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.

Paso a Paso

Can I start by saying I’m sorry for being quite remiss these last few months about keeping my blog up to date; however, I had reached a point where I really needed to re-evaluate my priorities and take a few things off my plate. Unfortunately this was one aspect that reached the chopping block. I am so happy to say, after two weeks of break, I’m ready to get back into writing and a new semester. And, yes, I did say it, a NEW semester! I successfully passed second semester, and am now officially a second year medical student. Honestly, the time has flown and part of me can’t believe it’s actually true, but it means I’m one step closer to moving back to the United States for good. There are many people who have not only been there throughout the past two semesters, but have offered ears to vent to, shoulders to cry on, wine to celebrate with, and experiences to relate to. Without these people, there is absolutely no way I would be where I am today, and for that I am indescribably thankful.

Now, on to the fun part- playing catch up! As most of you know, I usually have a hard time knowing exactly where to start when formulating my thought process. That’s over the course of a week or two- to try to determine where to start with life over the course of two months?! Oh, boy we’ll see how this goes. I’ll start at the end and maybe work my way backward. In reference to one my favorite parts of the University of Minnesota Marching Band pregame show- ARE YOU READY?!

As I mentioned earlier, I’ve been on a two- week break between semesters, and it’s been wonderful. Since it takes me about 2 days to get back to Minneapolis from Dominica, I decided to forego the trip home this time and instead, welcome a few visitors here with me. For the first week, my mom and her boyfriend, John, came to visit, and the second week my dad and his girlfriend, Victoria, came. Not only was it absolutely wonderful to see all of them, but having them here also gave me a reason to get outside of my comfort zone and the small area I spend most of my time in during the semester to see the small, yet simultaneously expansive island I currently call home. Between both of their trips, we ventured to waterfalls, the botanical garden in the capital city of Roseau, under the sea for some scuba diving, and to the second largest boiling lake in the world. Mind you, that last activity was what I thought might be the end of my life. I had heard from former students and faculty members that the hike to Boiling Lake was long, arduous, and challenging; however, it was, honestly, one of the most physically and mentally taxing things I have ever done. As I was hiking through various segments of the trail, one part of which is called “The Valley of Desolation,” different things popped into my head in attempts to keep myself motivated and encouraged. Anything from movie quotes to song lyrics to reminiscing about an experience I had downhill skiing as an 8 year old in Sun Valley, ID. I'll try to keep it short, but to put it into context, I digress briefly to share that story. As an 8 year old, I knew how to ski and had gone several times in Minnesota; however, this was first experience on a mountain that would take more than just one run to get to the bottom. I was terrified, but knew there was only one way out of the situation- down. Thanks to my mom for being there telling me all I had to do was go “fluffy to fluffy,” ie: just ski across the hill from one mound of snow to the other such that my speed never got away from me, I made it down the hill. That metaphor came back, and I knew all I needed to do was go segment to segment, step by step, and eventually I’d get there. At the end of it, I have to say it’s quite the feeling of accomplishment. Needless to say the things I did with my parents here were things I probably wouldn’t have had time to do otherwise, and I’m really glad they came.  

Botanical Garden in Roseau
Tree knocked down in 1979 by Hurricane David

 

Lobster Dinner at Sunset Bay

Post Scuba Dive Pina Coladas

Snorkeling

Survived to Boiling Lake after a few honest tears

Boiling Lake

At the end of my mom’s time on Dominica, I left the island with them for a 3 day mini-vacation in Puerto Rico. If you’ve never been to Puerto Rico- GO! It was just enough for me to get away for a few days to a place of four lane highways, CVS, Starbucks coffee, a chlorinated swimming pool, and speaking Spanish. One of the things we did while there was the Bacardí distillery tour- not just good rum, also much history! Although my drink of choice has changed since moving away from the land of Diet Coke, a Cuba Libre is still one of the most refreshing drinks there is in my book. At the end of our tour we participated in rum tasting, which was incredibly enlightening for me. I’ve never been one to enjoy spiced or dark rum; however, as our tour guide explained the undertones and flavors within each of the four rums we tasted, I gained a newfound appreciation for darker rums, and also other liquors. After the distillery tour, we took a ferry to Old San Juan where we ate a delicious lunch of plantain nachos, Mofongo, and chicken empanadas followed by an educational, albeit sweaty, tour of the El Morro Fort. By the end of this day- I was wiped and knew that everything I had wanted for the break was waiting for me the next day- 16 hours sitting by the pool with my book. Let me tell you, it was glorious. I had started the book Wild about halfway through the semester and had yet to finish, so having the opportunity to sit down and read without any other obligations was indescribable.

