It's all about the hair

Walking home today, I past several homes with the same activity happening on the porch. Big girls, little girls..."doing" each others' hair.

I've heard it called several thousand things over the years, and frankly, I'm not sure what it's called here. It's braiding, platting, twisting, spiraling, and probably many other names. But all seems to end with beads or other such adornment.

There are more hair salons on this island than gas stations. There is an absolute dedication to the hair and being sure that it is different on a regular basis and "taken care of" even more regularly. It takes hours upon hours to "do" the average head of hair and is part of the social fabric of parts of the island. My landlord is a self proclaimed "expert".

But then, with the adorned beauty of the island, it's people, it's vegetation, there is good reason to keep the hair just right. And, to be honest, there's not much else to do, so why not the hair.

Effect and Effectiveness

It is amazing to me how one person can change the environment of a small school. Bring on a "filler", a 2nd or perhaps 3rd string to take on the role of a star, and chaos is likely to ensue. Such is the case with a small institution.

Clearly, another hiring mistake has been made in a BIG way. I totally respect experience, my elders and that dynamic of fraternal organizations called "senior" or "upper class"...those that have conquered before me. But I am also acutely aware that this position power lasts only briefly before the deeds have a chance to be planted. 100 days in the case of the President of the U.S. I suspect then that new teachers get only 10-30 by extrapolation.

He is terrible. He is chaotically disorganized. He has so few teacher positive qualities. And he is turning off students as quickly as he has come. Out of 28 registered students for one of his classes this week, 5 showed up and I suspect (as represented by the number of Facebook and IM windows I saw open in front of me) that only 1 was paying any attention at all. When student recognize low quality they walk with their feet since they can't walk with their wallets once invested in the semester.

I thought it was a aberrancy because of the GREAT teachers clinicians that I have had in my past. I believed what Dr. Stead said about the history of medicine education, that clinicians had a duty to teach. But the moral of the story is clear...clinicians can tell great stories but can't teach automatically. It is clearly a skill in classroom & time management, preparation, humility, organization, communication, planning and delivery that requires attention and deliberate learning. Even perhaps "unlearning" of bad habits. But what else are they to do? They are truly unfit to do little else, and that in lies the conundrum of hiring authorities.

And on a small campus, the implications of poor hiring are inversely proportional to the size of the campus. The smaller the campus, the greater the impact of both good, and unfortunately, poor teachers.

Junies, Happy Birthday

Seems that I have many family and friends that have birthdays in June. I hope that it is a wonderful birthday, filled with celebration, peace, love, and happiness!

Gastroculture

I was talking on the phone yesterday and one of the wonderful faculty maintenance/cleaning staff walked up to me, said hello and handed me 3 "things" that I didn't recognize. She is one of the most sweet ladies in the world and we have exchanged cordial conversation over the time I've been here. For some reason on this night, she decided I needed the gift of food? Yes, it was food. She explained, after I put my phone conversation on hold, that this was a walnut. But I know walnuts and this was no walnut. In her typically broken, Dutch-Island English, she explained that it was a fruit and that the insides could be eaten. She told me she just picked them and they were ripe and ready to eat. I asked what you could eat and she said "inside". I thanked her very much and went back to my phone call. As I did, I studied the "fruit" intensely. That's a cashew!! 

Now, I don't usually do this, but this morning, I carved up the fruit and put it in my oatmeal and ate it. What don't I usually do? I don't usually put an item in my mouth that I know nothing about on the word of another person. I got 1/2 way thru the bowl before I got on Google. Whew! You actually can eat this thing.

It tastes pretty good, but I can see that a juice or by itself, you may need to sweeten it. It tastes a little like star fruit and is often called the "star apple". And yes, you actually can make a cashew like nut from the top seed.   Officially it is the Spanish jocote de marañón, probably from Guatemala originally, and the seed at the top is the official fruit of the red pod.

But is some ways I felt the intrepid traveler and discoverer, eating something for the very first time. Can you imagine the person that first ate anything from the forest? Besides food sources, toxic poisons and medicines with profound effects were also discovered this way. I can happily say that after about an hour, I'm still breathing and have no signs of GI disturbance, but it is early. If this is my last day on earth, it's been fun!

