The Dream, The Process, and The Outcome

Have you ever woken up one morning and just felt different, or made an executive decision that today was going to be different? That feeling accompanied me this morning…once I made the decision to allow it in. What I have come to find on this island, is that fighting against any of the experiences you have is extremely detrimental. Yes, we’re going to be homesick. Yes, we are going to wish for things that we have at home but can’t get here. Yes, we are going to miss our family, our friends, our significant others, and our pets who remain in a location and an environment that we’re comfortable in, but we cannot let the fact that we miss those things keep us from living our lives to the largest extent possible while we’re here. I know I’ve expressed that already, but it hasn’t really sunk in until now. Over the last couple weeks, I’ve come to terms with where I’m at, and made an executive decision this morning to work toward embracing an attitude that “everything works out in the end.” Anything that I felt tied to at home in the US will either be there when I’m done here in Dominica, or it will no longer be needed for me to continue moving forward with my life. As is said in one of my favorite movies (if you’ve never seen it, watch it!), The Best Exotic Marigold Hotel, “Everything will be alright in the end...if it’s not alright, it’s not yet the end.” I do not consider myself to be a very religious person; however, I do believe that there is something bigger. Something that gives life meaning, and serves as a reminder that we are not completely in control of what happens in our lives. As a “scientist,” it is sometimes difficult to accept the idea of a higher power, but there are so many things that no matter how well we plan, decisions and choices have to be made based on what life offers. Do I think we’re completely at the mercy of life? No, I do not. I do; however, think that there are experiences we each need to have, and that these experiences get worked into the decisions we make for our lives. In order to fully appreciate and learn from these experiences, we need to learn how to detach our decisions and happiness from specific outcomes. For example, when I was applying to medical school a year ago, the thought that I would be in medical school in Dominica was the furthest thing from my mind. I submitted my applications early, in July, to various schools throughout the United States in an attempt to give myself the best chance possible of getting into one of the programs as medical school admissions are completed on a rolling basis. Slowly, I began receiving the much dreaded “I’m sorry, but we cannot offer you a spot in the Class of 2018” letters. After receiving the first rejection, I began to feel discouraged about the future of my career. I wasn’t “good enough.” So much of my life had been spent dreaming, planning, and preparing for the day I became a physician. To think that this dream may not come true was devastating. That night, I received an email from the admissions department at Ross University inviting me to apply for the Fall 2014 semester. All the sudden my perspective completely changed. Any ideas that I had about not staying in the United States for medical school, and what that might mean for my future took a complete turn. I began researching Ross, and having formerly worked with a current student, reached out to him for opinions and perspective. No stone was left unturned in my research, and I finally decided that submitting my application could only help increase my chances of pursuing my long-lived goal. It was December 2, 2013. At this point, I knew the likelihood of getting accepted for the following year was low, but when I submitted that application, something about it just felt right. Most of the other people I knew applying for school were already accepted or at least interviewing, and here I was just starting another application. Needless to say, I was invited to interview on January 6, 2014, and received my acceptance less than four weeks later. Elation, gratefulness, disbelief, and shock do not even begin to sum up how I felt. Since that moment, I have continued to feel those emotions, but I have also felt fear. Fear of the unknown. Fear of failure. Fear of losing or missing out on things because I wouldn't be living in the United States. That being said, I have received quite a bit of motivation and pep over the last few days, and wholeheartedly believe that had I not received those unfortunate letters from the other schools I had applied to, I wouldn’t be here, nor would I be having the unique experience I am having.

I decided long ago that I was going to be a physician. Thinking about my future and where I will be, I can’t see myself in a particular place, but I cannot envision myself being anything other than Ashleigh Burt, MD. A few months ago in this blog, I said, “In the long run, what's two years?,” with regard to the time I would be in Dominica. I was right. In thinking about the grand scheme of life (assuming and hoping that my life is not even close to being complete), what is two years? I now know; however, that when placed in a situation or environment that removes you from anything and everything you’ve ever sought for comfort or stability, time has a completely different meaning. In thinking about the last five weeks, it seems like it was a decade ago that I arrived in Dominica and began my new life, but at the same time, it feels like just yesterday. When considering how much material I have learned over the course of three weeks, I feel like I should already be preparing for finals, and yet, it’s only been three weeks. The idea of having twelve more weeks of material to learn in order to continue into my second semester of medical school is extremely daunting, and it’s easy to get caught up in feelings of defeat or being overwhelmed. Within those overwhelming moments, though, are opportunities to do things like sit down for hours and dissect the nerves, arteries, veins, muscles, tendons, and bones of the human body. The euphoria and contentedness that I get when I’m doing THAT trumps anything else. This is what I’m meant to be doing, and I’m slowly learning why Dominica is the place I am meant to be learning how.

