Friday, January 30, 2009

A Bit Microbe Oriented


It is a real possibility that we may all die directly or indirectly from infection.  There was a family on the island that got very, very sick on year. It was likely food poisoning of an extreme nature like Salmonella. They are buried together in the cemetery here. Sad, but true. Many islanders died of infectious disease and the cemetery yards are filled with that memory. I had the chance to tour some of those sites recently. It is a reminder of how disease spreads, mutates, and kills.

Exams are here for the first round. Nothing unusual about it except nobody knows what to expect from the new profs. Those profs that have been here for awhile have a reputation and there is some sense of what they are about, and what they are after from us. The is the most anxiety provoking part of school for many...what do you want from me in order for me to be successful. That is the purpose of cogent lectures, syllabus, and information provided from the instructor. It is that link between the student and the content that the instructor permits. Remove the instructor, and you have self teaching and guess about the success path. I've learned not to expect too much from anyone and do what I can to just "get er done."

I'm gliding into the rhythm that is island life, and school. I have become more cognizant that it doesn't matter how much you complain or anguish over stuff...there is no way it will improve as long as there is no cognition of the real problems. But that's ok; We'll get what we need and the problem isn't's medical education in general. I've said plenty on that subject.

On another note, it's starting to feel like spring already. The days are getting longer and hotter. The "muggy" is coming back. The water will be warming up slowly between now and summer and I hope to take advantage of that between brain feeds. I'm moving steadily toward being 1/2 way done here, and that feels amazing.  It'll be summer way to soon, and very hot. We need some really strong, steady rain to fill the cisterns before then and before the endospores and bacillus grow rampant.

Salmonella The only unresolved issue is if I'll actually get Salmonella or not...I ate a product that has been recalled for possible contamination by the recent peanut butter paste Salmonella scare. I'm not sure that I would recognize Salmonella GI symptoms from island food symptoms though. Maybe it'll make me feel better? It is fitting thought that I have this possibility in my life as I study about the medical manifestations of the disease. Perhaps this is just all part of the lab exercise?

Wednesday, January 21, 2009


They are looming...2 weeks until first exams. But at 15% they are low risk, and really a time to feel out new instructors with no institutional track record to tap into. The content is voluminous this term, but we have hope that most of it is pretty straight forward, albeit those same pancakes we keep on eating.... 5 a day... everyday... and you have to eat each and every one of them. I know why people get sick of pancakes, but we can regurgitate them all back in about 2 weeks. Some relief in that.

Better? Stop the pancake madness and change to something else...French toast maybe? Like to make me just as sick, but a little more protein. Hope my lysosomal storage mechanisms are working properly.

French Toast

Topistically Speaking

"Topistics (Dr. E. V Walter)-- a holistic way of grasping a place as the location of shapes, powers, feelings, and meanings..." Mostly feelings and meanings.

Putting that inherently Buddhist nature aside (attached to nothing, with no future, and no past), home is where the heart and memory resides. Where does your heart reside? It could be in the bedroom of your parents home, or in an old house that you toiled to make a home. It might be a deck you sanded and painted, a classroom, a shopping mall you hung at or a vineyard you vacationed in. It could be a storage unit, a girlfriends house, or the back seat of a car. For some, it's multiple locations, brought to the surface by events, or times, or reflections. It is a feeling that few speak for fear of vulnerability, loss or attachments revealed.

But does the place provide the meaning, or does the meaning become assigned by the mind to the place? Dr. Walter attributed those feelings to the "place" and what that place does to us. That seems more like a diagnosis than a sociological phenomenon. It seems to be more a definition and feeling that we assign in our mind to a place. 

Memoryistics (2009): As I shed more places in my life, the "powers, feelings, and meanings" become redefined and scattered once again. I won't let home be where the stuff is or was. Home is where the heart is, and that can topistically be a dream, a goal, a lifestyle and a belief system. For the mind is a place where the heart really is. And memories are dangerous "places" with power, meaning and feelings. Places, of themselves, are not filled with such power. Amazing we do that to ourselves.