Expectations

There are few expectations that traumatize us more than those we place on our own success or performance. I have post traumatic test syndrome (PTTS). S/S manifestation: undeniable urge to go diving and hang out at the beach. Periods of mindless TV punctuated by refrigerator raids, complete with standing at an open door trying to figure out what to concoct. Intermittent and symptomatic Rx: Napping and giving into the urge to reflect on the successes, and anticipation of the future. Few feelings like it in the world. I hope there is no cure. I did fine enough on exams to come back for block #2.

Exams and Experimentation

You would think that after over a year and 12 major exams blocks with nearly 50 exams, I'd be used to it. But I'm not. Like some vestigial, deep, primitive brain implantation, my "fight of flight" activates on the Saturday before exams. It's nerve wracking and no amount of medication, cheesecake or shock therapy seems to avert the inevitable stress of the not knowing. And the first ones of the term are definitely the worst cause we haven't got a clue how the new profs are going to test.

It's sort of a game, with some sport, but I know that it is a means to an end. Deep in side I know that it's just another hurdle and I can almost rationalize the reasons for this ancient torture called testing, but clearly this is not a good way to create physicians. My hindsight as an educator is very valuable, but also very damning. This process is just not right, productive, educational or inspiring. Thank goodness I actually love the science. And I do.

This term too is full of contrast. I'm quite sure I have both the best classroom professor I've had in a long time, and the worst. I'm fortunate on one hand, but it is unfortunate that there is still the misguided notion that great and learned physicians who are likely wonderful bedside teachers are automatically good classroom professors and course directors. To the contrary, it is almost predictable that the opposite is true. Real teaching, and course management is a completely learned, non-innate skill. It is not automatically bestowed upon the MD or DO graduate at any time during training. But as long as there is ego, and the paternalistic belief that it is automatic, we'll end up with very learned men and women, muddling their way thru being teachers. Too bad, this time, I have to be the guinea pig to testing the theory, once again.

Quake, Oil & Storms

Recent natural and natural events have quaked me out of study into writing again. I've been so slack keeping up with the blog. Which only means I've been actually studying and not been dragged hither and yon by attention diverting distractions.

I didn't really know about it until I friend, who lives in the Western U.S., asked me about it. Seems that anyone who doesn't live this way believes that the Caribbean is the size of New Jersey. Yes, we (collectively the Caribbean) got "quaked", but didn't feel it WAY out here in the NE Caribe; At least not that I know. On Thursday, May 28, 2009 at 03:24 AM, and earthquake With magnitude of 7.4 hit in the far western Caribe, off the coast of Honduras. Beyond the great rum they produce, seems that Cuba shielded this side of the Caribe from any major effects.  It was centered right offshore and did some damage including killing a several people. There was lots of talk about it here, but to my knowledge it wasn't felt at all. It did stimulate my thinking about our vulnerability to various and sundry forces. We never heard about it officially at school, no sirens were heard, not much of anything to indicate a problems at any time. And while we may never know, reports of the water level in Puerto Rico dramatically receding as much as 50 feet raised from the deep recesses of my memory all the training I got while living in Hawaii about tsunamis. We would be clearly vulnerable.

This same week, a potential unnatural disaster also happened. We had an oil spill. On Saturday, May 23, there was a large oil spill originating from a tanker vessel moored at the Single Point mooring just outside the Northern Reserve of the Statia National Marine Park.
The mooring is used by large tankers that are too large to moor up to the Terminal pier to receive or deliver crude oil. It happened at 1:45pm , and it ultimately got pretty big...4 km x 500 meters.

And then, it happened AGAIN, just 3 days later! On Tuesday, May 26, at 5:30am, there was another spill originating at the Single Point mooring. This one much smaller, but it really brought home how much impact this oil facility could have. A major spill could have serious effects for the island's environment and economy. The same spills, with currents running a different direction could destroy the reef here.

And to further my joy, hurricane season is about to start. Reminds me I have to stock up on water again since I almost ran out during a 5 day suspension of port services after our almost direct hit from Omar the hurricane. The storm blew in tons of sediment into the harbor and we couldn't get nothing from no place, no how. We truly are dependent on the lifeline of barges, and shipments.

But I have first major exams of the summer term, another potential unnatural disaster, to keep my mind off of spills and quakes. Is this a great island, or what??

