Wednesday, April 30, 2008

Cab Baby

There are no (or should I say very few) taxis on island.  One saving grace is very few obstetrical emergencies take place here. Thank goodness.


A man comes into the ER and yells, "My wife's going to have her baby in the cab!" I grabbed my stuff, rushed out to the cab, lifted the lady's dress, and began to take off her underwear. Suddenly I noticed that there were several cabs -and I was in the wrong one. - Submitted by Dr. Mark MacDonald, San Antonio, TX.

BTW, I'm leaving on Saturday. It's not a degree, it's an adventure.

What I Am

Am I a doctor now? No I'm not. I thought I'd never go back to school though. I always thought I was too old. But I've been recently challenged into thinking otherwise. I'm a Physician Assistant or "PA". I am trained (bachelors and masters degrees), and licensed to practice medicine and perform physician services with physician supervision. I've been practicing my profession for over 20 years and have assisted on thousands of surgery cases. I do not have residency education as my physician supervisors, but do have a sound working knowledge of the profession and the specialty from working with some of the brightest and most educated physicians in the U.S. Now it's my turn.

Tuesday, April 22, 2008


One of my good friends (yea right) send me congratulations on going to school. He also sent me this information:

Great Hurricane of 1780
--This storm was one of several that year, which was one of the worst hurricane seasons in the era prior to record taking. Winds were estimated to be Category Four strength at 135 mph. This storm, which affected the Southern Windward Islands including Barbados, St. Vincent, Grenada, Martinique, St. Eustatius, and near Puerto Rico and Grand Turk Island, is believed to have killed approximately 22,000 people. Of that total, between 4,000 and 5,000 people were killed on St. Eustatius. Martinique had an estimated 9,000 people killed including 1,000 in St. Pierre, which had all of its homes destroyed.

I am thrilled to know that beyond the rigor of studying, I'll have to worry about hurricanes too. Should be a hell of a ride if we do get hit. I've got 2 seasons there.

The Closer You Get

"And the trouble is
if you don't risk anything
you risk even more." - Erica Jong

From the Boat

The closer I get the more interesting it looks and the more need there is for physicians in primary care.  I've had enough of standing in surgery for hours at a time.  Clearly the largest need as I start this process is in primary care. The growth in primary care physician assistants and nurse practitioners can attest to that.

"Areas of the United States where the most care is delivered by primary care physicians have lower overall costs, higher patient satisfaction, and, as a rule, better outcomes. A primary care doctor can be a trusted, friendly advisor who sees a patient over many years. When serious health problems strike, the primary care doctor can become the patient’s medical shepherd, helping to guide him through a complicated system of specialists and hospitals."

Off to school in about a week. Packing has become a way of life, and a method to sort out what is left of my former life.

Sunday, April 6, 2008

Amazing MRI

I love this stuff. The space around the spinal cord is filled with fluid so that the cord itself, and nerves exiting and entering the cord from the body, are cushioned and have room to accommodate our movement. When that space is impinged upon by portions of the soft pads between the vertebrae bones, you have a herniated disc, also known as HNP, herniated nucleus pulposus, "slipped" disc, extruded disc or similar. The most impressive case of this appeared in the clinic one afternoon. This is located at the level between the 5th lumbar and the 1st sacral vertebrae at the end of the spine near the buttocks.

This patient presented with low back pain, and some numbness and tingling in both legs including the inner thigh and buttocks (the place where you sit on a horse saddle...also known as "saddle numbness"). The patient noticed weakness in the legs and complained cold/heat intolerance (noticed in the shower) to both legs.

The family physician that had been following the patient for about 6 weeks ordered an MRI and sent her to be evaluated by an orthopaedic spine surgeon. Faced with the above presentation and the extremely pronounced extruded fragment of central disc into the spinal canal, surgery is not always indicated. However with the pain, weakness and pattern of sensory loss, surgery was indicated and performed. Symptoms cleared up within one month of surgery.

All disc herniation is not so severe. In fact, many persons walk around with herniations in varioius stages and don't even know they have one (or more) until they have an MRI (plain xray of the back can't see the discs since they have no bone in them). They are often asymptomatic. When they produce symptoms, conservative treatment can be very helpful and is work the trial before jumping into surgery. Spontaneous improvement of such symptoms has been known to happen with and without treatment. Conservative treatment might include: bedrest of no longer than 1-2 days, ice for immediate swelling and acute injuries, anti-inflammatory medicines like ibuprofen, warm and moist heating, physical therapy to improve flexability, stability, strength and stamina, muscle relaxers for muscle spasm and aerobic exercise like walking or swimming. Accupuncture and chiropractic have been helpful in some patients, but are not generally considered part of "allopathic" standard care (but that is changing in some areas of the country).

For more chronic pain, injections can also help to improve symptoms. Again, these can "heal" and shrink during this time period and may resolve with time. That is the key in many cases...time. However not everyone will improve at the same rate of time. Other time tested modalities that have shown to be helpful for symptoms: electrical stimulation, massage, hot packs, ultrasound and similar techniques to reduce inflammation, improve circulation and move toward normalized muscle and support structure function.Surgery is literally a last resort when all else fails. Unless symptoms threaten normal function and are in danger of progression or activities of daily living, surgery is not usually the first line of therapy and should be considered carefully. Usually symptoms of nerve compression, weakness (nerve signal to muscles) and tendon reflex changes are more indicative of the need for surgery. Surgery was successfully performed on this patient. No post operative complications occured. A very happy patient; And after back surgery, that is a great result.

