The Differential: Medscape Med Students Blogs

The Dog Days of Med School

Kendra Campbell -- I just returned from taking my two dogs to the veterinarian. These dogs were once puppies that I adopted while living in Dominica and taking my pre-clinical coursework. Over a year ago I wrote about an intensely emotional experience involving the death of another one of my puppies. Interestingly, the stress of med school had never brought me to my knees at that point, but the death of an animal, combined with other stressors really sent me on an emotional roller coaster.

As a child, I grew up on a dairy goat farm, and we had many other types of animals as well, including chickens, pigs, and many dogs and cats. I guess you could say that I grew up in a very animal-intense environment.

Okay, so now you’re thinking, “this is a blog about med school, not vet school, what does all this rambling have to do with human medicine?” Well, I actually happen to think it has a lot to do with it.

I’m going to go out on a limb here and say that being surrounded by animals all my life has definitely shaped my personality. I’ll even go as far as to say that it may have served to foster my compassion and ability to care for all living beings, humans included.

The two puppies that I adopted in Dominica turned out to be immensely valuable to me in medical school. I have fond memories of taking short breaks from studying to pet and cuddle my pups. Cuddling with them never failed to rejuvenate me when studying had sucked all the energy and life from my body and mind. And when I was stressed out about an upcoming exam, taking my pups for a walk on the beach or rubbing their bellies was always guaranteed to provide me with much needed stress relief.

You could assert that all this psycho babble about having dogs, or any pets for that matter, is a bunch of holistic mumbo jumbo. But the existing research actually supports my anecdotal evidence. Studies have shown that owning a pet can nurture both their owners’ physical and psychological well-being. Some of the medical benefits include lowering blood pressure and cholesterol levels, improving survival rates after surgery, and decreasing the number of visits to the doctor. As for psychological health, pets can help people cope with stress, reduce rates of depression, and even reduce loneliness.

So, I guess what I'm trying to say is that while there are some disadvantages (cost, allergies, responsibilities, poop-scooping) to owning a pet, the benefits shouldn’t be underestimated. My now almost two-year-old doggies are proof enough to me that owning pets can have a myriad of wonderful rewards. And that’s exactly what I told myself when I signed the $900 credit card charge at the vet’s office tonight!

The Gift of Psych

Kendra Campbell -- Oh my goodness, I’m quite tuckered out. I started my psych rotation last week, and I just had a full day packed with all kinds of psych goodies. I promised to share my feelings about my first clinical rotation, so here goes. To sum up everything that I’ve seen in six days on the psych ward: I am soooo in love with psych!

As I’ve mentioned before, while just out of college I worked for three years at a state psychiatric hospital. My undergrad degree was in psychology and neurobiology, so I do have some decent experiences in psych. But since leaving the field years ago, I’ve really considered going into a different specialty. I’ve recently been leaning towards emergency medicine for various reasons. However, being a “green” third year medical student, I realize that I simply don’t have enough experience to make a definite specialty decision. And I have one of those personalities where I tend to enjoy just about anything I do, so I am always suspicious when I fall in love with anything.

All that being said, man I really do love psych. The hospital that I’m rotating at is in Washington, DC, and it’s a district (DC is not a state) facility. What this means is that the patient population consists of clients with very serious mental illnesses. The facility is not a place for persons with simple psychological problems. Everyone who finds their way into the halls is extremely ill.

This patient population is exactly where my experience lies. Having worked at a state hospital, I’m very familiar with schizophrenic patients who are refractory to treatment. I’ve worked with homeless folks, and while I’m no expert, I do have experience helping those who are less fortunate.

I know I still have many rotations to complete, and I’m sure that I’ll probably change my mind a few more times. But right now, psych is certainly starting to look like a very tempting field.

The population of very ill patients really grabs my attention. Those who end up in state facilities tend to have a lot in common. They are the poor, the neglected, and the ones that have very little hope left. Often times, their friends and family have abandoned them. In the past, society has overlooked many of these unfortunate souls.

I guess what I’m trying to say is that to be able to share with these folks, to be able to help them in any way, to be able to make even the smallest impact in their life -- in my opinion, that’s one of the greatest gifts I can imagine.

Survey Says: Patients Like Pink Hair

Kendra Campbell -- I was utterly amazed by the huge response to my last post  about whether or not a med student can have pink hair. I wanted to thank everyone who left a comment. I read every single one, and rather than reply to each one individually, I thought I’d write a post to respond.

By and large it seemed that a good majority of people in the medical profession think that pink hair is simply unacceptable for a med student or doctor. The number one reason people gave is because it could potentially harm patients or threaten quality patient care.

Now if you read the comments closely, you’ll note something quite surprising. The vast majority of patients who commented actually said that they wouldn’t mind having a med student or doctor with pink hair. Some even said that it would be a refreshing change. Of course I can’t take this as fact. The response group is obviously self-selected, and this is in no way a valid study. However, I thought this finding was quite ironic.

Since so many people expressed interest in finding out how this story ends, I thought I’d share my solution to this problem. I decided to shave my hair into a pseudo-mohawk. I shaved the sides super short, and left a two-inch strip of hair down the middle. I then dyed the sides a dark brown color, and the “pseudo-mohawk” portion light blonde.

The result? I guess I have a new age mullet (as the saying goes, “business up front, party in the back). If I want to be more conservative, I simply press the hair down into a less obvious style. But if I want to be a little funkier, I simply spike up the mohawk portion. Voila! I stayed within the range of “human” colors, but still have a non-traditional cut and color combo.

Today was the first day of my psych rotation. I have a lot to say about how my day went, but I’ll save that for a later post. So, how was my hairstyle received? Actually, incredibly well. The doctor who runs the program didn’t even notice my hair, and my attending physician had absolutely no problem with it. None of the staff or patients gave me any strange looks, and in fact, a few of them complimented me on my hair.

If I had to do it all over again, I might have kept the pink. I really got the feeling that although I might have gotten some strange looks at first, I wouldn’t have been sent home, and many of the people would have actually enjoyed it.

Perhaps I will dye it pink sometime in the future. But for the time being, I have found a happy middle ground. I feel pleased and confident with my new style. I don’t feel like I’m trying to be someone I’m not. And honestly, because I felt so relaxed with my new style, I think it came through in my interactions with my colleagues and my patients. I felt like I could really be me. And maybe that’s the best way to treat my patients.

Can a Med Student Have Pink Hair?

Kendra Campbell -- I mentioned my pink hair in my last post, and some of you very observant folks out there may have noticed that my hair in the picture was in fact light brown. So, I thought I’d give some explanation for that, and also pose a question to the world. If you’ve been reading my posts for a while, you’ll know that I have gone through many different permutations of hair colors in my life. My hair has been every shade of the rainbow, and I’ve also cut it in many interesting ways.

Over a year ago, I wrote a post about whether or not it’s appropriate for a doctor to have a pink mohawk. I received a very big response, and it seems that everyone had varying views. At the time, I had just finished my first semester of basic science courses and wasn’t involved in patient contact, so I could sport my pink mohawk without anyone really caring. Eventually, my third and fourth semesters rolled around, and since I was involved in patient care and was required to dress “professionally,” I dyed my hair brown and had it cut as “professionally” as I could muster.

However, as soon as my break between classes would arrive, I’d either shave my head bald or into a mohawk and dye it a fun color. At the end of my fifth semester, which involved rotating at a hospital, I dyed my hair bright pink, and it’s been like that ever since. Because I have been studying for the USLME Step 1, I haven’t seen any patients or had to participate in any “professional” activities, so I could pretty much do whatever I pleased with my hair.

