St. Kitts Shopping Experience

Looking east from Statia, when sitting at Whitewall (fort) or the Botanical Gardens (national park), you can see across the channel to the island of St. Kitts. On a sunny day, it is a beautiful sight, sometimes topped with amazing cloud formations.

Apparently groceries are very expensive on St. Kitts and every week, ferries from SK come to Statia with boat loads to do nothing but grocery shop. The shoppers literally invade the few stores here and clean the shelves of most common items to the point where stuff is gone until the next shipment arrives.

The experience is most unsettling if you happen to be in the store when it happens. The ferries arrive at the harbor and they either walk, take taxi or have rides from locals to the stores. Masses of people enter the front door and shatter the peace. Items are packed into carts and fly off the shelves. Pushing and shoving to grab items is common and injury is possible. Nothing is left untouched. Items are then loaded onto truck, into barrels and crates and shuttled down to the ferries for the short ride back to St. Kitts.

It is a life threatening experience to be in the middle of. So much so, that most locals avoid the stores on those days. I've learned my lesson. Only had to experience that once before I learned. And I know shop the days before the St. Kitts shopping express arrives. Self preservation is a way of life on Statia.

Simple Pleasures

It is impossible to share the joy of finding something that makes you feel "at home." It happened the other day in the grocery store. All products are not available on Statia, all the time. Some show up irregularly, or are bought out by locals or shoppers from St. Kitts (more on that later). As I walk the aisles of our local stores, I scan for familiar items to "grab" while they are here. It happened...Lime Diet Coke. I bought the last 6 pack. I haven't seen it since I've been here, and it was a welcome site in a world of mostly sugar infested drink products largely responsible for the high rate of diabetes and obesity in the islands (along with the very high carbohydrate ingestion rate). I've been on mostly water, coffee, tea and fruit juices to drink, so this was a welcome sight. Sometimes the simple pleasures are the best ones. Hard to believe that a Diet Lime Coke could inspire such feelings.

It is Done

"Real peace will arise spontaneously
When your mind becomes free
Of attachments,
When you know that the objects of the world
Can never give you what you really want."

-Theragatha

...that is of course unless you have just completed a first anatomy lab exam. At this point, 1 hour after completion, I feel VERY attached to knowing what I scored on this, the first "real" exam of my medical school career. The nervous energy outside the lab, that you could cut with a dull knife, is behind us.

The set up was about 40 stations with multiple questions per station with 90 seconds per station. Each station included a specimen of some kind...a bone, a body part with a pin in it, an x-ray, a plastination. All stations has multiple questions. All fill in the blanks (no multiple choice).

The challenge to this type of exam is the time, and the specificity. The challenge of time is worse on those that need a few more minutes to think thing thru. On this exam, if you can't generate the answers in 90 seconds, you are forced to leave that to think about the next station. The specificity is most frustrating. You can study everything on a given section on your cadaver (and know it well), and because of your cadaver, not have a good representation of a certain detail of that section. Waldo's Rule (the name of my cadaver at UAB) sez, THAT (which your cadaver does not have) will be the thing that has a pin in it for the test. That was the case today.Ugh!

Another challenge to the scoring is the weight. If you missed the identification of the specimen, then you likely missed the follow up questions such as "what is it's insertion?, what is the blood supply? What part of the brachial plexus does that come from?...and so on. Thus each station is 3-4 points.

So I likely passed (based on my gut feeling and comparing answers with folks afterward), and will likely understand what I missed when I find out what I missed, but I'm dismayed at my errors. Scores should be ready tomorrow after the instructor contemplates the grade range. So while I search for intellectual nirvana and non-attachment, it is important to find out if I am on the right track about studying. And while "A's" are not my goal, I am amazingly "attached' to this first test score. But it is time to put it behind, clean up my apartment, and plot the study schedule for the next 3 exams coming early next week. I'll become more unattached after exams I think. For now, Nirvana will just have to wait.

 

Addendum: I passed the lab exam, but I could have done better. Exactly what I thought happened...missed the tag, and then all 3 or 4 of the follow up questions for that tag. That's is 3-4 points each right off the bat.  Made some really dumb mistakes. I will incorporate what I learned for the next exams. It's going to be a long summer, not to be judged by one exam. Onward...toward Nirvana!