Saturday, April 5, 2008

The Abyss

As I get closer to leaving, I feel like I'm looking over the edge into the abyss...scared out of my orthopaedic shoes, but really excited by the challenge and the "risk" of it all. I know that my complacency will only lead to my discontent, so this choice was really a no brainer. Now that the packing is actually happening, and the plans are being laid...the fear begins to sneak in. But, I can't let doubt become my master at this stage. It is about just taking one step at a time, taking and relishing in each and every day. It starts in May.
"The person who will risk nothing does nothing, has nothing, is nothing. Only a person who risks becomes truly free." -- Denis Waitley

"Dare to risk public criticism." --
Mary Kay Ash

"Twenty years from now you will be more disappointed by the things that you didn't do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover." --
Mark Twain

"Our doubts are traitors, and make us lose the good we oft might win by fearing to attempt." -- William Shakespeare

Friday, April 4, 2008


"The trouble with many plans is that they are based on the way things are now. To be successful, your personal plan must focus on what you want, not what you have." -- Nido Qubein

Almost 6 weeks and I'll be leaving for school. I'm scared shirtless, but really excited about finally doing this. I can't imagine doing anything else at this point in my life. My 5 year plan is solid and I just have to do the daily work to get there.

It's not the load that breaks you down, it's the way you carry it. - Lena Horne

I'm going to love it though...and I know it. I've been given a second chance of sorts, and I'm so happy about the prospects. I'll miss people I love, but I'll stay in close touch with them. They know I love matter where I am.

"Where will you be in five years? Develop a plan, and then activate that plan to put yourself where you want to be in five years. Be sure to update your five-year plan at least annually in order to stay ahead of the game." --
Tom Hopkins

"When schemes are laid in advance, it is surprising how often the circumstances will fit in with them." --
Sir William Osler

Statia Medicine

What a great place to go to medical school. I am so PSYCHED!. It’s not the Club Med, but not supposed to be, but it will be nearly a distraction free environment to study, and get back my mental health after working in hell. I am ready for this but will have to sacrifice things to make it happen. I’m OK with that. Onward…Onthaal aan Statia. U gaat hier naar gelijkaardig het.

Thursday, April 3, 2008


Beach Sign Statia

Statia is a beautiful island with a not so beautiful history. The beauty is there if you probe beneath surface. Statia was discovered in 1493 by Christopher Columbus.

The island has changed hands at least 22 times and has had a tumultuous trade, pirate, and weather (hurricane) history. In 1636, near the close of the 80 year war between Holland and Spain, the Dutch took possession and the island is now a part of the Netherlands. During the 17th and 18th century, Statia was a major trading center with some 20,000 inhabitants and thousands of ships calling at her shores. There are fewer than 3,000 now.

But I can't think of a better place to learn medicine at it's core, without the trappings of westernized health care. I'll bet I don't eat a single lunch or get a single pen provided by a drug rep while I'm here...but that wouldn't be a bad thing would it?

Wednesday, April 2, 2008


Thanks Country: "think.. when you are done studying, do I know this material? if so do you know it well enough that you aren't going to kill somebody? Would you be comfortable at this time looking someone in the eye and saying "you have x y or z wrong with you" if you can actually visualize this then you are done"


Tuesday, April 1, 2008

St. Eustatius

Large St. Eustatius map by World Atlas

I have no idea where the medical school is, but I'll be going to Statia for school. It seems like a far away, far off idea with strange purpose and intent, but it really makes perfect sense. I should have done this long ago. Marriage, love and kids got in path, but I seem to now have the time and attention that I need to make it happen. I am not sure what the future holds, but immediately it will be classes, boards and studies. I'm excited about this sabbatical.

The Trek Begins

This site is really about self-discovery and the continuous learning. I am rewarding myself on my 50th birthday by going to medical school in 2008 (probably May). I've been accepted, have resigned from my current work, and am getting the financing together. It is going to happen unless I get a spiritual message directing me otherwise.

My friends and family (some docs) call it "crazy", but in this crazy soap opera that has become my life, filled with unexpected results from perceptively bizarre choices (not only my own), it seem somehow logical at this stage. I've been involved in medicine for nearly 30 years and it is finally time to face my fears and "just do it." I really thrive on the challenge of the mind and the science of medicine has been a part of my life since I was a volunteer EMT in my youth.

Listen, I'm not delusional about is going to be hard as hell and I'm resigned to the fact that I may have to work harder than the young bucks filled with "hunger" and energy drinks. I've done alot of education (almost 300 transcripted college, master, and doctoral credit hours), but this is going to be very different and will culminate in the USMLE process in about 4 years. Grades and test scores will largely determine my residency and practice specialty, but if I end up practicing in the African bush...fine with me. It just feels right and I trust that.
Crazy yes...but somehow actually very right.

Medical Studies

This is not April Fools

Lectures, labs, and activities daily with more lecture, labs and activities the next day. Lots of information coming about school from students now on the island. Clearly they are busting butt for finals...cumulative. Nobody talks much about doing much else. Long hours. No falling behind. Cramming impossible. Not easy. Dedication, competitive nature to survive all seem to be recurring themes.

But have heart. Stay focused. Over 95% of the students accepted into medical school earn their M.D. degree. Wouldn't you like to go to Las Vegas with those odds?