Dominica put a different spin on my departure. Although I am ready to move into the next phase of my education and actually act like a doctor every single day, I feel bound to this island and many of the people I have met here more strongly that I imagined. Despite everything that has happened, I am honored to be able to call Dominica home, and the people I’ve met family. As school picks up again, I likely won’t be back until Christmas, but know that I am taking everything in as much as I can, enjoying and learning from every experience, and am so excited to be moving back to the United States in a few months. Leaving you all with lots of love, and a few pictures from the last few months (including the opportunity I had to observe surgery on a United States Navy hospital ship that visited Dominica for 11 days over the summer!!).  

Ready for surgery.

USNS Comfort

Sports Day with Dominican school children
"My Plate" activity

Pit stop while exploring the city via bicycle

Required pit stop at the U of M building at the fair
"Put me in, coach!"

Life in Color.

Again, I know it’s been forever, but as I near the end of what will be the only mid-semester break I’ll have while in Dominica, listening to One Republic’s “Life in Color,” I decided it might be an opportune time for an update. As I said, myself and my fellow 3^rd semester colleagues are coming to the end of our “spring break.” “Spring Break in med school?,” you may ask. Yes, and a much needed one at that. Now, did I get a break in previous semesters? No. That being said; however, 1^st and 2^nd semester workload and content have nothing on year 2 of med school. Despite the increased workload, I LOVE IT. Not in the same sense that I enjoyed 1^st and 2^nd, but in the sense that I actually want to sit down and study. Not only is it material that I have pretty much never seen, but it’s finally the application of all the foundation and basic sciences that we reviewed in the first year. The semester so far has been “Fundamentals 2,” which is the second go around for a lot of the topics we covered for the first part of 1^st semester last Fall. This time; however, we didn’t learn about what is “normal,” but instead, all of the things that can go wrong. Neoplasias, risk factors for cancer, bacterial and viral infections, and the list goes on. Now, when writing this list out it’s quite depressing. These are all the things that we never want to deal with, right? I mean, nobody wants to get sick. Nobody wakes up in the morning wishing for a stuffy nose and a cough. The fact; however, is that it does happen, so in those cases, I want to be able to fix it. And, finally being able to apply what I know is so incredibly rewarding and exciting. It doesn’t make it easy, but it makes it completely worth it. For the rest of the semester, we’ll hone in on specific organ systems and processes, starting tomorrow with the circulatory system and the cells it contains (ie. White and red blood cells). I’m quite intimidated by this block based on feedback I’ve received from students who have been here, done that, but I think I’m up for the challenge.

Secondly, for the first time, we have the opportunity to work with actual patients within the community and be real doctors. I had my first community clinic a week ago, and I can’t even begin to describe how wonderful it was. I was paired with another student from Ross, and we had one patient- a gentleman from the community who had come for a check-up. In the past, we would have been required to conduct the interview and the physical exam with a member of the faculty watching our every move. This time; however, we completed the entire process on our own. Yes, there was a faculty member present within the clinic to make sure we didn’t miss anything major, but the overall process was completely our own. Additionally, we have weekly standardized patient sessions on campus that require each of us to conduct a patient interview and focused physical exam twice throughout the semester. Despite each of these cases being “standardized,” meaning that a volunteer from the community acts from a script as a patient with a specific concern, they still give us a chance to really practice the skills we’ve learned. In the past, we have had these types of cases, but they were conducted in pairs and didn’t include the physical exam part. I won’t go so far as to say it’s been surprising, but in many ways, encouraging, to see how much of what we’ve been taught in clinical skills over the last 2 semesters has actually stuck. Obviously we were learning them all for a reason, but at the time it seemed so disjointed. You don’t think you’ll actually remember when to apply each part, and when to do a complete respiratory exam vs. the abbreviated version. All of the sudden, though, you’re just doing it and you’re not even sure where it’s coming from. If I had to describe it, I think I’d say it is very much intentional and second nature, while also being quite surreal. When I was placed in the role of “Dr.” for our standardized patient this week, I’ll admit I was quite nervous, but despite the slight quiver of trepidation that accompanied my words for the first few moments, I loved every minute of it.