Now comes the hard part. I’ll be starting a psychiatric rotation in less than two weeks. I pretty much had planned on dyeing my hair brown or some other natural color, until a few days ago. I started thinking about it, and wondered what would happen if I didn’t. I’m not sure of the hospital’s policy, but I have a feeling that they wouldn’t necessarily send me home if I showed up on my first day with pink hair.

Some of you might be thinking that I’m crazy for even considering doing this. I understand. Why start problems if you don’t have to, right? Yes, I get that. But my hair is as much a part of me as anything. Why should I have to change it just to blend in? Anyone who knows me will tell you that my bright hair simply matches my personality. If no one is going to be harmed by my hair, what’s the big deal?

My other option would be to show up with “normal” hair on my first day, and maybe for the first week, until everyone gets to know me. Then, I could think about dyeing it to something more fun. But that just seems kind of fake to me. And maybe I’d get a worse reaction if I did it that way.

The other thing to consider is that this is in fact a psychiatric rotation. I’ve worked in psych before, and I know that anything that draws attention to you can be both good and bad. Sometimes it might help to break the ice with a patient, but other times it might be the focus of some psychotic delusion. You have to be very careful.

So, that’s my hair dilemma. Yes, I know there are more important things to worry about other than the color of my hair. But this just happens to be on my mind today, so I thought I’d pose the question to all of you out there to get your feedback. Can a medical student have pink hair?

I Love the Smell of Freedom in the Morning

Kendra Campbell -- When I walked out of the room into the hallway and announced that I was finished, the lady looked at me like I was crazy. She was responsible for administering the exams. “I thought you were taking the USLME Step 1,” she said. “I was,” I replied. Apparently, she’d never seen anyone finish the 8-hour exam in less than 4 hours. And I’m sure she didn’t suspect that the girl with pink hair would be the one to set the new speed record.

That’s right, today I took the first test in the series of U.S. medical licensing exams, the so-called Step 1. I only have two more Steps to go, and I’ll be eligible for licensure in the States.

Today was an interesting day. I woke up early this morning, drank my coffee and forced myself to eat some breakfast. At around 8:00 a.m. my partner dropped me off at the testing center to take the exam. When I walked into the testing area, the lady informed me that I had to remove my headscarf, per policy. I reluctantly removed the scarf, revealing a pile of pink, greasy, hadn’t-been-washed-in-days-because-of-my-study-marathon, matted hair. Luckily, that turned out to be the worst part of the exam.

Less than four hours later, I strolled out of the testing area, took the elevator to the ground floor, and waltzed outside to breathe in the warm, city air. Ahhh, I do love the smell of freedom in the morning, it smells like victory.

I’ve been studying for this exam for over a month. My entire life had been reduced to memorizing a monumental pile of seemingly random facts. I had been living, eating, and breathing this exam for so long. And now it’s finally over!

It definitely wasn’t the easiest exam I’ve ever taken, but I don’t think it was unbearably difficult. Some of the questions I knew right away, and others I had to take a wild guess on. However, I don’t want to comment on how I think I did because I don’t have any wood to knock on nearby, and I’d rather not jinx myself.

The good news is that I have the next two weeks off, and then I start my first clinical rotation. I plan on enjoying every minute of the next two weeks. I don’t plan on reading a single medical textbook, and I’m certainly not going to be memorizing pharmacokinetic equations.

Instead, I’m going to enjoy the sweet smell of freedom, and savor every last drop of it, since I know it won’t last forever.

Just Say "No"

Kendra Campbell -- I’m currently waist-deep in studying for my upcoming board exam in ten days. Yesterday was “pharm” day, where I devoted the entire day to studying pharmacokinetics, drug indications, contraindications, side effects, etc. I only allowed one day to cover all of pharmacology, and I’m now realizing that was a big mistake. I managed to cover a lot of drugs, but I still have a lot more to study. At one point, I nonchalantly thought to myself that there were just too many drugs to study. But then I really started thinking about all the drugs that are available right now, and how the consumption of drugs has been rising.

A recent study reported that 51% of insured Americans were taking prescription drugs for at least one chronic health condition. The study found that over one in five people were on antihypertensive medications, and almost one in seven were taking cholesterol lowering drugs. For insured American men ages 20-44, cholesterol-lowering drugs were among the top four meds, and their use of these drugs has increased over 80% in seven years. In addition, almost 30% of children under age 19 were taking a medication for a chronic condition, the most popular ones being asthma, ADHD and depression.

What does all this mean? Not surprisingly, Americans young and old are taking more and more drugs. There are, of course, plenty of reasons for this trend, but I’m going to focus on just two of them.

I haven’t had access to television for a while, but the last time I sat down and watched it at a friend’s house I was astonished to see the number of drug advertisements in just a one hour period of time. The use of direct-to-consumer advertising (the promotion of prescription drugs through newspaper, magazine, television, and internet marketing) is currently banned in all developed countries except the U.S. and New Zealand. But some drug companies won’t stop campaigning to have it legalized in Europe and Canada.

If you’ve spent any time in the States, you’re probably all too familiar with the television advertisements for various drugs. The basic plot line is a person whose life is miserable until they discover drug X. Once they start taking the magic pill, their life is transformed and they run through fields of flowers and look more beautiful and happier than ever. The next thing you know, the person watching this commercial is in their doctor’s office, demanding that they, or maybe even their child, get a prescription for drug X. And how can the doctor say no to someone who is convinced that they will be beautiful and happy if they have drug X? Yes, I am taking this example a bit far, but I think you get the point.

The second reason I think that Americans are taking more prescription drugs is directly related to our increasing obesity, as I’ve written about before. It’s simply more work to eat healthy and exercise. Popping a pill is much easier than changing one’s entire lifestyle. While there are other factors (genetics, etc.) that contribute to hypertension and high cholesterol, a poor diet and sedentary lifestyle are certainly important risk factors. Obesity in children is also well documented to be on the rise. And no one seems to be arguing the fact that lack of exercise and poor diets are significantly impacting the health of Americans, both young and old.

There are, of course, many other factors that are contributing to the increase in prescription drug utilization in America and other countries, but I shall save those topics for another entry. The point is that Americans are using more and more prescription drugs, and it’s not just older people anymore. Our children are increasingly becoming the targets of pharmaceutical advertisements, and are being prescribed increasing numbers of medications for chronic conditions. While there are significant positive impacts because of the availability of new drugs, especially for chronic conditions, I don’t think the trend is necessarily a good thing.

In the 1980’s, the U.S. first lady Nancy Reagan coined the phrase “just say no” as a slogan to help decrease the use of recreational drugs, especially by children. Now our children and young adults are actually using more and more prescription drugs for chronic and preventable conditions. If our child seems a little too anxious, we seek out an antidepressant. If they’re a little too restless, we put them on Ritalin. When they start getting fat, we put them on statins.

I want to know when are we going to start taking responsibility for our own health and the health of our children? When will we realize that we can’t always take the easy way out and pop a pill whenever we have a problem? When are we going to start “just saying no?”

Have Aliens Stolen My Brain?