Finding Oneself

As of about 5 hours ago, the first exam of my medical career is complete. How did it go, you may ask? To be perfectly honest, I think it went quite well. At this point I'm not sure if that sentiment has more to do with the elation I feel simply having completed my first medical exam, or if it actually correlates to the accuracy with which I responded to their questions. Based on past experience, I think a combination of both. Either way, I'm done, and that feels amazing. Having essentially sequestered myself in classrooms, the library, group study spaces, my apartment, and the apartments of my colleagues over the last few days, a sense of freedom, even if for a few short hours, is extremely welcome.

Over the last few days whilst pouring information into my brain hoping it sticks, I've had a couple thoughts upon which I have wanted to reflect. Of course, in attempts to keep my priorities straight, I did not take the time to document them; however, now I am thrilled to have the chance to delve into them. The first observation I've made is related to the position and field of work I was in prior to matriculating at Ross. Working in a Genotoxicology lab testing medical devices, I knew there would be crossover between what I had been doing in the lab and my future career in medicine. I did not; however, expect the crossover to occur so quickly nor to have any profound impact on me. Last week while completing the required task of defining the brachial plexus in my first "patient," I overheard one of my colleagues say something about a pacemaker. Having tested several types of pacemakers during my time in the lab, I approached this group simply to look at the device. Obviously I knew that my work had a broader impact than just simply what I was doing on a day to day basis, but to actually see the potential outcome from the small part I had to play in the overall process was surreal, and even a bit overwhelming. Granted, I know I didn't do anything with THAT pacemaker, but I did have a part of play in how it got from the manufacturer to the patient. Secondly, as I had my nose buried in notes and lectures over the last few days, I came across a table of drugs used to treat various types of conditions affecting how a cell's internal structure in maintained and how its components are transported within the cell. In and of itself, this chart is interesting but nothing different than other tables of drugs I've seen in the past. This particular chart; however, listed a component required as a positive control for one of the main tests we ran in my former lab. Again, I knew there were clinical applications to everything we did, but to now see it in a completely different context was mind blowing. As much as I know it was time for me to move on and begin the next phase in my life, being able to see how important my work was in the overall scheme of medicine makes me extremely grateful for the opportunity I had to work in that lab. For some who may read this, I know how much I might have vented about various events or circumstances that came up over the last three years related to my job, and maybe even how excited I was to move on, but at the end of the day, having the experience I had taught me a lot of things. Without those experiences, I wouldn't be here today, nor would I have any idea how incredibly fascinating or biologically/ medically relevant chemicals like cyclophosphamide, methotrexate, and colcemid actually are.

The second thought I've wanted to reflect upon is related to "finding oneself." Throughout the course of our orientation and even the white coat ceremony last Friday, multiple people emphasized the importance of figuring out who we are while we're here in medical school. Clearly, we all understood the importance of making sure the reasons we are here align with our personal values, goals, and "identities," but I did not fully understand the significance of this until about halfway through last week. You see, starting about a week ago, I started to experience my first pings of homesickness. The first inklings of wanting to be with the people I love and not needing to coordinate our schedules in order to do so. Was it because of something that happened here in Dominica? Absolutely not. I still love where I live (although, I might do well with just a little less rain), and have really found some amazing friends who always seem to be on the same page as I am in nearly every situation we encounter. Honestly, I think the fact that I DO still love it here is exactly what made me homesick. I want the opportunity to share the experience I'm having with my friends, with my family, even with my dog. Talking via Skype, Viber, FaceTime, etc. is fantastic for keeping in touch with people, and I am incredibly grateful for those resources, but there is absolutely nothing that can compare to being in the same place with somebody and directly being able to share the ups, downs, and in-betweens as you go. For the first time this last week, my life had reached an equilibrium where it was "normal." The honeymoon phase of being on the island had really worn off, my schedule at school had become a routine, and I wanted to be in that normalcy with the people who know me most. One of the greatest gifts I received prior to leaving for school was a set of pre-written out greeting cards for various moments while I'm in Dominica. Last Sunday when those first feelings of homesickness started to hit, I pulled out the first card for "When you feel homesick." Appropriate, right? :) Although it didn't completely dispell my feelings, it made a world of difference. As some of you know, my favorite Disney character is Piglet from Winnie the Pooh, and contained within this card was a quote from Winnie the Pooh. "'I wonder what Piglet is doing,' thought Pooh, 'I wish I were there to be doing it too.'" Being away from home, it's easy to get caught up in what's going on in your own world, and know on some level that the people you left behind still think about you and care, but reading this card reminded me that most of these people deeply care and genuinely want to be here with me too. It really reassured me that, despite knowing I am capable of becoming the best physician I want to be, I also have people who will be there when the going gets tough and I just need a shoulder to rest on for a moment. In thinking about "finding myself" over the last four weeks (yes, it has already been four weeks!) this past week has shown me how much I value the people in my life. Honestly, do I miss Minneapolis? Of course. There are things about the city of Minneapolis, and the state of Minnesota, in general (Fall, changing seasons, sledding, theater and culture, state parks, etc.), that I can only find there, but the real thing that I miss are the people that I am able to enjoy those things with.