Deliberate Though and Creation

Sometimes life feels like a train wreck.

But from the ashes often arises great knowledge.  If you don't go willingly, away from the tracks, life experience and education beats you into submission...in a good way. It's actually a pleasant surprise once you recognize that the "change" and growth is both beneficial and welcomed. At the terminal stages of this process, you begin to recognize and develop abilities to handle life factors slightly better than before. I've seen that reflected in the many students and faculty around me over the past year. The most successful appear to be those who can think specifically and deliberately , communicate that thought to themselves and others, and create a different reality for themselves and those around them.  They have become "authors" of their lives.

But to create something in the physical world, it is imperative to create the idea in your mind. Those people who best contribute to the whole in this microcosm of school, have the ability to create the reality in their mind first, they effectively create whatever it is they are thinking in the world around them. This deliberate thinking becomes the tool to create the physical reality, because to create something in the physical world you first must create an idea in the mind...getting the mind "right" or thinking straight about that thing.

But thinking straight isn't a right wrong thing. It's not about thinking in alignment with others, or consistent with any dogma or belief system. It's merely making decision in creating our reality on what is the best thing for everyone involved, conducive to peace, consistent with empathy and identifying the humanness in those around us in which we slog thru life. Thinking straight maybe making decision even when risky given the current state of affairs in the "apparent" world.

I understand that not "thinking straight" and making wrong decisions leads to failure. Those thoughts are usually not "created", not made; We just manage to fall in to them because of our laziness and willingness to fall into the thoughts of others or circumstances around us. If thinking is straight the chances of making wrong decisions are greatly reduced. Deliberate, straight thinking is thought we actually and specifically create.

Deliberate, straight thinking is not about memory and creating thought from our experiences and past. It is not about thought created of our fears of the future. It is about the deliberate creation of though based on our best selves, greatest wants for the greatest number of people, and our yearning to be more directing of our lives. It is about becoming the source of our thoughts and thus our lives.

When you are the "source" you are creating thought. It doesn't have to be original or profound except to you. The only rule, it must be you creating the thought. Once you start this process, you remove yourself from the world working on you and your thoughts and you begin to work on the world with your thoughts...you become the source.

You can originate a thought that is neither a response nor a reaction to anything that has happened or gone before. Deliberate thinking, like any ability, improves with practice. It has been the goal of various meditative practices for years.

If you think you're beaten, you are.
If you think you dare not, you don't.
If you like to win, but think you can't,
It is almost certain you won't.
If you think you'll lose, you're lost.
For out in the world we find
Success begins with a fellow's will.
It's all a state of mind.
If you think you're outclassed, you are.
You've got to think high to rise.
You've got to be sure of yourself before
You can ever win a prize.
Life's battles don't always go
To the stronger or faster man,
But sooner or later the man who wins
Is the man who thinks he can.

So how do we tackle this thinking problem and straighten it out? How do you get your thinking straight?  We are all capable of deliberate thinking, and source awareness. When we step out of our ego (brain based, emotional, indoctrinated by others, physical perceptions, imitation, survival) we can move steadily toward the creation of though deliberately, and being more of the source in our lives...generate creation in the physical world.

Start small. "I feel the best I've ever felt." Work up. I am going to be a competent, confident, versatile physician.

And on we go

Up the river I course like Blue Man...

It's really strange seeing people who I know getting ready to leave school and move into the world or the next "step". They seem to be everywhere here, hanging out with little to do except study for the big exams coming. That will be me soon, but I don't think I'm ready. But on we go...

It's been a typical start this term. Shaking the cobwebs of the lazy break attitude and getting into the swing of studying again this weekend will be the first hurdle. It's already building to volume that I know are challenging to many, but I still hear things I "know", or at least vaguely remember, from my practice and former education. Amazing how some things stick.

Yet too, I am continually amazed at how much I don't know, never learned or did by menu or guideline instead of understanding the real "why". Such is the more technical education of my past. I don't think I put anyone in danger, but the "oh wow's" seem to come with greater frequency...or am I just paying more attention? I don't know but I'm loving this part of the learning.