Bacardi Tour

Rum Tasting

El Morro

Drinks our last night at The Vanderbilt Hotel

In an attempt to keep this a little more succinct, I think I’m going to try to put the rest of the semester into a highlight reel of sorts.

1. I followed through playing powder puff football with a fantastic group of ladies, and am proud to say we as Category X pulled off the win to beat the 3^rd and 4^th semester team. Since we are medical students, most of the sports teams we have on campus derive their names from something related to medicine. In our case, Category X refers to drugs that are completely contraindicated in pregnant women, and also in women who have the possibility of getting pregnant. Since it is unsafe for women to take any Category X rated drug, we thought it an appropriate name for our team with the tagline, “Under no circumstances can women take us.” It proved to be true. :) 

 

2. I fell in love with our neuroscience block. Not necessarily to the point that I am thinking about changing my specialty to something related to neuro, but enough to make me understand, appreciate, and respect the human body even more. Granted, each of our blocks this past semester, based in some aspect of human physiology, brought more and more to light in terms of how much our bodies do without us even having to think about it, but without the neurological system, NONE of that would happen. That’s humbling. Not only further bringing forward a sense of respect and humility, but also the honest interest it piqued in me. The various ways in which your brain is organized to control movements, senses, memories, and so much more. Knowing that all of your five senses except smell have to make a pit stop in a specific part of your brain before reaching their final destination. Or, that your spinal cord is organized in such a way that the majority of the information traveling TO your brain is contained in one half, while the information traveling AWAY from your brain is contained in the other half with a few other things interspersed between. Absolutely incredible, if you ask me. In fact, if you do ask, I probably won’t stop talking about it. Talk to anybody I’ve interacted with in the last couple weeks who are not in medical school, and they can probably attest to the fact that in nearly every conversation something pops into my head that ties everything back to medicine. What can I say- even when it’s hard, I still go back to what I love.

3. A wonderful young lady whom I have met and gotten to be friends with since moving to Dominica and her fiancée got married last weekend, and although I was unable to attend the wedding due to having visitors, I was honored to be a part of her beautiful bachelorette party about halfway through the semester. We started the day at one of the local restaurants owned by the sweetest British couple for breakfast and mimosas, and continued the day about an hour south of campus at a hot spring spa. Not only was it a spa with multiple hot/warm/cool natural pools, but as we walked around to explore the area, we ran into a guide from the resort who pointed out that there were also hundreds of different plants, herbs, and foliage, along with a peacock and many stick-bugs. Concluded by an amazingly delicious home-cooked lobster dinner, homemade apple pie, and a bonfire on the beach, it was by far the best bachelorette party I’ve been to with a group of some of the strongest, most supportive, and fun-loving people I’ve ever met.  

Cacao Plant

4. I planned and coordinated my second pediatrics clinic for about 100 primary school students about 45 minutes south of campus, and can honestly say it doesn’t get old. Yes, there were days that I was frustrated with some of the people I need to coordinate with, or was nervous that things weren’t going to come together in time, but in the end, all that mattered was that we were there and willing to provide as much support to these kids as we possible. Although clinics are great ways for each of us to practice clinical skills in a clinical environment, the best parts of the clinic for me are the kids who come. Some of them are shy and won’t leave their parents’, while others don’t stop talking. They’re each so different and unique that it honestly never ceases to put a smile on my face. Now, after this past semester, I am passing my coordinator torch to another member of the Pediatrics Student Association as I take on a different role within the organization, but will have no problem signing up for the clinic, simply to go.