Kendra Campbell -- I told myself that I’d write this blog post a few days ago. But here it is already Wednesday, and I’m just now starting it. I think I just realized why it’s been so hard for me to think of something to write about. I’m pretty sure that aliens kidnapped me, stole the creative parts of my brain to use as a giant battery charging device on their planet, and returned my body back to my apartment, all without anyone noticing anything.

Okay, so maybe there is another good explanation. I’m now several weeks into my studying program for my board exam. I only have two more weeks left until the day of pain and torture arrives. So, what has my life been like for the past few weeks? Unbearably lifeless and boring.

Yes, I have taken breaks to enjoy life and have fun with my friends, but the only thing that I’ve done related to medicine is study piles of basic science information that I once learned what seems like millions of years ago. At first, I was excited, and really started to have fun with the studying, but I’ve since hit a wall.

There is simply no context. There are no patients. There are no doctors. There aren’t even any professors or fellow med students as far as the eye can see. It’s just me, my books, and my laptop, banging away for hours in a creepy vortex.

I have lost all sense of space and time. And I think I’ve also lost all inspiration and creativity. I love to write. I have always loved scribbling down my thoughts and going on lengthy written rants. It’s always been a hobby that has kept me entertained. But sitting for hours upon hours, cramming seemingly pointless facts into my poor little brain has apparently sucked the creativity right out of me. It’s either that, or I was actually right about the alien theory.

Life Before Med School

Kendra Campbell -- The pre-med curriculum has been at the forefront of academic medicine discussions for years now, and many people have written about proposed changes to the current system. An article that recently appeared in the journal, Academic Medicine, discussed how the primary purpose of pre-medical education is to provide students with a broad-based education that prepares them for medical school and for becoming a physician. The author purports, however, that we’ve not really succeeded in this endeavor. Instead, the pre-med curriculum prepares students for the med school admissions test, and doesn’t always succeed in creating a well-rounded student, armed with everything that is needed to become a competent, caring physician.

In addition to the pre-med curriculum, many people have been discussing the other experiences necessary for preparing for med school, such as shadowing physicians and doing volunteer work. A few days ago, I received an email from a pre-med student asking about ways to “fluff” their resume with additional activities that might make them a better candidate for acceptance into med school. This really got me thinking about how the current pre-med experience is set up.

The “traditional” route into med school in the U.S. involves graduating from high school at around 18, spending about 4 years in undergrad to obtain a bachelors degree, and then applying to med school after graduation. During undergrad, students are supposed to take all of their required pre-med courses, and also gain experience in medicine.

I’ve recently been wondering if this “traditional” path might be flawed in one important way. If a student continues straight through school, with no breaks, they will eventually graduate from medical school, finish their residency, and make it to the “real world” where they can practice medicine and make a reasonable living. So, by the time they enter the work force, they’ve had little or no actual work experience. It’s possible that they had a part-time job, or even a few full-time jobs, but the majority of “traditional” students have never lived without student loans or parental financial support. Many of them may have never lived away (or far) from home.

There are plenty of “non-traditional” students, myself included. But the current system isn’t set up to encourage this path. I’ve thought a lot about the path I took to enter medicine. Do I think I made the right decision? Absolutely. I can’t emphasize enough how having experiences outside of school, and outside of medicine, have made me better prepared for handling med school, and I think eventually for becoming a competent, caring physician. I also know many other “non-traditional” students who feel exactly as I do. They believe that their path to becoming a doctor has better prepared them, and that they have an advantage over “traditional” students who never left school long enough to experience the world.

So, the question arises, “why do we encourage the current route to becoming a doctor?” What are the “traditional” students losing along the way, and can they ever make up for that lost time? What do you think it means to have a life before med school?

But I Don't Wanna Study!

Kendra Campbell -- I’m sitting at my desk typing on my laptop in my new apartment in Baltimore, Maryland. I now have a place to live, water, electricity and even an Internet connection. Most of my boxes have been unpacked, and I even have food in the fridge. I have about one month with no classes, and all I really have to do is study for the USMLE Step 1. Today is the beginning of my marathon studying routine.

Okay Kendra, you can study now. But I don’t want to study! Actually, I’ve been so swamped lately with moving, packing and unpacking, and running all the errands involved with moving to another country that I haven't studied in over a month. I don’t even feel like a student anymore. I feel like a professional mover. Over the past month, I kept telling myself that when I finally get everything unpacked, I will buckle down and start studying. But now that that time has finally arrived, I don’t even know where to begin.

I’ve made excuses like, “I can’t study until I have electricity,” or “I can’t study until I have unpacked all of my books,” or “I can’t study until my dogs get all of their vaccinations.” These seemed like reasonable excuses at the time, but when I stop and think about it, I realize that I’ve studied under worse conditions in the past.

In Dominica, I’ve studied without electricity or water. I’ve studied in the middle of a hurricane. I’ve studied right after having surgery. I’ve studied when I could barely keep my eyes open because I was sick and fatigued to the point of wanting to give up. But now I’m saying that I can’t study until my dogs get vaccinated? What on earth is wrong with me?!

I’ve written before about having a study block, but this time it seems a little different. Having a deadline that’s so far away means that I have to put the pressure on myself. I’m also in another country, and it’s been so long since I’ve studied that I wonder if I’ve forgotten how.

I’m wondering how many of you out there have been through a similar experience. Do you have any tips on how to get back into studying after taking so long of a break? I guess I should stop writing about not being able to study and just do it! If only it were that easy.

The End of One Journey and the Beginning of Another

Kendra Campbell -- Everything is so surreal right now. I’m riding in the passenger seat of a rented SUV on a major interstate highway, headed to a major international airport in Baltimore, Maryland. Do you ever have one of those moments in life where you pause and think, “How did I get here?” Well, I’m having one of those moments. There are hundreds of cars all around me. The highway has five lanes, and even has painted markings. At any moment I could stop and buy just about anything I could imagine. I could eat almost any type of food that exists. There is a McDonalds and Starbucks on almost every corner. I am in America.

For those of you who have lived for years in a less developed country, and then moved to a country of excess like the States, you can imagine what I’m going through right now. Culture shock is an understatement. I’m having a grand mal culture seizure right now. I’ve spent almost the entire past week traveling by bus, plane, and car to my home in the States. I somehow managed to get all my worldly possessions and my two dogs home safely. It wasn’t an easy undertaking. During my road trip, I stopped at a Target (a huge discount super store) and cried when I walked through the doors. The amount of stuff to buy was overwhelmingly unfathomable.

I completed one “transition” semester of short rotations in Dominica. I’m officially living in the States for at least the next few years. I’ll be taking the next month to study for the USMLE Step 1, the medical licensing exam for the US. Two weeks later I’ll be starting my first official clinical rotation in Washington, DC. After that, I’ll hopefully be starting more clinical rotations in Baltimore, Maryland. So, at least I do have a rough draft of a plan.

Honestly, though? I don’t really feel like my plans are all that solid. I still feel so jumbled up from all the moving. I feel homeless (technically, I am right now), carless, and pointless. Being in between homes, cars, and schools is a very dissociative experience.

As for my education, I’ve completed all of my basic science schooling. I’ve had an initial introduction to the clinical world, but I really haven’t yet begun that journey. So, once again I’m sort of in limbo with that too.

I feel like I’m teetering on the brink of something huge. Behind me, I see all the work that I’ve done to get here. I see Dominica, and a monumental pile of information that I’ve learned to get to this point. In front of me is the United States of America, and all of the clinical experiences I have yet to have. There’s a part of me that wants to take the easy way out and go running and screaming back to Dominica. But the responsible side of me knows that I must press on ahead. Luckily, there is actually a large part of me that is very excited to be starting a new adventure. So, here’s to the end of one journey and the beginning of another!