I have to admit that learning at this stage is simply more economical, efficient, and profound. I'm more ready to learn and more excited about learning, than ever before. I never got this excited about my education in education. I walk out of class now and feel energized, jolted into what can be, what will be...and that is just a pure, unadulterated rush. One that I'm sure many, many cannot, will not ever feel in their lives. Poor souls.

And so it begins...

I am poised on the great precipice of summer term and yet another battle for academic excellence and survival with the great "it".  Muhahaha! It is "me" against "it"!

I feel like if I make it sound like the great novel I'm more likely to pursue it with the passion it deserves. Actually I'm hoping it all comes together, there are enough students to pay the bills another term and that there is yet another delay in the implementation of the Netherlands taking over this paradise. It is a race against time, money, politics, power, learning, teaching skills (or the lack) and that which I know not (or know and have forgotten).

More Studying

The most important educational factor in medical school this term will likely be what organism? Algae! That little green plant stuff too small to make a decent salad.

The headlines tell the story...

Algae Plume Reaches Caribbean

This one "plume" is big and covers a wide expanse of Caribbean water. So big in fact, that it can be seen on satellite images from space.  It started in early April and appears to have begun as nutrient rich runoff fresh water flow from South America...likely from the Orinoco River, which exits Venezuela's northeast coast or directly from the Amazon river further south. 

While difficult to notice from the surface to the untrained eye, the water is eerie green around the island. Upon entering the water it feels like you are descending into pea soup...cloudy green water noticeable to those of us used to swimming normally in crystal clear blue water. "They" say it is starting to break up, but you'd never know it.  A short swim yesterday proved "them" to be wrong. The water is still too cold to cause up/down currents in the water to break up the mass. "Them "must not be swimmers or divers.

It is dramatic how the color of the water has changed. I dove a wreck in 90 feet of water about 2 weeks ago and it was really thick green. Pretty interesting to dive in different conditions on a wreck, but I wouldn't want to make a habit of it. You can see the now (Left, green) photo of the prop and one before the plume about 3 months ago (Right, blue). The photos are at the same depth, with same camera, with same settings and almost exactly the same lighting conditions. Dramatic effect on visibility and feeling of the dive.

And the fish LOVE it...it's a buffet! So while the diving and swimming visibility is less, the amount of fish on the wreck is especially high. The little ones love the algae and the big ones love the little ones. Hunting and eating for fish is further enhanced at the wrecks and ledges of reefs. So while the clear inviting waters are gone for the moment, we are seeing fish we've not seen in some time. NICE! One dive master said, "so thick we had to physically push them out of the way".

So as the plume (or bloom as many call it) continues, and makes swimming a bit more dangerous (sharks, and barracuda love to feed in the murky waters), studying may be the natural alternative to getting eaten by a confused carnivore. I am glad though that I could experience the conditions at least once, but I am looking forward to clear conditions again.

Break

It's not Saturday Night Fever, or Dengue Hemorrhagic fever...it's Rock Fever. "Rock Fever" is a subtle combination of subjective and objective signs and symptoms that often are not truly experienced until you separate from the source of the fever...the island. Once the possibilities of drive thru burgers, steaks of known origin, and other such comforts take hold, the true nature of the fever becomes apparent. I miss access.

It's not really the getting that is so important, but the knowledge that access is possible is often enough. I walk thru Costco near home, and I understand that the possibility of buying and devouring one of those wonderful cakes is possible. The mere possibility is better than the eating, digesting and the effects of the high blood sugar to follow (well maybe not completely better).

Access is a quality of life that is universally experienced at some level by all free people. Access is only denied to those incarcerated by the judiciary or by the geographical situation they find themselves. The latter contributes to the disease of Rock Fever.

So I drive thru where I might not drive thru otherwise, and stuff my self with the Taco Bell knowledge that soon again I won't be able to do so. My fever will then return, and I'll be immersed in the near end of my time on the rock...one of the most wonderful experiences of my life. And I can't wait to get back and get started again.

Wonderful State of Mind

The waning moments before finals for this term are upon us. Hard to believe I've been here almost a year already, but it has really flown by. When I contemplate where I am today compared to a year ago, I'm sure glad I took that leap of faith into the abyss and thank my family and friends for their support.

It's not been without it's moments, and it's not been the easiest thing I've done in my life, but overall this was a great decision, and I love where it's going. Break in a short bit will be welcomed, but I'm looking forward to coming back and finishing up this part of the process and heading toward national boards part 1.

