Dreams

                   

It seems impossible. I can barely believe it, and I'm the one living it! I'm 10 days away from finishing my 2nd year of medical school. 

It seems like it was only yesterday, that I was living in Berlin, having a crisis about my future and talking with a good friend about the fact that the only thing I had really ever wanted to do was medicine, but the chance had passed me by. I was too old. I couldn't drop everything now and start over. 

Or could I? 

The phrase on the picture above is so obvious, but so hard to see sometimes. Medicine is a long term goal. It takes a lot of time and effort. You might have to give up other things, and you'll definitely have to make sacrifices in order to achieve it. But if it's what you really want, you owe it to yourself to go for it. Because if you don't, the time will pass anyway, and you might look back and realize that if you had started then, you'd have accomplished it now. 

So do it. Whatever your dream is, run to it. Be brave. The first step, the decision, is the hardest. After that, nothing can stop you. Nothing should stop you. 

That time when... med school kicked my butt

Second year of med school has been a blur so far. I arrived back from my trip to Africa on the day my classes started, literally dropped my bags at home and went straight to class. I do not advise doing that and will not be doing it again.

My brain was not ready to jump from Chad straight to classes. So while I tried to adapt to being back, I started running behind class materials and felt like I was playing catch up. The entire semester. My stress levels went to record highs, and I even had insomnia, something that, with rare exceptions, I had never had. I passed all of my classes, but my class ranking suffered a bit and I'll have to work extra hard to recover.

The result is that I finished the semester utterly exhausted. But since I'm an overachiever at heart, instead of taking advantage of winter break to recuperate before second semester, I went ahead and signed up for an elective. Because I'm insane. I did escape for a week to go to the beach, because I felt that I could simply not start 2nd semester without recharging my batteries at least a little bit. I'll talk about that on the next blog post, suffice to say, it worked! A week in paradise was just what the doctor ordered. :)

However, I realized that I need to cut myself some slack, and not be so hard on myself. This semester was pretty tough, but I passed. Beating myself up because of class rank is stupid, and I know I can do better next semester, when I won't start out stressed and already playing catch up. Plus, we start out with Neuro and I love neuro!! So it should be fun.

So the two lessons to take home are: 1- don't come back from a stressful trip to Africa (or elsewhere) the same day your classes start. Give yourself some time to arrive and adapt before classes start. 2- do your best and don't beat yourself up if the results are not exactly what you expected. After all, it was just 1 semester and I passed!!

Mentors

Even before I started med school, I knew that I would need a good support system. And I knew that was going to be a little complicated, because I was moving to a country where I knew nobody at all. I have good friends, but the closest to me geographically, are still in the next country. It's 4hrs away, so it turned out ok and I get to see them on a somewhat regular basis (money and time being short and all.)

I also knew I'd need mentors. I had never actually had a mentor, so I didn't know where/how to find one.

Then I went to Africa and worked with Dr. Scott. Before I went, I had no idea if we'd get along, I was even a little aprehensive. But we got along great, he taught me a lot, trusted me, and told me to come back any time. So I went back, and learned even more. I know he'll be there for me if I need help or encouragement, and I'm lucky to have him.

Last year, I had also contacted a Neurosurgeon from the US about an article he wrote, and to my greatest surprise, he wrote me back, gave me his phone number and told me if I ever had any questions, to feel free to contact him. I am planning on working with him in the near future, so we've emailed a few times, and even though we haven't met yet, I feel like he's also becoming a mentor, and I'm grateful for that.

To finish, I recently went to a neurosurgery congress and met another great neurosurgeon. It was a small congress, and I ended up talking one-on-one with him on numerous occasions, about medicine, but also about philosophy, injustice and traveling. He gave me some great advice and also invited me to do a rotation with him when the time comes (I'm still an MS2).

I can't believe how lucky I am, that without even trying to, I have found myself 3 mentors. Three great surgeons and great human beings, to look up to, ask advice from, and generally have "in my corner," should I ever need help or get discouraged.

To all of you pre-med, med students and residents out there, find a mentor. At least one. Someone you can trust and who can help keep you motivated, inspired and give you a little push once in a while. We all need it. :) 

Call me surgeon!!

I think there comes a moment in every med student's life, when they feel like their dreams are coming true, that they're in the right path, that all the effort (past, present and future) is worth it.

My moment happened when I performed my first surgical procedure (minor!) on my own, from beginning to end. I was supervised, of course, but I did everything. Local anesthesia, incision, disecting the lipoma out, suturing. It was removing a lipoma from someone's thigh, so nothing transcendental, but it was awesome. And it was a pretty big lipoma too!!

I feel like a surgeon. Of course, I have *many* years of hard work ahead before I am really a surgeon, but I'm getting there.