Now, shifting gears completely, in all of our free time, 5 of my fellow students and I are getting SCUBA certified. We’ve had 2 confined water dives so far, and have 2 more total dives remaining. As I mentioned the last time I checked in with you all, I had done a “Discover Scuba” course while my dad was in town and fell in love. To this point in our training, we haven’t seen anything other than the sandy bottom of an area that’s about 10 feet deep; however, even that is incredible. I don’t know how many of you have been scuba diving, but when it finally hits you that you’re under water, just sitting, as fish swim by and the currents come and go with each wave, it’s amazing. Granted, I know I’m not the first person who has ever been scuba diving, but realizing that, with enough air in my tank and at the right depth, I can literally stay underwater and simply observe a whole different world for hours is amazingly humbling. When I went diving with my dad, he made a reference to icebergs, and I found it to be so accurate. On the surface (and even snorkeling), you get a sample of what life under water is like. The fish and the coral, the sand moving each time a wave comes into the shore, but once you get 45 feet below the surface? The world as you’ve always known it to be becomes tiny. You’re eyes are opened to a completely new existence and life, and you realize how small we are. You watch schools of 50 fish swim by, and it suddenly strikes you that the world doesn’t revolve around us. That, like I’ve mentioned with reference to the stars at night, there are so many other things in the world that rely on the existence of the earth. I’m not sure if we’ll be able to finish our certification this semester due to time constraints, but I do know that I will be certified when I leave the island, and I can’t wait to explore.  

As strange as it may sound, I’ve found today that writing has been more difficult than it usually is. Normally, I don’t know where to begin because I have so much that I want to say. I’m not sure why, but I haven’t been able to really find a common theme or string to run with. Perhaps because I’ve had a week off not to really think about school, and actually relieve stress. Or, maybe because I haven’t done much other than school for the last 5 weeks to this point, and feel there is not much to tell you about. Who knows? What I do know; however, is that my eyes have been opened even further to where I’m headed, and I like the way it looks. My time in Dominica is more than half over, and as much as there are things I am going to miss, I also am becoming more and more ready to move back to the United States. Perhaps because I didn’t go home for our last break, and didn’t feel like I really was able to re-charge, but it feels very much like this semester is dragging. I know, come tomorrow with class starting again, things will pick up and I won’t even know what to do with a spare moment, subsequently looking at the calendar and realizing it’s time to go home and I will be ready to start my last semester in Dominica, but right now, it seems like an eternity. At the same time, I think about the fact that I’ve been in Dominica for almost a year, and it blows me away. Where has the time gone? I’ve had several conversations recently with both friends from back in the US and friends here about the concept of time. The realization that I base my perception of time passing on the seasons. Now, I realize that I fit right into the cliché of being from MN. All we talk about is the weather, right? Well, I now accept and fully embrace that, although I don’t want to JUST talk about the weather, it is something that defines how I go about experiencing my day to day existence. Did I miss the traffic and hassle that comes from driving in MN in the winter? Absolutely not. How about the below zero temperature that often accompanies that snow? Nah, not really. I did; however, miss the transition that occurs signaling the passage of a new month. The simple fact that seeing the leaves change color from a lush green to a crisp yellow or a fiery red means it’s time to put the shorts away and take out jeans and sweatshirts. Time to sit outside at night with the refreshingly crisp breeze and a blanket next to a bon fire. Similarly, how the sudden aroma of lilacs signals the end of those cold, winter months and the beginning of more bearable temperatures and much longer days. Here in Dominica, the length of the days remains the same, give or take 10-15 minutes. Yes, there is hurricane season bringing rain and more humidity, but it’s consistent. Temperatures fluctuate 10 degrees at the most. Rain comes whether it’s the “rainy season” or not. Palm trees maintain their long, green leaves year-round. Don’t get me wrong, it’s beautiful. Being able to look at the Caribbean Sea everyday is something that I will never take for granted. But, it’s also placed me in a time capsule of sorts, leading me to believe that it’s still only the beginning of 2015 when I was home where the snow signaled winter and the start of a new beginning. Knowing that the month of June is more than half over, yet feeling like the new year just began is a strange sentiment to express. Just like it’s imperative that a pilot maintain visualization of the horizon as a reference, I need the temporal, seasonal changes to orient with time passing. If I were to stay here in Dominica, I know that losing those seasonal changes would become the norm. That time would pick back up, and I would no longer feel as though I am stuck in a capsule. For now; however, I am left to try to take the day to day and accept that it is, in fact, June, and that time doesn’t actually stop. That life is continuing around the world despite me feeling as if it’s on pause and all I need to do is push “play” again to get back to normalcy. This IS normal, and it is, in fact, unique and beautiful. In many ways, it’s life in color- even if the color is a little different than what I have always considered to be “normal.”

With that, I will leave you with a few pictures from a brief stint in Barbados last weekend, and of course, lots of love.   

Free drinks upon arrival.

Chocolate cake with chocolate ice cream and chocolate sauce. Need I say more?

Breakfast on the balcony.

EBV out on the town.