And, I got a chocolate bunny this past week that I just ate for breakfast...so everything looks wonderful from the buzz of chocolate, caffeine, and sugar

Tenacity

Tenacity: The capacity to move forward without allowing "bumps" in the road (or falls) deter you from your goal; doggedness: persistent determination; See "Lance Armstrong"

So, 2 days after major orthopaedic surgery to repair his busted up clavicle, Lance was on a bike training. The x-ray is evidence of how severe the break was (noted to be in 4 pieces) and how much metal was placed. This surgery took hours. And to be out training within days is amazing let alone against recommendations of the surgeon.

But, that's why he's Lance right? I'll never complain about an injury again.

Scared

It's good to be scared. It means you still have something to lose.

I feel is almost daily, and it's not obtrusive or debilitating. It's just there. It's that genetic or learned implant of the limbic system that has us watchful and protective, like a gazelle drinking from the African stream, knowing the cheetah drinks there too.

Finals are like that cheetah, off in the distance, slowly sauntering toward the stream. I'm drinking quickly, as much as I can before I have to engage it. Sometimes you feel like you have more time than other times (Like now).

Don't wonder why people go crazy. Wonder why they don't. In face of what we can lose in a day, in an instant, wonder what the hell it is that make us hold it together.

Happy Passover & Easter

It is that time of year. It's a 4 day holiday here, and this place will shut down Thursday afternoon for the weekend to celebrate Easter. A mini seder tonight, and hopefully sunrise on an Atlantic beach on Sunday. There are plenty of wandering goats to slaughter here, and I am the first born, but I don't think I'll be doing any paint jobs this week. I don't think my landlord would appreciate it anyway.

But I want to wish everyone a Happy Passover and Easter...the time of the year where Old Testament  meets New...

The last supper, a Passover seder...

It is a great time to reflect on the blessings and wonderful people in our lives, and appreciate the depth of our history and heritage.

I Can See the Light

We have been BLESSED and visited by the angel of healthcare!! OMG...the arrival of new prof of pathology, and experiencing his first lecture left me in awe, breathless and energized. He's sooooo GOOD!! Just when you think things can't get any worse, they get better. And I don't know who is responsible for getting him here, but we are so grateful for this breath of intellectual, teaching and professorial fresh air. In the words of an administrator, we move from embarrassment to the light.

Whew!! It's about time! We really needed this.

Only 2 weeks until finals and then a needed break for home. I'm so going to enjoy this one after this last assault. Can't wait to see everyone, eat my fave foods and ready my brain for summer term. And after today, I'm actually looking forward to summer term. That's a great feeling.

Aye, Fame

You know you are getting old when your fave bands are being inducted into the Rock Hall of Fame. Two of my them are being inducted...Jeff Beck and Metallica. Ugh!

As a new police recruit, I was assigned to Kevin, a senior training officer. Kevin was cool, calm and let me make mistakes to learn the craft of keeping the peace. He also introduced me to Metallica cruising the streets on those late midnight shifts or running radar sitting the median of the highway. We could just pick up a distance FM station from a neighboring state, high in the mountains. It was a treat and a great way to stay awake on those quiet nights. Thanks for introducing me to the rockingest band and some of the most fun air guitar sessions ever.

Oh ya, school....two more weeks until finals and break. I am ready for some U.S. food, drive thru, and chillaxin with family and friends. The courses haven't changed much. The painful transition of course instructors has just drifted into total powerless numbness. It just is what it is, and in the words of a physician friend of mine now in practice...just get thru this part to "pledge the fraternity" that is medicine. The daily struggle is more a daily drift wherever the river takes me. Too close to tip the boat. In the meantime, the diving has been AWESOME!

"All these words I don't just say, and nothing else matters..."

Soon enough!

I'm not really counting down. It'll get here when it gets here. I am really enjoying school and life here. I relish in everyday and the learning has been pretty good as we shift to more study alone and small groups. They less I've expected of the profs, the better it feels. They are, for the most part, useless. Medical school could be all self study and we wouldn't miss a thing. Alas, the ones that add value are all gone now :( Sad really.

Studying, Really!

I'm really studying :)