Continuous Learning

The nature of medical education is continuous...it has to be! The act of certification and licensure often includes that element (CME, CEU, etc) in order to renew, re-certify or re-license. I am reminded daily of how important, as a teacher, it is to stay current with the ever, and quickly changing information database that is medicine. Coming to medical school was really the only logical progression from being a clinical PA. No matter what happens here, I have continued my learning and, hopefully, my effective use of that knowledge. I become more fully aware of that fact each day I hear our our professors with clinical knowledge detail a process or disease or anatomy or physiology.

"He who graduates today, and stops learning tomorrow, is uneducated the day after." - Newton d. Baker (1871-1937), Politician

Service to Others

This is a very enlightened student body, who come from all corners of the earth. There was a very interesting discussion on "the ramp" (the entry into the classroom building with the great view of the harbor and the volcano). There is so much destruction in the world today and invariably there is someone close to someone or who is from one of these areas...China, Myanmar, Iowa, Iraq, South America...

The conversation among those standing there shifted to what do we do with these "gifts" that we are receiving, the knowledge of medicine and of healing. Clearly, there is a contingent of folks here that will high tail back to the U.S. and specialty medicine and surgery in some urban location. It is the financial draw of that life that many are drawn to.  Others clearly have a more "service" mentality and plan to use our gifts for others, and deny ourselves. Most are where I am...not sure. But there is one thing certain that we are being provided an opportunity and a gift to better mankind in some meaningful way as long as the process of our education, the financial drain for many and the rigors of the sacrifice don't cloud the spirit. I don't know where I stand but I am clearly going to "listen" to my colleagues and be open to the possibilities.

"It is clear to us, friends, that God not only loves you very much but also has put his hand on you for something special" (1 Thessalonians 1:4)

Education & Experience

"The only time we should look back to yesterday is to look at the positive things that were accomplished to encourage us to do better things today and tomorrow."
Stevie Wonder, Musician

We really got into the plastinated specimen today. Plastination is a process where formerly dissected cadavers are then subject to the process of replacing water with plastic. Same process that the "Bodies" exhibit is in the U.S. They eliminate the need for real cadavers and exposure to the formalin or some such solutions that the bodies are bathed in. I'm sure that this air can't be good for the lungs, but a mask helps.

Besides immersing ourselves in a quasi hazardous environment of the anatomy lab, I cannot imagine approaching this exam week without the knowledge and experience of patient care. I look around at my colleagues and wonder how it is that they make sense of it all. But then I remember me, a PA student, many years ago with that same excitement and amazement. I know this is the first time that many have seen the inside of the body, and experienced testing on a formally alive person. A shock for many in addition to the intellectual challenge.

But without the clinical connection, it is an assemblage of facts and figures, angels and layers. The clinical discussion are definitions and have no real basis without the experience of patient care. Again I find myself so thankful that I've had this stuff before and can relate it to someone or something I've seen before. That experience has truly encouraged me to do better things today and tomorrow...all positive things in my history.

Can't Get Enough

I love this stuff!! I can't seem to get enough of medical science facts and figures right now, but it's early. And I may have to exclude "public health" from my list of loves right now. This is truly what advanced, doctoral level, graduate education is supposed to be.

Even though I'm babbling, pure exhaustion hasn't really taken hold yet, but test week is coming and I know that I will be studying hard to "make the grade". I'd hate for the 20-somethings to blow me out of the testing waters. I'm feeling a subtle balance of abject cockiness and pure panic about the volume that we are going to have to regurgitate (what cranial nerve assists with that function?) next week. I do feel that I'll be ready, but I am amazed at how much I don't know, or have forgotten. It's great to have those "eureka" experiences again and realize the connection with actual patient care. I suppose that I am lucky in that over my liberal arts and sciences brother and sister classmates.

Yet even as I still try to find my niche in the pecking order of students, I still hear the "epiphanies" of others, see the smiles on the faces, and remember how wonderful that feeling is and how much I enjoyed seeing that in my students when I taught. For the moment, I am enjoying that perspective from the back of the classroom instead of the front. Tonight is a practice session with physical examination...I can't wait. This is the class I last taught. I wonder if I really know it?