Third World Learning Curve

Kendra Campbell -- I have lived here in Dominica for close to two years. In ten short days I will be leaving my home and returning to the States to start my clinical rotations. I know there are a lot of students out there who have lived, worked, or gone to school in so-called Third World countries. For me, it’s been an experience that I will treasure for the rest of my life. For those of you out there who haven’t lived in underdeveloped countries, but are considering doing so for school or as a volunteer, I thought I’d compile a fun list of things that I’ve learned while living here in Dominica. Enjoy.

1. Having a rooster for an alarm clock. No matter where you live in Dominica, you’re likely not far from a rooster. Mine wakes me up religiously at 6:00 every morning, whether or not I ask it to. I guess I’ll have to go back to the electronic variety in the States.

2. Using Chinese food restaurants as convenience stores. In Dominica, almost everything closes on Sundays. If you need food, soda, or other beverages, your only option is to get them from the Chinese food restaurants, because they are the only businesses that are open.

3. Not having an address. They don’t have a mail delivery system in Dominica, and although I think the roads might have names, they don’t have any road signs. My address is “Banana Trail, Portsmouth.” If I’m getting food delivered, I specifically say that my apartment is past the green house on the top of the hill with the dogs that bark loudly, and across from the black and white goat.

4. People carry machetes instead of briefcases. Pretty much everyone here owns a machete, and it’s commonplace to carry it around with you. Instead of the bland briefcases that I’m used to seeing everyone toting around, people walk down the streets with sleek and stylish machetes.

5. Traffic jams because of runaway cows, sheep, goats, or other livestock. I was quite used to traffic jams in the States, but I’d never seen a herd of goats causing traffic mayhem as they run down the street with a torn rope around their neck dragging behind them.

6. Electricity is a luxury. No seriously, it is. The electricity usually goes out at least once a week, and I’ve seen it off for days at a time. You eventually learn tricks to live without electricity like having lots of candles, and making sure you have a gas stove. If you don’t have a huge exam to study for, it can actually be pretty fun. If you do, then you try to avoid the temptation to burn the house down.

7. Being kept up all night because of mosquitoes. The mosquitoes can get so bad here that they literally buzz you out of your mind! Even with netting, mosquito spray and special candles, the little buggers will find their way to your ear at 3:00 in the morning.

8. Eating expired food. Shipping things to Dominica can be tricky for a variety of reasons. It’s not uncommon to see food on the shelves of grocery stores that has been expired for over a year. I guess eventually you just get used to the taste of stale food.

9. Hitchhiking is safe. Actually, it’s not only considered safe, it’s pretty much the only way to get around. If you stick out your thumb, either a transport, a person driving a pickup truck with an empty bed, or just about anyone else will stop quickly and take you where you need to go. Even young children use this method to get to and from school everyday!

10. Taking showers in brown water. The water here is very unpredictable. After it rains, it will turn off for hours and then if you’re lucky, it will come back on. But it’s frequently a lovely shade of beige, and loaded with sand. It might sound unbelievable, but you really do feel cleaner after a muddy shower!

If any of you have lived or currently live in an underdeveloped country, please do add to the list!

Trust Me, I'm a Doctor

Kendra Campbell -- Last week I completed my very last clinical rotation for this semester. My group rotated in the psychiatric ward of the hospital. I met a lot of intriguing patients with all-too-familiar stories. Before medical school, I worked for three years at a state psychiatric hospital. In fact, the experience at the psych hospital is what gave me my first thirst for medicine.

Having met so many psychiatric patients in the States, I was very interested in discovering the kinds of patients I’d find here in Dominica. Surprisingly, the patients’ stories, experiences, and struggles with mental illness were strikingly similar to the ones I’d seen in the States. The ward was also set up comparably to the hospital I worked at and psychiatric wards that I’d seen in the States. The treatment team still consisted of almost the same group of people: a psychiatrist, a psychologist, a nurse, a social worker, and a nursing assistant. The pain and frustration that the families were experiencing was also sadly familiar to me. I immediately recognized their wrinkled and fatigued faces and knew that they’d encountered endless challenges and setbacks while trying to help their loved ones.

There was only one thing that I noticed that was prominently distinctive about the psych ward here in Dominica: the patients were not verbally or physically abusive towards the staff. Not only were they not abusive, but they were relatively pleasant. The patients actually listened to the nurses and doctors. They rarely defied them. The chief psychiatrist confirmed my observation. He said that it was exceedingly rare for a patient to attack a staff member and that the majority of patients respected the staff immensely.

I can’t emphasize how shocked I was by this revelation! For three years I came in to work prepared to deal with abuse. I worked on the acute unit and most of the patients were very unstable. I was continually verbally abused, and physically attacked on more than one occasion. We did everything we could to ensure a safe unit, but sometimes the abuse was just inevitable. All of the staff were on constant alert. We knew that at any moment a patient could take their rage out on one of us.

Not only were the patients aggressive at times, but they rarely listened to the advice or encouragements of the staff. Getting a patient to take their medication voluntarily was a daily battle. Convincing them to take a shower or change their clothes was no easy task. There were definitely some cooperative patients, but most patients downright hated the staff.

The contrast between the trustful Dominican psych patients and the distrustful American patients is profound. A common phrase uttered by Dominican patients is “yes, doctor.” The first time I heard it, I didn’t think much of it, but over this semester, I’ve heard it over and over again. It’s almost like a patient mantra. At first I thought they were saying it mockingly, but I’ve since realized that they actually mean it. They really do put all of their trust into their doctors’ guidance.

I’m so fascinated by this that I’d love to research how the differences in patient trust have evolved. I’d really like to know how the cultural aspects come into play. And the big question I have on my mind is how patient trust in their doctor might affect patient outcomes. Are the trusting patients more likely to be compliant with their treatment plans, and hence have better outcomes? Or is a little distrust important in keeping the patient super vigilant? How much do you think patients should trust their doctor?

To Test or Not to Test: That Is the Question

Kendra -- Have you ever seen a doctor for a simple complaint and been subjected to a plethora of blood tests, scans, x-rays, urine screens and other investigations, only to be told that you had something obvious that could have been diagnosed without a single test being performed? Perhaps you were sent home with a prescription, or maybe you were just told to go home and see if the symptoms resolved on their own? Many people would feel relieved to know that their doctor ruled out every possible diagnosis with all the various tests. Some people might feel frustrated that they had to be poked and scanned so many times, only to be told that they just needed to wait and see if they felt better in a few days or weeks.

An article recently published in the New York Times touched on this very topic. The author describes how medical testing has been on the increase for a while. He suggests that because of reductions in Medicare payments and the decline of reimbursement rates, doctors have to subject patients to many unnecessary tests just to break even. In addition, many people demand that doctors perform as many tests as possible. There’s a perception that more tests equals a more thorough investigation, and a higher quality physician.

I think there is some truth to his argument, but I think the problem is multifactorial. The number of medical investigations that can be performed has increased substantially over the past few years, for many different reasons. Part of the problem, however, is that many of these tests don’t necessarily rule in or rule out any diagnoses. While I’m not arguing that these tests aren’t important, I’m just saying that they don’t always aid in diagnosing a patient or even lead to a treatment plan.