Here's a picture of me, grinning from ear to ear, with the lipoma I just removed!

Children

(Surgical pictures at the end of the post, scroll slowly if you don't want to see them.) 

It's a recurring theme in Tchad that nobody seeks medical attention until they're about to die, or whatever ails them becomes unbearable. And since they are extremely resilient, sometimes that means years.

Today we had 3 surgeries, the first of which was a 4 year old with an exposed femur fracture for 1 year. The exposed bone was dead, of course, but surprisingly, he had no infection.

So Dr. Scott cut off the dead bone and put the 2 ends together, put them on an external fixator and closed. The hope is that the bone will actually grow enough to compensate for the loss and he will have legs of equal length. In any case, he will definitely get to walk. Again, something that isn't possible with an exposed femur fracture...

Then another little kid, from yet another motorcycle accident. That one was 10 days ago, but the arm had gotten stuck on something and almost completely ripped from the torso. Almost, but not completely. Except the nerves, ligaments and blood supply was part of what got ripped... and the result is a child attached to a completely dead, cold, putrefying arm. I'll let you imagine the smell. So it was an amputation, leaving the wound open because of the infection.

The third was a woman with a large, hard mass on her thigh. It looked like a giant mole. It was deep into her sub-cutaneous fat, but had not reached her muscles. Besides a little bleeding, it was removed without complications. Of course, we have no way of knowing if it spread somewhere else, and that thing was massive. 7cm by 5cm at least.

Anyway, I had been craving surgeries, and it felt great to scrub in again, but that little kid who lost his arm made me really sad.

Things that happen in Tchad that you have to get used to but probably never will...

Living arrangements

A lot of people have asked me how the living conditions in Tchad are, so I thought I'd make a post with some pictures to give you guys a better idea.

The first time I came to Tchad, I didn't know what to expect when it came to my living arrangements. The hospital and the living quarters are located in the same walled complex, and separated from each other by a brick wall. The house is pretty modern, with everything you would expect in a normal house, normal bathroom with shower (cold water but you don't really need it to be hot) and flushing toilet. The only exception is wifi which doesn't exist. Electricity is provided by a generator and internet from mobile phones. I got a little bedroom with a lockable door, a nice bed with mosquito net and a dresser. I was beyond happy, as I had expected a lot worse.

This year, when Bekki wrote me to say they were excited for me to arrive and my room was ready, I had expected the same room. What isn't my surprise when Bekki takes me to my own little apartment!! When I was here last, it had been a shipping container used for storage. They converted it into a full apartment, with full kitchen and bathroom! And it was just for me!!

Here are some pictures:

That's the door on the wall that separates the hospital from the residencial area

That's the outside of the house I live in

My very own kitchen!! 

Bedroom

Bathroom

Garden at sunset 

So there you have it. I really had not expected to have all the comforts we expect in other countries. Coming to Tchad is hard in many ways, but the living conditions are not one of them. Of course, this is not how the general population lives... but I'll have to write another post about that. :) 

Tchad- round two

I am sitting on a bus, crossing Tchad from the capital, N'Djamena, to Moundou in the south. I'm really excited, and can't wait to get there and see Dr. Scott and Bekki (his wife) again.

The first time I was here, it was the unknown. Arriving in the middle of the ebola epidemic, there was fear it would come to Tchad (it didn't). And like this time, I was arriving at 11pm in N'Djamena and leaving at 6am on a bus to Moundou. It was certainly an adventure and I won't deny, there was a little bit of fear mixed in with excitement. I knew that trip would change me. I was afraid I wasn't up for the challenge.

I hadn't even started med school yet, and my only training was what I had learned in a nursing's assistant course and the basics of giving shots, drawing blood and putting in IVs, that I learned during my internships in hospitals in Germany.

Now, after a year of med school, my practical knowledge hasn't changed much, except for all the things I learned my first time in Tchad. This is such an incredible opportunity, I am very lucky and blessed to be able to do it. I hope to learn a lot more, maybe even suture and catch a baby or two! (The hospital where I will spend most of my time does not have maternity/gynecology, but I will spend 2 weeks at a different hospital, where they have it!)

It's funny how the unknown has become familiar, and I can feel like I am going back home, in the heart of Africa.

I'll leave you with a picture of the sunrise. It's bad quality, but it will give you a small idea of the beauty I am lucky enough to see. Enjoy!

Irony in the New Year

Right before New Year's 2014/2015 I wrote a post about losing my phone and feeling guilty and stupid when I thought about buying a new one and how many people that money could help. But I found the phone and everything was ok.

This time, the phone was actually stolen from my bag, so I obviously didn't get it back. My mom offered to buy me a new one, but I declined. As much as it sucks to not have my awesome iPhone, I borrowed and old Samsung from a friend and it will have to do. 