Why Medical School

"The main thing to get out of medical school is a feeling of satisfaction with medicine. If so, the patterns developed will continue through life. It matters little the number of facts you accumulate in school." (Steadism #137, pg 51)

I'm fortunate to have developed patterns of care that are patient driven and had me enjoying the practice of medicine at the bedside...before medical school. I know in my heart that this collection of facts, figures, formulas and such is merely a fraternal pledging exercise to gain entry into "the club" that is medicine. I'm ok with that. I am beginning to better understand this political reality and recognize the power in that gateway. Yet it is likely that same gateway that is ultimately responsible for the shortage of physicians now, and (even worse) later. I'm killing two birds with one stone...getting my doctorate (moving forward from my PA education) and being part of the physician shortage solution.

"You build stronger medical centers not by getting better teachers, but by getting better students." (Steadism #135, pg 50)

Argument

There is a raging debate in the world of physician assistant education and among professionals about moving to the "doctorate" degree. The argument is largely stimulated by the perception that physician assistant need this "sheepskin" to compete with the nurse practitioners who are doing the same (Dr. Nurses). It is also fueled by academic physician assistants with various doctorate degrees, who represents institutions of higher learning that stand to benefit from advanced doctorate education.

 

Physician Assistants are clinicians who practice medicine with physician supervision. PA's are medical practitioners at the BS and Masters level. If we are to expand our degrees to the doctorate doesn't it make sense that it be a MD or DO degree.  After all, isn't that the terminal "clinical" degree for the practice of medicine? If PA's want to be doctors, they should just got to medical school. What a great idea?

Hungry

I am not hungry. Well I am hungry for this knowledge, but I'm not gastrointestinally hungry. I am eating quite well. This is an island and everything is more expensive. I can't find fresh fruits and vegetables easily, and cooking can be a hassle with the conditions of school, and my apartment, but I am not hungry. I am eating well and find plenty of what I need. I'm taking care of myself and trying to stay in shape (or get in shape, depending on your perspective) and not getting sick. I am NOT hungry...but maybe I should be?

In 2006 or so I read an article about being hungry and learning.  Researchers at Yale Medical School found that hungry subjects  took in information more quickly, and retained it better. I am not sure if the subjects were medical students, adults or mice, but the conclusions were intriguing.

This "empty-stomach intelligence" promoted better performance in learning. There is apparently a hormone activity related to hunger that assists us to "think about" how and where to find food, and preps the brain to think harder about that. We can probably use that to our cognitive advantage in medical school by going mildly hungry right before an exam, not CHO (carbohydrate)-loading, and snacking to provide baseline energy for living.

Is it possible that the obesity epidemic has contributed to declining test scores and other American educational woes? Might this knowledge help me on my next exam (covering 10 chapters of Anatomy)? I am not hungry, but perhaps I should be. I may test the theory next week...first exams are coming. Hungry may be better.

Shipping Slow

1.9 miles per hour...That was the speed that my shipment from the mainland to Statia...Almost a month to cover about 1300 miles. Took just as long for a jeep (the car) to get shipped here also (same boat). But I did get it,  intact and without damage or loss.  I thought I had planned the timing out, but such was not the case. We had to wait for mother nature and and a boat, and an assortment of other reasons. It was supposed to take 5 days.

But in the end it is amazing what you can do without when you don't have it; And more amazing what I shipped and didn't need. Somehow, for example, I have 5 flashlights. Better safe than sorry. After all it is hurricane season soon....very soon.

First exams are coming...one in lab and one each in three classes. I am feeling amazingly ready, but then I've had this before. I hope that my brain doesn't fail me when I need it, but having first exams will help me gauge where I am in the process. So far I'm having a blast at the learning. I have a structure in my brain about the practice of medicine, and this all helps fill in the details. I can't imagine what it is like for a 20 something without medical experience to listen to this, let alone learn it. I think this is one of the major problems with medical education, but who am I to comment or judge?

I am a Steadism

I am a scholar and great fan of Dr. Eugene Stead, founder of the physician assistant profession at Duke University, consummate mentor and teacher. Dr. Stead was known for his "Steadisms"...comments about life, medicine, medical school and education in general. He produced a manual collection of these comments, "Just Say for Me", that has become for many, like me, a marvel of observation...particularly about medical education.