All of these tests come at a hefty price. According to the article, the overuse of healthcare services probably cost hundreds of billions of dollars last year. And the data suggest that this increase in services is not causing a concomitant increase in the quality of healthcare in the U.S.

The question of whether or not to pay for expensive medical testing was really drilled home with me during the past two months. I’ve been rotating at a hospital in Dominica with much fewer resources than U.S. hospitals. In addition, the average patient is not wealthy and does not have health insurance. Not long ago, I met an elderly gentleman with obvious signs of a stroke. Unfortunately, he could not afford a CT scan, nor an MRI, for which he’d have to be sent off island. We ended up doing the standard interventions with the assumption that he did in fact have a stroke. He ended up faring about as well as he would have if he had the proper diagnostic tests. Obviously, it might not have turned out this well. It’s possible that he could have needed a surgical intervention, but since we don’t have a neurosurgeon on the island, he wouldn’t have been able to get the surgery anyway.

I’ve been amazed at how well the hospital here runs, even with very little means. Patients still get a good quality of care. Of course there are exceptions, but many patients are successfully treated at very low costs. The clinicians at the hospital are all too aware of the deficits, but they use low-tech methods of good history taking and physical examination to diagnose patients.

Because of the current structure of the healthcare system in the States, I don’t predict that rising healthcare costs and the misuse of diagnostic testing will decrease any time soon. But I think that as doctors and future doctors, we should all do our best to not add to the problem. The next time a patient comes in and we consider performing a huge barrage of investigations, we should ask ourselves how much information we really stand to gain, and whether or not it will actually benefit the patient.

The Operating Theatre Performance

Kendra Campbell -- I’ve spent the past two weeks rotating in anesthesiology, which means I’ve basically put in a lot of hours in the operating room (or theatre, as it’s called here). In just two short weeks I feel like I’ve come a long way. When I first started, I barely knew the right way to put on my mask or sterile gloves, and now I understand most of the rules (both unwritten and otherwise) in the OR. I can hold the oxygen mask properly, start IV lines, and I even intubated my first patient the other day! I haven’t yet scrubbed in for a surgery, since I am with the anesthesiologist, but I know that I’ll be doing that in the near future.

At this point, I’ve only seen 20-30 surgeries, so I know that I am still “green,” but I have enough knowledge to at least avoid getting yelled at by the nurses and surgeons, and I can even help out every once in a while.

The doctors and nurses that I’ve seen working in the OR absolutely amaze me. They handle patients so efficiently that it’s obvious that most of them have been in this business for years. In fact, they are so good at their routines that they sometimes forget to explain their procedures to us ignorant med students.

I think the relationship between the surgeon and the surgical nurse assistant is the most fascinating. The nurse has seen enough surgeries that he or she knows exactly which instrument the surgeon needs at any moment. I realized during a surgery the other day that the surgeon rarely had to request an instrument. Rather, the nurse had it prepared and waiting for him before he even asked. Some of the nurses even know the details and personal preferences of each surgeon, and take that into account when assisting.

During a surgery, there is a wonderful ballet between the anesthesiologist, surgeons, nurses, and techs. When you add the sound of the beeping heart monitor, the ventilator, and all the other various background noises, it really does create a scene reminiscent of a spectacular performance. And as with any good show, the actors and actresses are all dressed in elaborate and purposeful costumes. Perhaps the United States has it wrong in calling it merely a room. It seems that it is much more similar to a theatre.

Watching the surgeon skillfully slice, clamp and suture reminds me of cheironomy, or the process of using hand gestures to indicate melodic shape. This process was used beginning all the way back in the Middle Ages, but has since mutated into the modern conducting baton, which is used more to keep the beat of an orchestra. And similar to a conductor, the surgeon’s hands, scalpel, and needle provide the beat for the entire operating theatre.

(The picture is of my friend and me preparing to head into the operating theatre.)

Can Med Students Save the World?

Kendra Campbell -- I am a total sucker in many ways. I can’t count the number of wounded squirrels, rabbits, mice, deer and other animals that I’ve brought home in the past. When I see an animal in need, I lose all sensibility, and immediately pick it up, bring it home, and figure out the best way to care for it.

This certainly became a problem for me when I moved to Dominica. There is an abundance of neglected, homeless and abused animals everywhere you look. Within days of moving here, I found what I thought were two homeless dogs, brought them home, cleaned them up, and gave them plenty of food and water. Then came the puppy phase. For about a year, my apartment served as a makeshift puppy shelter/rehabilitation center. I’d bring home puppies and de-worm, de-flea, de-tick, and rehydrate them. After they were overwhelmed with food and love, I’d put a collar on them and try to find them a good home. I even ended up keeping three of them for myself. (Unfortunately, one passed away.)

Eventually, however, I became somewhat overwhelmed by the shear number of animals that needed care. It was simply more than I could handle by myself, and I realized that I was barely making a dent in the problem. So, I stopped taking in the strays and just focused all my attention on my two puppies. Now, when I see a homeless or neglected animal, my heart still goes out to them, but not in the same way it did in the beginning. I think I’ve become somewhat desensitized to them. Has the harsh reality set in? Has my empathy been pounded out of me, leaving only apathy behind?

In many ways, my transformation reminds me of the one that many med students go through. In their pre-med and first two years of med school, they want to save the world. When they first start seeing patients, they have the utmost empathy for them and go out of their way to care for and help them. Then the reality of the overwhelming number of people in need sets in. Not only that, but they begin to realize that in many cases, people can’t be saved. Patients don’t listen. The healthcare system fails them. It all becomes an exercise in futility. The process reminds me of Martin Seligman's famous experiments on learned helplessness. The dogs in the experiments eventually learned that they couldn’t escape the electric shocks and hence gave up. Med students eventually learn that they can’t save the world, and in a way, they learn to give up trying to save everyone.

In a study recently published in the journal Academic Medicine, researchers found that undergraduate medical education does in fact reduce vicarious empathy in medical students. So, there is some proof that the medical education process is not always promoting empathy and compassion. Ironically, the schooling process seems to have a deleterious effect on a med student’s ability to care.

I can tell that I have yet to have all the empathy sucked out of me. The other day at the hospital, I met a 1-month old baby whose mother had left him at the hospital. The staff had been unable to contact any of the mother’s relatives, and there are no orphanages in Dominica. So, the baby will remain in the hospital until a home is found. Of course, I reflexively wanted to take the baby home with me and care for it. Seconds later, reality sunk in, and I knew that I couldn’t handle the responsibility. But there is still a part of me that wants to run back, grab the baby, and take him home with me.

We see many patients who can’t afford to have necessary surgeries performed. Every time I meet a patient in this predicament, I want to write them a check from my own bank account for the surgery. Of course, I quickly realize that I’d eventually run out of money, so I don’t.

So, while I know that I can’t help everyone in the world, I still have the instinctual response to try. And every once in a while, I am actually able to help a person or two. I don’t think it’s wrong to have those kinds of feelings. I think the problem will come the day I stop trying to save the world.

The Fun of Performing Rectal Exams

Kendra Campbell -- This past week I have been rotating in the Accidents and Emergency (A&E) department at the local hospital. I think I’ve had more fun this week than I’ve had in all the other weeks combined. Our attending physician is absolutely amazing. The A&E department at this hospital is at times pretty chaotic. There are patients literally everywhere. The nurses (or sisters, as they are called here) are always trying to keep up, but there is always a constant flow of patients. Usually, there are only three med students following around the physician, but due to a scheduling conflict, they had to assign six students to this one physician. In the midst of all the chaos and confusion, our doctor remains completely calm and manages to teach us quite a bit in the process.