That being said, to anybody who has had any role in my life up to this point, know that I appreciate you, and that I miss you.  

Until next time,
Ashleigh 

The White Coat

This afternoon ceremoniously marked my entrance into the medical profession. The white coat was placed by current RUSM physician faculty members onto each student's shoulders. The actual "Donning of the Coats" only required a small portion of the ceremony's total duration; however, as much as I would have liked this portion to be completed in a more individual fashion for each student, I think it served as a symbol of the type of profession we are entering; One that cannot function without an entire team of people working together to defeat tough enemies. Instead of putting each one of us on a pedestal to receive our coats, we did it together- as a team. Throughout the course of the ceremony, various keynote speakers talked about what it means to be a doctor. Each one of these speeches was fantastic, but the one that really stood out to me was related to the connection between our white coats and who we are as physicians.

Now, I want you to take a couple minutes to think about what a physician's white coat symbolizes. 

What kind of images does it evoke? What kind of emotions? Memories? Ideas? Expectations?

This question was posed a few hours ago by a RUSM faculty member to myself and my fellow MDs in training. She followed the question up with single words that describe what our white coats will become over the course of the next four years. In some cases, the words used to describe our white coats related to how the public and our patients will perceive us. Such things as: "knowledgeable," "role-model," "moral," "trustworthy," "intimidating" (ie. in Pediatrics, some children are afraid of the white coat and what it means for what they will have to go through), etc. In other cases, it literally related to the different purposes our coats will serve while we wear them. "Handkerchief;" patients sometimes need that shoulder to cry on, and we will have to be that for them. "Pillow;" there WILL be times that we will fall asleep with our white coat crumpled and used as a makeshift pillow. "An indication that we need to do laundry;" the sleeves are dirty and the lapel is wrinkled (so much for the classic "whenever I run out of underwear" rule :) ). "An extra layer;" clinical rotations in the Upper Midwest in the middle of January, anyone? At the end of the day, though, in spite of all these words and mental pictures, our white coat symbolizes our entrance into an elite and respected group of professionals. When we wear this coat, we are no longer just people walking down the street. There is an expectation, a standard universally understood, that we, as physicians, will be all of those things listed above.....and more. I, personally, heed this responsibility with immense gratitude and appreciation, and know that I will never have to do it alone. Am I going to be perfect? Absolutely not (who is?), but the challenge to constantly be better, to seek improvement every single day with every single patient case I have, is one that I could not be more thrilled to tackle. I read a quote after the ceremony that goes as follows:

"We can't help everyone, but everyone can help someone." - Ronald Reagan  

Upon reading this, I immediately applied it to the medical profession. We all are here because we want to help people, but so often we forget that there are going to be times when we won't be able to help someone as much as we want. That reality will not be an easy one to digest- especially the first few times- however, knowing that I have colleagues who will still support me, or who might be able to help someone in a way that I am unable, is incredible.

Although I know teamwork will be a critical piece in the future success of my career as a physician, I have learned over the last 5 days that the teamwork starts as soon as you start medical school. Never in my life have I experienced the sensation of consistently running as fast as I can on a treadmill and still not being able to keep up. The lecture contents are dense and the time that the student has to master the material is significantly less than any educational program I have been a part of. That being said, I wouldn't have it any other way. Am I tired and want a nap? Yes'siree. Are there times when I just want to sit down and watch a movie? Absolutely. What keeps me from doing those things; however, is knowing what awaits at the end of the seemingly endless tunnel of coursework. Experiences and interactions that I have with faculty and upper semester students only works to solidify what I already know- that being a doctor is what I am supposed to do. Additionally, at the end of the day, I actually love what I am learning. Being able to personally dissect the human body is incredible. After my first lab on Tuesday, I was on cloud 9. Learning about muscles, bones, ligaments, blood vessels, nerves, etc in lecture and from a textbook is one thing, but to actually SEE it, is completely different. By the time I return home to friends and family in December, I'm not sure how my brain will be able to process the idea of having free-time, but I won't worry about that just yet. 