He once called me on the phone, when I was involved in PA education, about my ideas about distance education. He had read an article I wrote about distance education pedagogy. He thought medical school could be done at home in the first two years, and then "apprenticed" with a seasoned provider for the last two years. He even talked about 5 years of total education for medical school and residency as "sufficient" for general practice.

While I can't comment about these theories (I am too close to it), I am beginning to fully appreciate his thoughts on the subject now that I am being "tortured" by the system known as medical education.

His basic premise was (he recently died) that medical school is a waste of time, effort and resources and needs radical overhaulment (I made that word up, but I seem to be doing a lot of that lately) to address the needs of society, the individual provider being created and healthcare of the future. He often spoke about the environment of "persecution" and "torture" that existed in medical schools.

"I'd like to see all medical school examinations open book. Books are useful."
(Steadism, #168, pg. 56)

I now fully understand and commend Dr. Stead for his thought on the subject. But I may not be completely objective as I attempt to memorize the origin, insertion, nerve supply, action and blood supply for all the muscles of the back, neck, and upper extremity...including the brachial plexus. And while we are on that subject, does Randy Travis like his coffee black? (a mnemonic for memorizing the segments of the plexus)

Does a person's memory make him/her a good physician? Will the exercise of fully detailing every anatomical feature in my brain provide me with the skills I need to perform as a healer? All I know is that it will hopefully get me to and thru USMLE Step 1.

"It is a neurotic goal to try to learn everything. One must pick and choose." (#177, pg. 57)

I hope I pick the right ones for this first battery of tests coming. My brain hurts. But I don't want to sound too down about this. I'm not...I love this stuff!! Thanks Dr. Stead. I hope they do make my anatomy exam next week open book, but I'm not hopeful.

Strange Noises on the Roof

I woke last night to a loud, sounds coming from the roof. It was rain!! I haven't seen rain since I arrived almost 3 weeks ago and didn't know what it sounded like on my roof. And this isn't an ordinary roof...cement, with metal siding. It was loud!

Now rain doesn't normally rise to the surface of blog interest, except on Statia. We HAVE to have it. It IS our water supply. Every single home here has a system that "catches" the water from the roof and feeds the storage system. You see these strange things around yards here.

Water hits the roof, runs down the siding, into large pipes and into the container. We use this for everything...toilet, shower, faucets. And when you run out, you run out (although you can order delivery of an expensive truck full from the local desalinization plant). Water conservation is alive and well on Statia. When you shower here, you wet yourself, shut off the water, soap up and then turn the water back on to rinse. No standing under the shower allowed.

So while the noise was a surprise, it was welcome. I can shower another day. My classmates will be happy about that.

I'm and UNCLE!!

I'm so excited. I'M AN UNCLE! My brother's chickens had their first eggs. I'm so proud. I'm sorry I couldn't be there for the birth, but I got an announcement officially.  And I feel like I am becoming an expert on the subject as I traverse the world of "grand chickens" on Statia. I'm sure that he is just as happy to be the father of two new yolks as I am. Way to go! See, there is a reason why chickens are actually in existence other than keeping me up at night. Can I have my nephews scrambled with cheese please?

The United Nations

"Start with a dream. Maybe a dream that is personal and small, but worth doing. Then dream a bigger dream. Keep dreaming until your dreams seem impossible to achieve. Then you’ll know you’re on the right track. Then you’ll know you’re ready to conjure up a dream big enough to define your future and perhaps your generation’s future."  Vance Coffman, Business executive

As I look around this room of students I am amazed at the diversity. We all want to practice medicine, but that is where our similarities end.  We have students from all walks of life, all past  histories, many nations. Most of us are from the U.S., but we have members from Africa, other Caribbean islands, mainland Netherlands, the UK, India, Pakistan, and South America.  This fact alone adds an element of the learning process that cannot be measured. I know that this is not a unique phenomenon even in the states, but for us it is a chance to experience a different way of thinking. When you add that to our Dutch environment, and mostly non-U.S. instructors, the synergy is almost electric. This is not only an international medical school, it is an international education. And that can only be a good thing.