As many of my colleagues, myself included, have now reached the halfway point of our time on the island, it’s definitely starting to become bittersweet. On the one hand, being on The Rock (or Jurassic Park, as many others fondly call Dominica) has afforded me opportunities both personally and professionally that I would not have had in a different environment or at a different school (did I mention I’m getting scuba certified this semester?!). On the other hand, because it is a small island and you often run into the same people and the same situations, it can become stifling if you let it. That being said, there are less than 8 months during which I will call my apartment, this city, and the island of Dominica my home. I know it is going to fly, and just as things have unfolded thus far in this experience, I will continue to take life one step at a time, or paso a paso.

Until next time, I leave you with all the love in the world, and a few more miscellaneous pictures. 

Welcoming Spring with the Indian holiday of Holi

The only regulatory street sign posted within several miles of campus

 

Loving Life.

Well, as nearly everybody in the world knows, today is Valentine’s Day, or as some of my fellow singles may say, Single’s Awareness Day. Although that may be true, I am in fact spending today technically single, I couldn’t be happier. You see, the truth is, despite having been single for the majority of my adult life, I’ve come to really appreciate and embrace it. Even more than that, I love my friends and what they bring to my life. Just last night I had the wonderful privilege of going out to dinner at a restaurant about 45 minutes south of campus with a group of fellow students whom I don’t usually spend a lot of time with. Despite not knowing them very well, I had a fantastic time. Based on the way our evening began- I wouldn’t have expected anything else. This not being the first time I’ve been to this particular restaurant, I was caught off guard when our transport was not a large taxi van as I had taken in the past, but two yellow taxi- cabs. Yes, they do actually have yellow cabs here in Dominica. As a result, our group of 11 needed to split into two cars. Now, I don’t know what the condition of the other vehicle was, but the steering column in our cab revealed a few exposed wires, and there was a tablet on the dashboard which the driver fiddled with consistently throughout our drive. Add to that a Styrofoam cup filled with vodka (completely legal here in Dominica) given to us by a member of our group in the other taxi, and how could this evening NOT start on a good foot?! Throughout the course of our drive through the ups, downs, and twisting roads of Dominica we enjoyed conversation and the salty wind rushing through the windows as the cup was passed around- each of us trying to avoid drinking it. As we arrived at the restaurant so aptly named “Sunset Bay,” the sun was just beginning to set through the clouds. Although I may say it all the time, and I’m sure everybody back home is sick of hearing about it from me, I don’t think there will ever come a time that the view of the setting sun over the water will become mundane or “just another thing that happens.” Each day is different- from the way the colors reflect on the water to the way the clouds absorb and display those exquisite tones. To put it simply, I love it, and take pictures at every chance I get. In addition to it being a beautiful place to watch the sunset, Sunset Bay’s other “claim to fame” is its lobster dinner. Between 8 of us, we split 5 lobster dinners and 3 buckets of garlic mussels. Although I had dined there previously, this was my first experience with their lobster, and let me tell you, there is only one phrase that may even come close to describing it- to die for. At one point, the person I was sitting next to and I looked at each other with garlic butter covering our fingers and agreed that we felt like we were literally inhaling our food because it was so incredibly delicious. In addition to the lobster, the mussels are exquisite. We’ll just say that at the end of the meal, Ashleigh was a very happy camper. I was so grateful and excited to have had the opportunity to spend such a wonderful evening getting to know people who I see everyday, but may not have had a chance to talk in the same way without this dinner.

Now, the dinner, the sunset, and the company were great, but that was just the beginning. You see, over the last several weeks, one of my friends has been trying to put together a game night at his apartment. Between exams and others’ schedules, it just hadn’t worked out until, finally, everybody agreed on last night. He and his roommates had everything planned out based on the number of people coming, and we all had to sign up on a team to make sure all of the games worked out. Everything was supposed to start at 9, and I figured I’d have no problem being back from dinner at that point. Well, I was wrong. Our taxi arrived back on campus at 9:30, and I felt awful. Not only was I going to be late, but I was letting my game partner down by not being there. Luckily, the start time had been pushed back by an hour, but even had that not occurred, the response from my teammate, Ericka, who is honestly much more like a sister to me than I could have imagined, was completely understanding of it. Yes, I think she was a little worried I wasn’t going to make it in time, but she knew it was out of my control and she just rolled with it. So, we got to the party, had a great time with other wonderful friends, won some rounds, lost others, and went home laughing about those little things that in the end add up to a lot. Needless to say, despite all of the cliché and cheesiness that it brings, I’m extremely lucky and feel incredibly blessed to have met so many wonderful friends since moving here, and one in particular whom I know will be around for the long haul.