On the first day of my rotation, I was already writing notes in patients’ charts, writing orders, and even writing scripts (with his signature as well). Okay, so this might sound pretty lame to all of you, but this is the first time I’ve ever actually written a script! It was so much fun!

By the second day, we were interviewing all the patients and performing exams on them. The physician would leave us alone and return a little while later for our report. Then we’d tell him our proposed diagnosis, and usually we were right on. It made me think that I actually might know a thing or two.

The most interesting part of the second day was a 78-year old man with BPH. He was very friendly and smiled at all three of us med students as we filed in the room. The next thing I knew, our doctor was asking us all if we had performed a rectal exam yet. “Only on the model,” we all replied. “Well,” he said, “today is your lucky day!” I was so excited that I almost started shaking. I gloved up, applied the lube, and performed the exam. Afterwards, the other two students also took a shot. Luckily, our patient was more than willing to allow us the opportunity to learn (amazing!).

After we performed the rectal exam, it was time to change his urinary catheter. I guessed the right number, so the doctor gave me the responsibility. This was the first time I’d ever performed a procedure that required sterile gloves, and I stumbled a bit getting them on. I removed the old catheter, inserted the new one, and inflated the bladder, all with instructions from the doctor. After it was all over, I stepped back and admired my work! I was incredibly proud of this quite miniscule accomplishment.

Today was just as much fun as the first two days, and I have learned that I absolutely love A&E. I feel more like a doctor now than I ever have before. I can’t believe that I can actually diagnose patients correctly and come up with treatment plans. I’ve come a long way since my first days of med school. But there is one thing that hasn’t changed, and that’s my giddy excitement over learning the little things. Many people consider performing rectal exams to be scut work that’s given to med students as a sort of rite of passage. But I don’t mind performing them in the least. I’m actually thrilled and enthused to have the opportunity to perform one. Now, I know this might seem silly and ignorant to many of you seasoned med students and physicians out there, but I don’t care. I like getting excited about seemingly insignificant or boring tasks. It’s what makes life fun and interesting. People all too frequently lose the childlike excitement with their jobs and their lives, because they stop seeing the importance of things, and they just mindlessly float (half asleep) through life.

It reminds me of a sign I once read: “You don’t become old and stop playing in playgrounds. You become old BECAUSE you stop playing in playgrounds.” So, here’s to never getting tired of performing rectal exams!

Finding Inspiration

Kendra Campbell -- My last post involved a little bit of me ranting about losing my study groove. Well, I’m happy and proud to say that I think I finally found it again. I actually did end up putting on a festive outfit and joining in the Carnival activities. Dancing with my friends turned out to be exactly what I needed that night. But the next few days I continued to be in somewhat of a slump. I started questioning my dedication to medicine, and even my dedication to myself.

Yesterday morning, I worked at the outpatient Ob/Gyn clinic at the local hospital. I had the opportunity to interview a few patients, and then got to observe an abdominal and pelvic exam on a few pregnant patients. Talking with the women, and learning about their pregnancies and their lives, really sparked my interest. These women are bringing human beings into the world. And my input has the possibility of making an impact on both the mother and child’s lives. As the attending physician starting pimping me on complications due to the mother’s uncontrolled diabetes, I felt an energy welling up inside me. I really did care, and I really wanted to answer her questions correctly. It wasn’t a multiple-choice question on an exam. It was a question that affected the outcome of someone’s life.

That afternoon, we had a clinical skills review session with a doctor from the hospital. I could tell that he loves being a physician, as well as being a teacher. His energy and enthusiasm were quite contagious. He really cares about his patients, and has a burning passion for medicine. He taught me new ways of thinking about patient care, and explained “why” we perform certain exams in certain ways. Before yesterday, I don’t think I really understood the “why” portion of some of the exams. But as he explained the techniques, a huge, brilliant light bulb lit up above my head, and I could hear the angels’ chorus. It finally all started to click. Moments like that are what got me interested in medicine in the first place.

So, as you can tell by now, yesterday was a good day. I can feel the fire burning inside me yet again. I remember why I wanted to pursue this crazy field called medicine. I have the energy and motivation to study, and to improve my clinical skills. I actually feel like it’s a privilege to be on the path towards becoming a physician. I really want to change the world. Of course, none of this has anything to do with the fact that I had espresso yesterday and coffee this morning! (And some of you said that caffeine was bad!)

In reality, I know that I am back in my groove. In my last post, I also mentioned my view of the Caribbean Sea from my balcony. It is in fact completely and utterly gorgeous. The last time I looked out at the view, I was inspired to go join the Carnival revelers. Now that I have my study groove back, I’m inspired to go down to campus and catch up on my lectures. The same view inspired completely different actions on different days. I think it’s because true inspiration is not generated from things external, but rather is something that comes from within. Or perhaps external events provide the kindling for the fire that’s always burning inside. And on two different days, the view from my balcony helped to light two different fires.

How Kendra Got Her Groove Back

Kendra Campbell -- I’m currently sitting on my balcony, which overlooks the Caribbean Sea. Today is the Carnival celebration here in Dominica. I can hear the calypso music blaring from the speakers in town, and I know that the city is currently full of half naked drunk people dancing in the street. I don’t have to go to the hospital for two more days. We had a long weekend because of the Carnival celebration. I don’t really feel so much like a med student right now.

This semester has been so different from the previous ones. We only have a few hours of lecture every week, and we only have one written exam. I have to go to the hospital three times a week, but other than that, my schedule is very open. So, with all this free time on my hands, I have plenty of time to study for the USMLE Step 1 … right? Well, that was the plan. In fact, I should be studying right now instead of pondering whether or not I should put on a colorful outfit and go join the Carnival festivities.

So, why am I not studying? I think it’s a multitude of reasons. Firstly, I know that I won’t have an exam for many more weeks. It’s simply so far in the future that it’s really hard to get motivated for it. We also have very few lectures, so there isn’t all that much to study for this semester. I think I also never really made it back mentally from my vacation a few weeks ago. It was just so long, and I had so much fun that I think I forgot how to be a student.

Strangely, it’s times like this that I question whether or not medicine is a good fit for me. I’d think that most people question their decision when they’re right in the middle of studying, or when they just received a bad grade. But I’m basically the opposite. It’s when I’m doing well, or when I’m just really bored that I wonder whether or not I’ve made the right decision. Maybe I’ve just had too much time to think about things. When I’m super busy and in the middle of a hectic schedule, I simply don’t have enough time to ponder my life’s purpose.

Anyway, I think I’ll stop pontificating now and get off my butt and do some work. Maybe I’ll do some practice questions or something. Perhaps that will distract me long enough that I can get back into my groove. On second thought, maybe I’ll go check out Carnival instead. I know how easy it is for me to dance the day away. At least that’s a groove that I know I can get back.

Excuse Me While I Kiss the Ground

Kendra Campbell -- Everyone is familiar with the stories of people getting queasy at the sight of blood, and even passing out. Even if it’s never happened to you, I’m sure you’ve heard of someone who has. I’ve always considered myself to be fairly comfortable with blood and needles. I like to watch when getting my own blood drawn, and I don’t even mind getting poked with needles. When I worked and volunteered at hospitals, I saw blood all the time, and even carried it around the hospital. In anatomy lab, I was the first person to cut into our body, and I never got grossed out by any of the dissections (granted, there isn’t much actual blood left in the bodies). I’ve cut open live rats while working in a neuroscience lab, and I’ve even gotten to watch a few surgeries on humans. So, I assumed that I had a pretty strong stomach when it came to blood, needles, and medical procedures. But a few days ago, I found out that it might not be so strong after all.