In the words of Jimmy Dugan from A League of Their Own, "It's supposed to be hard. If it wasn't hard, everyone would do it. The hard.....is what makes it great."  

Until next time, 

Ashleigh

"The New"

The first day of classes has finally arrived and is staring me directly in the face. Friday was the final day of our week-long orientation, and we are all technically ready to dive headfirst into coursework tomorrow morning. Honestly, the weeks have flown by, and I feel completely ready to begin. Throughout the course of orientation we heard from various members of the RUSM faculty, alumni, current students, community members, and RUSM staff. Each provided me with additional information to mull over, and insights that I really took to heart. That being said, a couple presentations really stuck out to me, and had a greater impact on the entire orientation week.

1. Introduction to the Anatomy lab
2. Alumni presentation from Dr. Daniel Kemple

Upon being accepted to medical school I knew I would have to master human anatomy, and I couldn't wait. Having been extremely fortunate enough to have taken it as an undergraduate student, I knew I would love it. As students, we are required to wear green scrubs as our uniform anytime we are in the anatomy lab. The faculty and other staff members wear black to denote the difference between "master" and student. I had worn scrubs before in various roles, but this was the first time I was wearing scrubs as a medical student. That feeling was indescribable. Once in the lab, we went through policies and procedures, expectations of staff, faculty and students within the lab, oriented ourselves with all the tools and equipment, and became comfortable with the space. The facility is absolutely amazing; nicer even than the anatomy lab at the University of Minnesota. After all this was over, we were given the chance, if we so chose, to meet our first patients. To put this experience into words is honestly impossible. Knowing that this person made a deliberate choice to further my education and afford me the opportunity to pursue my dream is extremely humbling. At the end of the semester the school invites the family members of our patients to a ceremony during which we honor their loved ones and thank them for playing such a critical role in our education. I can't wait to have this chance to meet my patient's family, and attempt to put into words how incredibly grateful I am.

The second presentation was given by Dr. Daniel Kemple. A 2013 RUSM graduate who just completed his intern year in Emergency Medicine in Ohio, Dr. Kemple provided some amazing insights into what we can expect, how we should approach studying, the importance of all the STEP exams in landing the coveted residency spot we all want, and how best to utilize our faculty for help as we need it. Seeing that he made it through, and not only landed his top residency choice, but was voted "Best Intern," showed me that despite the long, arduous road ahead, it's completely doable. The best piece of advice I got from him; however, was to "experience the island." A fellow classmate posted a video the other day that really rang true to this advice. The last couple weeks have been incredible, and I feel so fortunate to have had the time to get out and see the island. Granted, it's really only the tip of the iceberg of what Dominica has to offer, but it was a great introduction and motivation to continue "seeing" the island. Despite knowing that my time will be limited over the next several months and that I won't be able to take much time to venture out to the "big" sights, the little things I see and do each day are just as much experiencing the island as driving an hour away. For a lot of people, living on "The Rock," as Dominica is affectionately called, is more of a chore. They can't wait to get off the island and go back to what they know. Back to being able to find whatever they want at the grocery store. Back to not having to plan your electricity usage over the weekend because they may run out at the store (or the store isn't open for you to buy more). Back to not waiting an hour to get your food when you eat out (or watching your friends eat while you still wait). Don't get me wrong, I completely understand where these feelings come from, and would be lying if I didn't have moments when I wished that I didn't have to worry about these things. On the other hand, these are the things that make Dominica, well, Dominica. Being able to wake up in the morning, look out my kitchen window and see the Caribbean Sea. Knowing that forgetting my umbrella when I leave home in the morning is the biggest mistake I could make- it WILL rain. Walking into a restaurant having only visited once and having the owner and/ or server recognize me and maybe even remember my name. These are the things that I don't ever want to take for granted throughout the 16 months I call The Rock my home away from home. I know there will be times when I just want to be home with my friends and family, but trying to keep these things in mind and embrace them instead of resenting them will help diffuse my homesickness.  

In the interest of time and necessity to preview for tomorrow's lectures, I will leave you with a list of 9 firsts (and some pictures) that I have experienced over the last two weeks. Enjoy! :)

1. First lunch at The Shacks (basically a row of shacks on campus that sell different kinds of food and drink- the best juice I have ever had)

Chicken Pita....delicious!