The last thing that I will touch on before returning to the current love of my life, school, is actually school. As I mentioned in my last post, the first few weeks of the this semester were a little rough for whatever reason in terms of getting back into the swing of things. I felt like I was in a funk that I just couldn’t shake and I couldn’t figure out why. Now, I’m not here to delve further into that or even explain why it happened, but to do quite the opposite. To express how doing things like practicing physical exam (PE) skills brings me back to the roots of why I’m here. Yesterday we didn’t have classes, but we, as 2^nd semester students, had our abdominal exam PE skills lab in the afternoon. Now, we’ve had experience with these several times up to this point for various things- blood pressure, pulses, cardiovascular and respiratory exams, and an intro abdominal exam last semester, so we all knew what to expect. We had watched the introductory video online and read (or at least skimmed) the handout posted before arriving. Knowing we would have a standardized community patient, we arrived at school with our white coats and professional dress in tow. After stepping into my group’s exam room (imagine your standard Dr.’s office exam room), we waited for our patient to arrive so we could get started. Walking in just on time, our patient walked in, and it was none other than Mr. Charles! Okay, okay, for anybody reading who is not from Ross, that means absolutely nothing, but let me try to explain it to you. For each of these labs, as I mentioned, we have a video that we have to watch that essentially goes through the entire exam as we are supposed to practice and perform it during our sessions. In nearly all of these videos, Mr. Charles is the patient, which pretty much makes him a local celebrity. I had heard from friends who had had previous sessions with him that as a result of him doing these sessions multiple times, he knew the protocol of each exam almost better than the students, but for me to have the chance to work with him? I couldn’t believe it. Everything that I had heard from others about him was absolutely true. His hands were already raised in preparation of them being checked for jaundice caused by possible liver failure, and he knew exactly where to place them in order to perform a test checking for ascites, or extra fluid, in the abdomen. He was funny, which put everybody at ease, and was completely comfortable with us all poking and prodding him for practice. In fact, maybe a little too comfortable. Halfway through my exam, he fell asleep!! I was trying to check for possible lower abdominal pain caused by appendicitis, and asked him to lift his leg against resistance. The response? Nothing. No movement, no verbal response, just silence. Despite my best efforts (and the efforts of everybody else in the room), we all just started laughing- Mr. Charles included. Needless to say, although it wasn’t an incredibly tense environment to begin with, his falling asleep definitely removed any remaining tension or nerves. It was refreshing, and it reminded me again not only how much I really do enjoy what I’m working toward, but that every encounter I have with a patient has the possibility of becoming something I don’t even expect- whether good or bad.

As always, the writing could continue for days and days, and although we have a long weekend due to Carnivale on the island, I just don’t have that much time and I need to get ready for what will arguably be one of the greatest Valentine's Day dinners with the best teammate, study buddy, and most of all friend a girl could ask for. That being said, I hope you all have a wonderful Valentine’s Day wherever you are, whomever you’re with, and whatever you’re doing. Until next time, and with lots of love.

 Team #Flawless: best teammate ever

Sunset at Sunset Bay

Challenges.

Hello again! Despite me “having more time” this semester, I’ve ironically found it more difficult to find time to sit down and update you all on the goings on. So, here I am on a Friday afternoon to sit down and do just that.