I was rounding with a physician and she decided to take us to the dialysis unit to see a patient. By this point, it was about 12:30 in the afternoon, and I had not eaten anything all day. We stepped inside the clinic and met a lady who was being dialyzed. I watched the blood running through all the tubes and was fascinated, since this was the first dialysis machine I’d ever seen in use. But as the physician started describing how the machine works, I realized that I was starting to drip with sweat. I could feel the blood draining from my face, and then the world became a little fuzzy. As the doctor pulled back the blanket to reveal the arteriovenous fistula on the patient’s arm, I felt my knees becoming weak. The sweat was dripping down my back, and I could barely see. Luckily, at the last moment, I gathered all my strength and ran out of the unit into the outside corridor.

After I made it outside, I looked around for a place to sit. There was a bench nearby, so I stumbled towards it and collapsed. As I sat there, waiting for my blood to return, I realized that there were patients all around me, staring intently. I guess I must have looked like a mess, covered with sweat, with an absolutely white face that matched my white coat. I sat on the bench for several minutes before I could stand again. I knew I desperately needed sugar, but I didn’t have any change on me, so I just bravely stepped back inside the unit. I was pleased to realize that the other students in my group had covered for me, and I hadn’t made as big of a scene as I had originally thought.

The whole incident really got me thinking, though. If something as innocuous as a lady on dialysis is enough to send me to the floor, how will I deal with a spurting artery? Or a severed limb? Or one of a million bloody scenarios to come? I guess I’m really nervous that I picked the wrong profession. What if I can never overcome the vasovagal response to the sight of blood, or someone being poked with needles? I’m wondering if there are other people like me out there. Did you ever figure out a way to prevent passing out at the sight of blood? Does it eventually just go away after working in medicine long enough? Or is it something that you always have to battle?

My First Day of Clinical Rotations

Kendra Campbell -- Today was my first day of rotating in a hospital as a medical student. I was assigned to internal medicine, and basically followed the attending physician and intern around the wards with two other med students. This is actually supposed to be a transition semester. I’m finished with the basic sciences, but don’t know enough about the clinical world to begin my official rotations, so I have 12 weeks to learn the ropes.

The hospital where I’m rotating is a pretty far cry from the hospitals that I’m used to working at in the States. The halls have no walls, since there is no air conditioning. Many of the beds and rooms are quite dilapidated. There is no MRI machine or even “nurse call” buttons. However, the hospital actually runs surprisingly well. The hierarchy of nurses and doctors is pretty similar, and many of the protocols are almost identical.

Since today was my first day, I had absolutely no idea what to do. Combine that with the fact that I was in a different country, with different rules, and you have one very confused Kendra. I spent a good 30% of the day just standing around with a confused look on my face, smiling at all the doctors, nurses, and patients as they walked by. A few patients approached me with questions, and of course I had no idea of the answer, so I had to redirect them to someone who would.

Eventually, I learned where to find the charts and started familiarizing myself with the various colors that are used for lab work, doctors’ orders, prescriptions, etc. I read through a few patients’ charts, and looked up the various drug names that I didn’t know.

As we rounded with the attending physician, she began to drill us on diseases, meds and tests. Because I have not picked up a medical book in over a month, I thought that I had most likely lost everything that I had learned. But I soon realized that I was able to answer most of her questions.

Later on, I observed the intern do a urinary catheterization on a patient who was somewhat demented and uncooperative. I could tell that she was having a hard time, so I instinctively grabbed a pair of gloves and helped hold the patient still and tried to calm him down. I could tell that she was pleased to see me jump up and help, without her having to ask, and afterwards I was glad that I hadn’t just stood there with a glazed look on my face.

So, I would say that although I felt pretty silly standing around most of the day, not really knowing what to do, I actually had an amazing day. I still feel pretty incompetent, and know that I have a lot to learn. But the desire to learn is burning inside me, and I think that’s probably the most important thing right now.

Would You Prescribe Medical Marijuana?

Kendra Campbell -- I recently watched a video of presidential candidate Mike Huckabee responding to a question on whether or not he would support medical marijuana. In his response, he mentioned that narcotics could potentially be an alternative to medical marijuana for the relief of pain. This really got me thinking.

Before I delve into the subject, I’d like to say that I’m not necessarily for or against legalizing marijuana across the board, or even just for medical use. However, I am definitely for the relief of others’ suffering, and I also believe in anecdotal evidence, as well as findings from clinical research.

I can’t claim to be an expert on the subject of medical marijuana. But from what I’ve read, there seems to be a lot of research that suports the claim that marijuana can be effective in treating chronic pain, nausea, increased interlobular pressure, and a variety of other symptoms. It has been promoted in the treatment of diseases such as AIDS, cancer, glaucoma, and multiple sclerosis. Of course, on the other side of the coin, there has been research that supports the notion that marijuana can have some long-term negative effects. I could go on to list all the research for and against the use of medical marijuana, but that would require a much longer post, and it wouldn't prove anything in the end.

The statement that Huckabee made regarding narcotics (and by narcotics, I’m guessing he meant opioids) really fascinated me. His comment would mean that morphine, for example, is a viable alternative to marijuana for the treatment of chronic pain. Any physician, or medical student for that matter, can testify to the fact that morphine is effective in relieving short-term pain, and some research supports its use in the treatment of chronic pain. However, if you’ve ever seen the consequences of the administration of morphine long-term, you can guess why I have a problem with this argument. There is no debate that morphine is physically addictive. I’ve seen it with my own eyes, and the drug seekers who show up in clinics and hospitals are first-hand evidence of the addictive potential of this drug.

Is marijuana also a physically addictive drug? Well, this seems to be a highly debated topic. I’ve seen evidence for both sides, but I think the preponderance of evidence favors the fact that it’s not physically addictive. Even if there is an addictive component, however, could it ever be as strong as the addiction to opioids? I guess that’s for all of you to answer.

Currently, federal law prohibits a doctor from prescribing medical marijuana to their patients. However, certain states have passed laws that allow doctors to prescribe marijuana for various medical reasons. I’m curious as to why certain doctors believe in prescribing marijuana for their patients, and how they would feel if they lived in a state (or country) where its use is prohibited. I also know very little about its use internationally. Do other countries have similar laws about the use of marijuana? I have years before I’ll be able to use a prescription pad, so I have plenty of time to think about this subject. But I wonder what I would do if I had a patient who clearly benefited from the use of medical marijuana. Would I prescribe marijuana if I knew it would relieve their suffering, and even aid in their healing? What would you do?

Super-Sized America

Kendra Campbell -- I’m currently sitting in a suburb outside of Washington, DC, the capital of the United States. I’m on vacation from everything that is med school. So far, I’ve had a wonderful time with my family, hanging out with my friends, and eating all the delicious foods that I can’t get in the country where I go to school, Dominica.