The Faculty

Having taught before, I am totally amazed and impressed with the faculty here. If I've heard it once I've heard it a thousand times..."if you need anything, let me (us) know." The demonstrated commitment to student is quite evident in their excitement for teaching, providing tutoring and help, facillitating access to the classroom and labs after hours and the general, "I'd love to help you...what else is there to do on Statia?"...very, very refreshing and totally unexpected. I've never been at a school where upper class student, come back to the classroom to say hello, and good morning to former professors. That says volumes to me about the relationships that are formed and the support that is provided. So far that has translated into the feeling that we are really getting what we need, and that we are being "looked after" to some extent, even if in the end we are on our own to get the work done. Kudos to the faculty! Thanks for what you do.

Difference? Maybe, the view

Every single graduate of the first 2 years of medical school (called the basic science years) is after the same prize...passing the USMLE, part I. That accomplishment allows the student to move into the "clinical years" (years 3 and 4) and clinical rotations in hospitals, doctors offices, clinics, etc. Whether you are in school at Harvard School of Medicine or Baartphuc Medical Tech Institute in Iran, if you want to do clinical rotations and practice in the U.S., you must pass USMLE...Part 1 after year 2, Part 2 after year 4 (before residency).

Therefore, as the saying goes here in the Dutch Caribbean...Wij allen zijn het bestuderen van hetzelfde (We all study the same thing). Even the text books are the same as our U.S. counterparts. And with the Internet, the world is an information "oyster" for medicine today. So what is the difference?

I'd have to say the view. During class breaks (or really butt breaks from the intensive lectures in Anatomy, Embryology, Histology, and Public Health - prevention, epidemiology, and biostatistics), we go out to the "deck" to chat, stretch, grab a soda and...look to the right...the Caribbean, the stuff of legend...

And then to the left..."the Quill", dormant volcano (where my brush with the black bull happened):

then the community and the people. There are few place left on the earth today where waving at each passing person or car, and smiling with regularity and vigor, is the norm and expected. That is Statia.

We are truly lucky to be learning in this environment. We are all focused on the "prize" of USMLE, part 1, but fully conscious that this international experience opens our horizons to other possibilities about ourselves, our studies and ultimately our practice of medicine. Het is Statia man. Ontspan en studie. (It's Statia man. Relax and study.)

Rocky, the Rooster

I was cutting through a small field walking to class one day (involved in my own thoughts about the anatomical structure of vertebra) and I came across one of the master race roosters. I turned a small stone wall and there he was, Rocky the Rooster. Bigger than a bread box? Much. This was a rooster on steroids, clearly on a workout program and huge (the photo doesn't do him justice).

I stopped short. For a short moment, we glared at each other as he thought to himself, "I can take this human". Then his little chicken brain kicked in and he realized that this was likely not the case. In true chicken fashion, he scampered off into the surrounding brush. Thank goodness. I think he would have actually kicked my ass. I think I need to carry a big stick when I walk to class.

Anatomy, With Conditions

I can only imagine that thousands of medical and other health professional students around the world have done what we did today...got introduced to our cadavers in anatomy dissection lab. Although many programs of study are eliminating the cadaver all together (cost, biohazards, time, questionable learning value), the actual dissection of the human body is a rite of passage for some, and a pure joy and excitement for others. I am one of those. Being of surgical mind I love the challenge and hands on learning of the cadaver. Using the classic lab manual "dissector" used by many, and in a traditional anatomy lab, this is the way many have learned this science. The sounds of crowing roosters in the background is truly a unique sound as you slice through human flesh to learn the inner workings of the body.

 

But this is the Caribbean, and an island. Just as an aside, these aren't your average roosters. I've my share of encounters with them, including one morning where one decided that he didn't like that I was still sleeping at 4 AM. These are fairly aggressive roosters. They are loud, large and run freely everywhere. Rumor is that if you can catch one, he's yours (and dinner). My brother the chicken farmer says they'd be to tough to eat. They've been running around and "working out" on the hills of Statia. Nuts! Just when I thought I was going to have fresh meat.  But I digress...

On Statia, there are other challenges related to anatomy lab. Half way through the skin dissection of the back on the way down to the nuchal prominance, lattismus dorsi muscle and the spinous processes...the electricity went off for 10 minutes. The room A/C went off, and the lights went dark. In a desperate attempt not to lose time, we wheeled the cadaver table (on wheels) close to the window to be able to see what we were doing and to avoid slicing a finger off with the rather sharp #10 scalpel blades.