2. First time eating Lionfish (and lobster that a couple classmates caught with a local Dominican)

3. First time attending a Reggae festival
4. First time seeing both the Caribbean Sea and Atlantic Ocean at the same time

Scott's Head on the southern point of the island
Caribbean on the left, Atlantic on the right

5. First time eating Cassava bread
6. First time taking a hot shower
7. First time having a pet that I didn't voluntarily purchase (I have two geckos in my apartment)
8. First time seeing SimMan and Harvey for use in our clinical skills labs

SimMan

Harvey
used to practice listening for heart sounds

9. First time having my laundry done (picked up and delivered upon completion)

Until next time, and with much love. 

The Bridge Between "Vacation" and Reality

I cannot believe it's already been a week since I landed and started my life in Dominica; just yesterday I was receiving my acceptance letter, and pinching myself into the reality that in 7 months time I'd be moving to a foreign country 3000 miles away from home to become what I have always wanted to be- Ashleigh Burt, MD. Arriving on the island the week before orientation started was the best decision I made. It both allowed me time to adjust to my surroundings, get to know my neighbors and the area around my apartment, explore a lot of what the island has to offer, build relationships with people who are going to carry me and push me through the next 4 semesters, and get through both the initial "honeymoon" and homesick phases of my culture shock.


Today marked the "official" beginning of my medical career on the island of Dominica with the commencement of orientation. This morning each first semester student was required to go through the motions of "checking-in" to ensure all addresses, phone numbers, and emergency contacts were correct; receive our financial aid refund checks (aka: the only way I will financially support myself throughout this endeavor); and to receive a neon pink sticker on our student ID's stating we are registered and officially checked in for the Fall 2014 semester (see picture below). Despite the redundancy of signing my name multiple times and repeating the same things multiple times, the final station provided each of us with the one tangible article that every aspiring physician looks forward to and takes immense pride in.....our white coats. Officially we are not able to wear them until Friday, September 12 when they are placed on our shoulders by current faculty and practicing physicians; however, looking in my closet to see my white coat hanging synthesizes every single emotion I've experienced up to this point, knowing that I am ready to tackle the tough road required to place "MD" after my name. As nervous as I am, and has difficult as I know it will be, looking at that coat makes it all worth it.

 

Later in the evening, we had an optional session providing us with more information about the island, it's history, the government structure, etc. Throughout the course of our first week on the island, the group of people I met on my flight from Puerto Rico and I have explored several areas within the island. After this historical introduction this evening, it was really exciting to be able to put some of our ventures into context. For example, yesterday we went on an excursion to the Kalinago Territory on the Eastern side of the island. The Kalinago people are the indigenous population of Dominica, and throughout the course of both English and French reign sought refuge in the inner regions of the island where terrain is much  more rugged and difficult to navigate. In 1903, 3700 acres were set aside as a territory specifically for them. They are able to rule their community much like a Native American reservation would in the United States- with their own government system and ability to maintain cultural norms and traditions. Their willingness to share music, dances, food, and open their lives to us was beautiful. Following our visit to their territory we traveled approximately 25 mins south to a small body of water called the Emerald Pool. It is located within a rain forest, and the pool is literally the collecting body of water from a waterfall. Finding words to describe the environment and the lush greenery would not even skim the surface of how absolutely stunning the locale is. We all waded in the water (it was freezing!!), and some group members courageously stood under the waterfall. Of course, being that it is a rain forest, the rain arrived promptly as we were on our way back to buses. Needless to say, living on this island has taught me that rain can literally come at ANY time of the day. Even when it's completely sunny, don't ever leave home without your umbrella. Despite the rain, it was our last hurrah prior to jumping into the reality that is school, and it couldn't have been a better way to end my first week here on the "Nature Isle."

Traditional dance of the Kalinago People

Emerald Pool

Throughout this week we will continue to have speakers and introductions regarding the island, it's rich history, food, and culture, but more and more focus will be shifted to our curriculum, exam schedules, course schedules, and, of course, thinking about USMLE testing down the road. I cannot believe (still) that I am fortunate enough to be here to train and become what I hope will be a compassionate, determined, optimistic, and inspiring physician.

Until next time, I will leave you all with some more pictures from our venture to the weekly market about 15 minutes away from my apartment for some fresh produce. Up until this moment, I had never had coconut water in my life. Now, I will never have coconut water again unless it is poured directly from the coconut into my water bottle. :)