When I first stepped off of the plane a few days ago, I had a similar experience to the last time I was in the States, over eight months ago. As I wrote in a blog entry before, I was immediately shocked by the large size of many Americans, as well as the overabundance of incredibly unhealthy food options. Yesterday, my partner and I went to grab a bite to eat for lunch at a popular restaurant. I wasn’t that hungry, so I offered to eat half of whatever he ordered. He picked the steak special (I’m currently a meat eater but was a vegetarian for 13 years), and I agreed to eat some. When the server brought out the plate, my first reaction was that he was playing a practical joke on us. The plate was huge! On top of the plate was the largest steak I’ve ever seen, covered with huge pieces of greasy bacon, and topped with a one-inch pile of cheese! On the side were mashed potatoes (about 4 potatoes worth), and a small pile of greasy spinach. At that moment, I could barely contain myself. I looked outside into the parking lot filled with huge SUVs, and around the restaurant at the many large patrons, and realized that America had in fact become a super-sized country.

My experience at the restaurant really got me thinking about public health and responsibility. Why would a restaurant even offer a meal that provides 500% of the daily recommended allowance of fat? Shouldn’t restaurants be more responsible when it comes to the health of their patrons? I guess it all comes down to supply and demand. If people want it, restaurants will offer it. Then I started thinking about the public health department and their responsibility. When is it necessary for the government to step in and do something? New York City, for example, has passed a law banning trans fat in all restaurants. Should cities also ban dishes that contain over a certain amount of fat? Fried chicken? Doughnuts? Where should they draw the line?

I guess it all comes down to free will. We certainly all have the ability to make our own choices when it comes to eating (except of course that cost does play a major role… but that’s another rant). But what about our children? Many public school systems have been trying to provide children with healthier food options in their cafeterias. Should we be doing the same thing for adults? I know that many restaurants have been trying to provide healthier options for their patrons, but at the same time, it seems like they are providing even more unhealthy options. Some restaurants have even begun to list the nutrition information on the menus. I think this is definitely a step in the right direction.

It’s no secret that America’s expanding waistlines are directly correlated with our expanding health woes. I think one of the problems is a general lack of responsibility and action on everyone’s part. Hopefully, people will start stepping up and finding some solutions, because everyone’s health is at risk.

For the record, I actually did try a few bites of the steak we purchased (between the two of us, we couldn’t even eat one-fourth of the meal). It actually made me a bit nauseous, so I stuck with the greasy spinach instead.

How to Study for a Big Exam

Kendra Campbell -- I have finished all my regular school exams for this semester and have about one week to study for the NBME's "Comprehensive Basic Science Examination." My score will not be counted towards my grades in school, but rather is a pass/fail exam that I must pass in order to sit for the USMLE Step 1 Exam (the medical licensing exam for the US). Having a week with nothing to do but study is a daunting task for me. At my school, we usually don’t have so much time to study for an exam, but since this covers all of the basic science material learned during our first two years in med school, they give us a week to prepare. I’m sure all of you out there have either already faced this issue, or will be facing it in the near future, so I decided to make a list of some helpful suggestions that have worked for me.

1. Make a schedule, and try to stick to it. This is probably the most important tip. Having a schedule provides you with structure, and is a good way to prevent falling into the trap of running out of time in the end. It also ensures that you always have a task at hand, instead of sitting around bored, wondering what you should do. I usually go as far as creating a schedule down to the hour, but depending upon how much time you have to study, this wouldn’t always be necessary.

2. Get up every day at a similar hour. This obviously goes along with #1, but it’s always a good idea. In addition to getting up around the same time every day, it’s also a good idea to "try" and go to sleep at a reasonable hour every night.

3. Don’t forget to schedule in "fun time" or time off from studying to relax. This is incredibly important, and will prevent the dreaded "burn-out." If you’re lucky enough to have a dog (or other pet), take them for a walk, or play a game of fetch. Playing with my dogs is one of my most favorite de-stressors. If you’re somewhat obsessed with cleaning (like I am), take off 20-30 minutes to wash your dishes or do some laundry. Do you enjoy being outside? If so, take a walk around the block or to a nearby park. You may have noticed that all of these activities involve physical activity. There’s an obvious reason for that. Unless you are studying while on the elliptical trainer (which I actually don’t recommend), you are probably sitting on your butt for hours at a time. We’re med students. We know that moving around and getting your blood flowing is advantageous to both your mind and body. Don’t forget what you know.

4. Do questions. This is a great way to learn. Use an online question bank, or one of the thousands of prep books. And don’t just look at the correct answers. Actually figure out why you got the question wrong (and even right), and learn from your mistakes.

5. Don’t study what you already know. This is pretty obvious, but people sometimes do it anyway. Stop wasting your time!

6. Caffeine is your friend. Never forget your friends.

7. Change it up! If you find yourself getting incredibly bored, and wondering if chewing your leg off might actually be a more enjoyable experience, change something! Either change the subject you’re studying, how you’re studying it, or where you’re studying. If you’re lucky enough to live by a beach, go there and crack open your books! It will save your sanity, and also your innocent leg.

8. Take the day or night off before your exam. Don’t forget to do this! I don’t care if you’re behind, or you think you can stuff more information into your head if you keep studying. Don’t do it! And especially don’t stay up all night before the exam. This might be the worst idea ever. Let all those pharmacology drugs simmer in your brain for a while. Give the information time to cement. Have a nice dinner or go see a movie (preferably a completely mindless comedy) and reward yourself for all your hard work.

Okay, those tips should help to at least get you started. Do you have some suggestions that I missed? Feel free to add them to the list.

Living in the Moment

Kendra Campbell -- A week ago I began the end-of-semester final exam marathon, which involves eight exams. I just finished exam number six, which means I only have two left to go. My brain is tired, my motivation is dwindling, and my enthusiasm with med school is at an all time low. I’m at the end of my second year of medical education. On the horizon is the beginning of my third year, which will involve actually working with real, live patients in a real hospital. I’m looking forward to that, but I’m struggling mentally to finish this semester.

As all of you students and physicians out there know all too well, med school is basically about jumping through thousands of hoops to get to the final destination of becoming a practicing physician. I've experienced many setbacks along the way, but I've kept trudging along. First there were the pre-med classes and the MCAT, then came applying to med school (which involves about a million little hoops). Once you’ve been accepted, there are endless forms, exams and challenges. Each time you get to the next step, you give it all you’ve got, and then you look on your horizon and see the next hoop looming before you.

I’ve always been a somewhat spontaneous person. Okay, actually I would say that I’m prone to non-random bouts of calculated spontaneity. But nonetheless, I do have some flickers of true spontaneity. I also have always enjoyed living in the moment. I try to cherish the here and now, without always worrying about the future. This isn’t exactly congruent with the med school experience. It’s quite challenging to focus on all the tasks and exams at hand while at the same time living in the moment. This is the paradox that I face.

I’m trying to come up with a solution to this daunting issue. Is it really possible to keep your eye on the prize (graduating from med school) while continuing to appreciate life as you’re living it? My gut tells me that it is, but it will probably continue to be a challenge. I have two more huge exams looming on the horizon. After that, I will have to make it through the next semester at the hospital. After that, I will have to pass the USMLE Step 1. After that, I will have to fill out forms and get accepted into a clinical rotation. After that… okay, I think you get the picture.

Perhaps it’s better to just try and live life to the very fullest every day -- savor every last yummy drop of life’s nectar -- but always with one eye on the next goal ahead. Is this even possible? It certainly does sound nice. But for now, I don’t have another exam for two days, so I’ll just celebrate the one I just took with a glass of wine, and try my very best to savor its nectar.