The dissection, four of us cutting now, continued. The temperature climbs fast in a closed room when you are 150 miles from the equator, and today was no different. Yet we endured and finished the dissection for the day as the power went back on. From a medical education standpoint, a great day filled with nuances of skin adherence to deeper fascia, and lots of superficial back anatomy (have to start somewhere). They'll be many more hours of this place before the term is over. I am quite sure that everything I own will smell like cadaver preservative. It is quite the pungent (and likely toxic) liquid...and it gets on everything.

So while this is a common event, dissection in anatomy class, the conditions certainly add some spice when you are a student on a 2x5 mile island. I'll bet my colleagues at Harvard Medical School aren't having as much fun as we are. I am quite sure that we smell the same.

Animals Have the Right of Way

Beyond the beautiful and inviting animals of the deep for divers, the land animals are celebrated on Statia with complete freedom to roam. The animals here are more than a part of the daily life and scenery, they are honored in the folklore and art. Coming from the U.S. I would never imagine this phenomenon.

The chickens appear to be everywhere. Mostly in small packs of one or two male roosters and a few females with or without young chicks. They don't seem to get too close to town, but in the burbs of this 2x5 they seem to everywhere; even on the face of the dormant volcano, the Quill. There are many more in pens behind houses too.

The (and I do mean "the") donkey is the stuff of legend, but I don't know it yet. I've got to find out more about this guy, but he seems to be all over. I've seen him close to the administration building of the school mostly, but I saw a photo of him near the beach too. This isn't a large island, but he is an old guy. Doesn't seem to have much jive in his step anymore. And he doesn't move out of the way of a rental car very quickly either. I think there is actually a "donkey" clause in the rental contract.

Beside the dogs, and occasional (obviously) feral cats, the goats and the cows are the biggest population of "roamers with right of way" here. On the back side of the island, on the "highway" (and I use that term loosely) there are pigs as well. And like Hawaii, they are absolutely destroying the ground with their "rooting" eating habits. Whole areas seem to have been denuded by this behavior. If they don't pen them, or control them soon, more areas of the this 2x5 will be without ground cover and any heavy rains will wash the land out to sea.

By far the most exciting "right of way" was my meeting a bull on the national park trail hiking on the volcano. Needless to say, we scared the piss out of each other when we met. I came tooling around the corner and almost had the chance to experience the life of a matador. He finally decided that it wasn't worth the effort, or more likely, that I was just another of the 3000 other two legged creatures that share "right of way" with him. I am comforted though that if the delivery barge ever gets stuck in St. Maarten with food supplies, there are plenty of pickings from the free roaming "deli" that is here on the 2x5. I will not starve in medical school. There is plenty of meat walking around school and my apartment.

Amazing Group

International medical school have a reputation of attracting less than qualified students. You wouldn't know it by my group. Lots of education, life and medical experience, advanced degrees and  other "resume builders" that can't be ignored. Moreover, there isn't a single person in the group that doesn't truly want to be involved in the health care of people...really practicing patient centered care. I've met dozens of current physicians in the U.S. that didn't get in to medicine for that reason.

I feel lucky to be surrounded by such a wonderful group of human beings, both faculty and students. I can't help but think that my real education will go far beyond the books and studying for USMLE. I like that.

The fact is that this is the face of the future of primary care medicine world-wide. Over a 1000 IMG's (International Medical Graduates) entered residencies this year and the number is growing as U.S. graduates fill higher paying specialty residency slots. But if you've been to the doctor lately, you know that.

Tragedies

Already two casualties in my new life on Statia...my PDA and my camera. Fortunately I have a back up for the latter (a camera I've had for some time), but I don't for the former...and it is my cell phone in the U.S. too. Have to replace that ASAP for the PDA stuff alone. I really like the quiz program that is circulating among students for studying the basic sciences. My thought at this point is that a PDA is essential for the practice of medicine, let alone studying it. The cell phone I can do without.

And when I say this thing is dead, I mean dead. I am wondering if the combination of fluctuating electricity current on the charger and the dusty hot environment here pushed this old technology into oblivion. The final test for one of the original Treo SmartPhones, but it served me well.