Island View

"The real voyage of discovery consists not in seeing new landscapes but in having new eyes."  -Marcel Proust

Tuesday, January 20, 2009

Teaching Gaff

One goal of teaching is connecting the student, in a meaningful way, to the content. My view of teaching is that of a facilitator and "guide on the side" to excite and instill motivation to seek greater detail, and clarification of presented materials in the content.

It begins with a coherent syllabus that dictates how the class will be conducted and the rules of engagement for success pathways. That should also provide information on where the content for presentation, clarification and testing will come from (the "final authority"). That component is all important in this world of unlimited medical resources.

Worse case scenario...change your syllabus at will, teach with slides copied and pasted from a book we don't have access to and is not indicated in the syllabus, and Dr. Stead - Teacherteach in such a way to make it incoherent. That is my class. Same story, different term. Sad really. Just because you have an advanced degree, doesn't mean you know how to teach. I have to remember that. I've also learned that good teachers don't need advanced degrees. Frankly, I'm not sure that you need teachers to learn medicine. Dr. Stead taught me that. Great teacher.

Monday, January 19, 2009

Fantasy Land

I first saw this vessel when I landed in St. Maarten the the other day. It was sitting off the coastal runway, and even then (before I knew what it was) I took a photo. It's huge, and very conspicuous. Surrounded by the masted sailboat and the private jets just highlighted the obvious nature of it's silhouette.

Mega off St. Maarten

I've never actually owned a boat, but I've had access to them for a long, long time. I've been around and seen big boats forever growing up in Miami and Ft. Lauderdale, going to all the boat shows and recently cruising the Inter-coastal professionally (didn't own, but used the heck out of a few).  But this is a MEGA! And they visited Statia too. What a beautiful craft!

377 foot yacht

The P*e*l*o*r*u*s is one of the largest private yachts in the world. It is 377 feet long (a football field, plus) and is owned by a Russian billionaire.  It's a big boat. It has a crew of about 45 persons. Amazing by any standard. Seeing it off the coast from my study hall window to the Caribe world was captivating.

I wonder if they need an on board doc when I'm done. Can't be too hard to add a 46 crew.

Sunday, January 18, 2009

New Everyday

The sunset is different every day. You think that the sun does the same thing. And in general it does. And in the Caribe, it moves very little thru the year and sets almost in the same place each day. But what's different each day is it's surroundings during that time...air quality, pollution, clouds etc. I guess that's why I'm so amazed at the event each day. It is totally unpredictable, and a moment to just sit, and take it it is...without any imposition from us. This one the other day was so unusual....amazing. Nice to know that I'm still amazed by sunsets. I hope I never lose that.Sunset Aura

Friday, January 16, 2009

Hippocratic Oath

Interesting diversion from studies....what do we stand for? What is our history, our legacy, our charge? Is it just a hazy image of a man and his passion for the "art" and practice of medicine, or something more gripping, higher in "the realm"? Is it any wonder that some physicians are not enjoying life, their practice and are so disrespected?  Is the dream possible, practical, and prudent?


"I swear by Apollo, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath.  To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.  I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.
But I will preserve the purity of my life and my arts.
I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.  All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.  If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."

Wednesday, January 14, 2009

Excitement Interrupted

It is after the rejuvenation of break that the greatest expectations emerge...for a great term, exciting presentations, wonderful professors, student camaraderie. That wide eyed excitement and visions of knowledge left unconquered, diseases to discover...consuming every ounce of energy and left over Starbucks running thru the veins. But then, the reality sets in. It's really a dog eat...uh, me world.


And it really came quick, furious and open jawed this time. The professor I love, is leaving. The professor that was supposed to be (and I was used to) isn't. And the one who did, well, I'll reserve comment until after finals. But lets just say, my expectations are once again dashed into the Buddhist reality that in every expectation there is disappointment and suffering.