To start, I have successfully completed my first mini exam for second semester, and it finally feels like I’m back in school. It’s a hard sentiment to express, but the first three weeks were a little hard to get into. Not because the material was boring, or even because I wasn’t trying to study, things just didn’t feel like they were falling into place. Luckily, I was able to get a grasp on things last weekend before the exam, and everything worked out. After our exam on Tuesday, everybody from my class gathered, as usual, outside the testing center as the security guards attempted to clear us in order to allow the second group of students to begin their exam. Let me explain that for a minute- our class is too big for all of us to fit inside the testing center, so they have to split us into two groups based on last name alphabetically. Therefore, whoever is part of the first group of testing needs to clear the area surrounding the testing center as soon as possible so as not to delay the second group. With that minor detail cleared up, I’ll get back to where I was. We were all gathered trying to determine what the plan of action would be for the rest of the day. Initially, I was going to be productive. I arrived at the testing center at 7:45 before my exam, not with my backpack (what’s the point of bringing notes to review mere minutes before the test?), but instead with my insulated grocery bag. You see the grocery store is right down the street from the testing center, and the testing center is more than halfway between my apartment and the grocery store, so it just made sense to continue heading that direction for just a bit longer and take care of my errands. Well, this exam was probably the most challenging exam I’ve personally taken on the island. Not because I didn’t understand the material, but in the way the answer choices were presented. I rarely finish an exam without at least 20 minutes left to go back through and review my answer choices. In this case, I barely finished. My brain was fried. So, as you may guess, I didn’t make it to the grocery store. A few friends decided to go out for brunch, and the state of my brain much preferred that option to “being productive.” I have yet to make it to the store. :)

Following brunch, people started heading to the beach- where we all tend to congregate in the aftermath of exams. I followed suit for a few hours, and then returned to campus for a group training session with six colleagues who serve as leaders of the New Student Ambassador program. At the time, I didn’t know exactly what to expect from this training, and if I’m being completely honest, was a little sad to be going back inside on the first afternoon in a while that I literally didn’t have anything to do related to school. What started as a leadership training session; however, became an hour and half of team building and bonding that I wouldn’t have traded for anything. Don’t get me wrong, I absolutely love the beach, and pinch myself frequently in disbelief that this is where I live, but the discussions we had were invaluable. Based on the book, The Leadership Challenge, we went through each of five practices that make an effective, successful leader: 

1. Model the Way
2. Inspire a Shared Vision
3. Challenge the Process
4. Enable Others to Act
5. Encourage the Heart
            

Each practice had a different “activity” associated with it, but my favorites was "Model the Way." We each had to sit down and make a list of our top ten values. Now, I understand, that this may sound cliché and “cheesy,” but it made me realize a few things. 1. Choosing only 10 values is hard. 2. Although they are each separate, each value somehow stems from another. In other words, they are all interconnected. 3. When you work with people who have similar goals, your values tend to overlap. Once we had finished, we each briefly discussed some of the ones on our list, and subsequently had to choose ONE value that we hold in higher esteem or of utmost importance. This was hard. It further demonstrated; however, how interrelated each of our values is. Now, this will not be the first time that I mention this, but my number one value was relationships. From the diverse relationships I currently have in my life, and those I’ve had with people in the past, I am able to observe and really appreciate my other values. Some of which include integrity, education, creativity, honesty, and understanding. I had never really thought of each being so connected, but it was really enlightening to realize. This activity also brought me back to a conversation I had with a colleague back in August. She has become one of the best people I’ve met since moving to Dominica. At the time, she and I were out to dinner with a larger group of people, and at one point in our conversation she asked me what I value more than anything. Bear in mind, I'm from Minnesota where people tend not to skim more than the surface when it comes to talking about life, how things (actually) are going in life, and opening up about who they really are, so having only met her a couple days prior, I was a little caught off guard by how her question probed directly into who I am as a person and why. Not in an offensive or off-putting way, but in a way that was refreshingly genuine and completely real. She and I have a weekly lunch date that we’ve maintained since the middle of last semester, and within those breaks, whether for 15 or 45 minutes, we cover the gamut of topics. I always walk away feeling better than when I sat down. It’s honestly incredible. In the midst of the stress and consuming nature of medical school, it feels really wonderful to just be human and remember what that means. After all, that’s why most of us want to go into medicine, right- to be human and help heal the human condition, whatever that may entail? I suppose that sentiment will vary from person to person, but it's an interesting thought to think. 