Now when I'll get to a Sprint store is another matter.

The Adventure Begins

Traveling to school isn't too bad, particularly when you have a 110 mile per hour tail wind, clear skies, good company, and views of the Caribbean out the window. Spirit Air only has one flight per week to St. Maarten, and I was on it.

The first thing I realized was how many medical students were in FLL airport. I later found out why...both AUC and Saba medical schools start class on Monday, a week before St. Eustatius (SE-SOM)

As fate would have it, the guy sitting next to me was over three hundred pounds. As he sat down he oozed over into my seat and imposed himself on what little seat I had acquired for my fare. I immediately started scanning the cabin for alternatives...and found one. As the doors to the plane closed, I made a dash for an empty aisle seat in a set of three.

I didn't realize it as I scooted into the seat quickly, but there was a cute girl sitting at the window. She was sleeping already and we hadn't left yet. I followed suit and fell asleep before we left FLL.

I awoke to the flight attendant asking me about my order and handing me a immigration form for St. Maarten (SXM). I had forgotten I was traveling international, and I was hungry. I ordered the $3 breakfast of champions, and filled out my form. Just then, the girl at the window awoke.

We cordially started talking and I found out pretty quickly she as a medical student at AUC in St. Maarten. Needless to say my excitement took over and we talked the entire trip about her 1st term experience that started in January. She was articulate, intelligent, 20 something and I learned more from her than I had in the past month. She was gorgeous too...Filipino decent (I love that). She even "beamed" me a software program that produces anatomy flashcards so you can study with your Palm Pilot. My TREO will come in handy. Before I left the SXM airport I had the program, her email and some great information about being a Caribbean med student. Thanks JC! You are the best! Good luck term 2.

The landing at SXM was one I was looking forward to for a few months. While researching the area I stumbled upon a YouTube video of the landing of a 747 over the beach at SXM. It was even more amazing from the air, but the ground experience appears to be body shaking as planes land just feet above the heads of beach goers. It was pretty cool.

The rest of the day was traditional travel....processing at SXM, baggage claim, recheck at WinAir (the only carrier to Statia), and the wait, and wait...6 hours. Fortunately the airport at St. Maarten is brand new and gorgeous and is filled with shopping, eating, rum and free Wireless Internet. And abuse them all I did. The free French chocolate was the best. The views from the massive picture windows was pure Caribbean. Great place to people watch too. I realized I hadn't eaten since the power meal so I challenged my gut with a starchy looking dish called "fig". It was delicious. I'm going to enjoy the islands.

It was dark by the time we boarded for Statia. The flight was quick, only 20 minutes. I was "home" for the next few months, and I felt I had been transported in time. Stepping on to the tarmac, the cool breeze from the Atlantic side hit me...it felt great. I had a momentary Maui flashback and felt my body sigh. I think I have an island spirit of sort. A short walk to the Franklin Delano Roosevelt terminal, and quick processing by the INS agent obviously waiting for us, the last flight. "How long are you here for?", he asked. I paused as I said "4 months". His demeanor changed and he looked up for the first time. Apparently only criminals stay that long...oh, and medical students. "Here for medical school,"...he smiled...and stamped my passport as he checked his list of incoming students. I was in country now. I walked 5 step to the baggage ramp, a term I use loosely, and waited for my bag. As I expected (and had been warned) only 1 of my 3 checked bags made it. I filled out the form, and the agent assured me it would be there the next day. This will be my quest for the morning.

The sign over the exit welcomed me personally (LOL). My landlord was waiting outside of the terminal and he carted me in his mini pick up to my new apt. We stopped by the grocery store as well to get some starter stuff for the fridge. I settled into the place a bit (meaning my IPOD now has home), checked email, called home and fell asleep quickly. Long first day commute for this grad student.

AARP Discount?

The week after I got my AARP (association of retired persons) membership in the mail, I ordered textbooks for my first year. I decided to call to pay rather than do the dirty deep online. The clerk at the bookstore sounded to be 20 y/o tops and almost screeched when I asked her about an AARP discount for the books. Apparently, it is not usual for folks to ask for that discount to be applied to book purchases in medical school. I'm not sure, but I think I'm the oldest in the class. I'll find out soon enough.