Oh nuts! We'll do fine AGAIN, but in those moments of blissful expectation, I dream of those professors of days past that stimulated my mind, my emotions, my spirit and love for medicine instead of dashing them against the rocks of cynicism, politics, business, mythology, fear and lack of basic skills. I am so lucky though to be here, so blessed to still have the notion that I have something to contribute, and happy that I've experienced the best teachers life could offer in courses gone by. It is what it is, and hopefully will get me to USMLE part 1 soon. That is of course if the tidal wave of financial mayhem doesn't swallow us up first.


Don't listen to me. I learned today that men are neurologically challenged, develop slowly and peak at age 40 neurologically, have about 10 minutes of normal, and then begin the slow decline to brain atrophy, demyelination, memory dissolution, and diapers. Women are, it seems, the superior gender and I concede defeat. What the hell was I thinking??

Tuesday, January 13, 2009

BTW Beautiful

By the way, it's frickin beautiful in the Caribe in the winter. Even if school is a challenge, the surroundings are wonderful, distraction free and filled with cultural opportunities.

Sunset on Statia

Sunday, January 11, 2009


imageIf school was a patient, I'd call a code. I just had a tearful good bye from my next  door neighbor just packed up all her stuff into a small truck for the short trip to load it on a boat and ship to St. Kitts. She's transferring and doesn't want to. The school is "bleeding" good people in financial trouble. She's leaving because she has run out of money and there are no loans in the immediate future for our students. I'm one of the lucky ones, but if this situation doesn't change quickly, if there isn't a bandage for this arterial ooze, this patient is dead, and any attempt at resuscitation is a futile.  We aren't on the brink yet, but we are mighty close. Off to the food store for provisions for the week.

Injured But Not Out

"A pearl is a beautiful thing that is produced by an injured life. It is the tear [that results] from the injury of the oyster. The treasure of our being in this world is also produced by an injured life. If we had not been wounded, if we had not been injured, then we will not produce the pearl." - Stephan Hoeller


I'm back on the rock after a wonderful break with family, and friends. My "over" bags all arrived intact and together...a first.  The view of Statia from the air at night was actually exciting. The reminders of life here have already returned, complete with "itching" from mosquito bites (I just realized I didn't get bit once at home, near the mosquito infested swamps).

I've recovered my sensibility I hope and managed to stem the tide of personal fear in many areas of my life including school. I joke about closure and having to relocate, but realize that all acts of God cannot be influenced by our fears. And, if school closes, so be it. But I won't leave voluntarily and hope that others consider that action carefully. Each person who transfers could be the straw that breaks the camels back and forces the school to close. These are tough times and tough minded students will just stay put, and contribute to the success. In the end we all win. I've resolved to smile a lot and hang in there. For the moment, my bank agrees.

We, as a school and a students body, are wounded. I hope that issues of loans, faculty, curriculum, communication, costs etc are being addressed in a prudent manner for a win/win result for every stakeholder (and yes, students are stakeholders too; Contrary to the belief of school administrators in general). But it is thru the wound that "pearls" are created and this could be that wound. As the air of "no confidence" lifts (hopefully) among remaining students and faculty, I hope that we will emerge stronger. That is a great possibility that we could all benefit from. One can hope. As Helen Keller said - "Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired, and success achieved." This could be that trial.

So now, onward to the next term...starting in a few days. I'm filled with excitement again about this challenge, the science and the opportunities. I'm sure it won't be long until I'm beat into submission by pathways, microbes and disease, but it is refreshing to be back, and on track with a clear focus on the goal. That is the true benefit of the "break" beyond the family, friends, food. I have to admit though, strolling thru Costco the other day, eating a multitude of samples, was a spiritual experience with near out of body qualities that I will soon miss.


Thanks everyone for making break so wonderful. I can't thank you enough for the love, hospitality, food, attention, rum, bed space, travel companionship, cheesecake, Strongbow, soccer, roller coaster thrills, ears, and hearts. I am a very lucky human with more blessings than sense.