As I was walking to class this morning, I was struck by how much things have changed since I’ve been back. Granted, the last time I was here, I commented on how comfortable I feel here in Dominica, and how excited I was to be back. Although I still feel both of those things, I experienced a much stronger sense of homesickness this semester than I ever did last semester. Actually, "homesickness" can't even come close to describing how I've felt. I missed my friends and family, but knew I'd be seeing them again soon. I missed my dog, but again, I'll be able to see her soon. Minneapolis pulled at my heartstrings, but I wasn't dying to go back. So, what was it? Still to this day, I can't pinpoint what it was that I felt. I knew I would adapt and settle in again, but it was really one of the most unnerving feelings. After all, hadn’t I lived here for four months? Gone through the adjustment? Like I mentioned a couple weeks ago, shouldn’t I be able to walk back in knowing exactly what to expect? Theoretically, yes. For whatever reason; however, I couldn't figure out how. I spent much time pondering this and why it was different now than last semester. The conclusion I came to was that this (“this” being Dominica and school) is no longer new. I know exactly what to expect. Where to go for the best food at the shacks. What to do when I need to stay on campus to study, but the Large Learning Lab is closed. How to go about getting approval to run a clinic for Peds. Basically, I know enough to get by and live successfully day to day. These days; however, that’s not enough. So, I’ve been thinking about what more I can do to be successful and content here. What opportunities can I take advantage of this semester that I didn’t have time to do last semester? How can I adjust my life in a way that I get out of each day (almost) exactly what I want? Instead of needing to simply survive as I did in first semester, I need to establish a way of life. That was it. Something had finally clicked as I realized that as much as I don’t like change, it allows me to never have to establish parameters. For the last 5 years, I’ve known what I wanted to do (become a doctor), but I’ve never been in a position to have to settle down. To establish a life. My mailing address has changed at least once a year since I graduated high school. I had three different jobs over the course of nearly three years within the same company. I’ve started, but not finished, a master’s degree. Now that I’m finally getting to do what I want to do and starting to "settle down," it’s scary. Don’t get me wrong, I’m absolutely thrilled, but for the first time, I don’t have to think about when I’m going to start doing that thing I’ve always wanted to do. I’m actually doing it, and as much as I’ve wanted for the last few years to be settled, the idea that I’m getting there is terrifying. Now, quick perspective, I do still live in the Caribbean, and there are still a lot of things about my life that are up in the air. For example, things that often run through my head are: “Where will I spend the last two years of school while I complete rotations? Where will my residency placement be? Will my family continue to mostly reside in Minnesota, or will better opportunities present themselves elsewhere that encourage them to move?” That being said, the one thing that has been uncertain for so long is finally not uncertain, and I’m finally coming to terms with that. Does it mean that I don’t want to be here? In no way, shape, nor form. Still to this day, I can’t imagine doing anything else. It does further show me; however, that continuing to face life with an open mind and one that is focused on continuous growth and learning is essential. The fact that my life isn’t constantly changing for the first time in a while is a change…..so, maybe I’m actually more resistant to change than I realized. :)

Alright, alright, enough with the serious, philosophical talk. What I have not mentioned is that I am playing powder-puff football this semester with a few other first and second semester young ladies. We’ve had two practices so far, and it’s been a blast! Technically it’s a flag, no-tackle game, but our practices have gotten a bit intense at times, and I know that the games will only be more. It’s been a really good way for me to get outside of studying for a bit, though, and meet some people from my class that I otherwise wouldn’t have a chance to get to know. Needless to say, I know I’m biased, but I think our team is going to do quite well. I’ll keep you posted.

Unfortunately I believe I should move my head back to where it needs to be- the books- but I will leave you with a few photos of the island since I’ve been back, and as always, lots of love.

The Beach: ideal location for snorkeling and studying Cardiovascular Pharmacology

A young kid on my way to campus.

Rain clouds rolling in over the mountains toward campus

Sunset on the ocean

A local stray who followed me home from school.

Dominican sunsets will never get old.

Faint, but very present rainbow on a Friday walk to class