I guess I learned something. 

So for this new year 2016, as I prepare to go back to Tchad and deal with real poverty, hunger, need, I hope to keep my priorities in order and remember that there are many things more important and necessary than a phone. 

And I wish for all of us, whether you have something to do with medicine or not, that we strive to make the world a better place. Even a little bit. We really *can* make a difference, and if we all do just a little, it all adds up to something great. 

Happy New Year from Berlin!!!!

Med Student vacation: truth or myth?

Well folks, I successfully finished my 1st year of Medical School and don't have to do the monster final exam, which means I'm already on vacation. 

As it happens, I have traveled a lot, but barely know my own country. So I thought I'd start to rectify that and go to a beach town up the coast, called Punta del Diablo, which I heard was amazing. 

And amazing it was. Miles of sandy beach, not too many people but just enough, perfect weather, great food, fun company. What else could I hope for? 

The pictures don't do it justice, really. The sunset was just a fantastic explosion of color and seemed to last forever. It was so peaceful! I really needed that after the crazy semester I just finished. 

We even had a big fire on Friday night and just sat around talking and hanging out until the wee hours of the morning. 

Unfortunately, I only had a few days. I had to go back home to finish all the things I need to do before flying to Europe in 9 days and then on to Chad!!

However, what isn't my surprise when I'm coming back to the city today, and get a message saying that my group's poster was selected to receive an award and asking who could go next Tuesday to present it!! 

So yes, I am *technically* on vacation, but it never really stops. They own us and if they say "jump!" the most we can do is ask "how high?" 

Shouldn't complain though, we worked hard on this project/poster and it's nice to be recognized. 

But as the tittle implies: Vacation? What's that? 

Life cycles

Life's been good lately. So good that I haven't been writing much here. Isn't that usually how it goes? When there's too much going on, you don't have time to write.

I am now studying for exams later this week, and slowly starting to freak out. And procrastinating (by way of writing a blog post) is a sure sign of freaking out. 

 (How I feel under my pile of books)

I'm studying lots of biochemestry, you know, glycolysis, Krebs Cycle, Electron-chain transport, Fatty-acid oxidation, gluconeogenesis, etc. and there are a lot of cycles. Chain reactions. This thing activates that thing, which activates that thing... 

It all got me thinking about all the chain reactions that brought me here, right now. The domino-effect of our actions and decisions, that seemed so small and unimportant at the time, but have made us who we are and brought us to where we are. 

I guess all I'm trying to say is that I'm happy. Somehow all the dominos fell where they were supposed to--a place I could never have predicted--and the picture is complete. 

So besides the little stress of the moment which always comes with exam week, and the inevitable feeling of being overwhelmed, I have nothing transcendent to report. 

Happy life is boring from the outside. 😉

Hospital -- day 1

Now that I'm done with 1st semester, I can start going to the hospital. I'm technically on vacation, so I don't *have* to go anywhere. I want to. 

So I went, and made myself useful right away. It was great to see how they accepted my presence there and didn't make me feel like I was annoying or useless. 

Sure, the when the doc asked if I knew how to do an EKG, I looked at her blankly and apologized that I did not. She didn't blink though, just called an upper-level med student and told him **to show me**!!! Before that she had also heard a clinical arrhythmia and gave me her stethoscope so I could hear it too. And I did!!! 

I also came up with the diagnosis on my own. In my head, I didn't share it with the doctor. But she told me and what I had thought of was correct!! The patient had a bowel obstruction, not really that complicated to figure out, belly pain, not passing gas or stool for 5 days, big lump on belly. But it felt great to actually know what was going on!! 

The cause of the obstruction however, was still unknown. We handed the patient over to gen. surgery and they were going to get image studies to see what was going on in there. 

Anyway, I just wanted to give you all an update. This doctor thing is awesome. 

I'm definitely going back to the hospital next week!! :) 

Untapped

Today I got my last grade for the 1st semester of Medical School. It might seem like not such a big deal, but to me, it is huge. My school works a little differently than most: we have 2 midterm exams and then continuous evaluations that take homework, group projects and class participation into account, for each class. If we do well enough on all of those things, we don't need to take one FINAL exam of the semester, which is a monster exam with ALL the material of the ENTIRE semester for EVERY class.

I do not have to go to final exam. That makes me happy. It also makes me extremely relieved!!

However, I just saw a video that made me think: I shared a couple of months ago that even after I started med school, I was afraid I wouldn't cut it. I never doubted that this was what I was born to do... but was I good enough? Then there was a day when I realized I could do it, and I'll never forget it. But maybe there are other people out there who feel what I felt. Fear of not being good enough. Afraid to try because you don't want to fail.

Well, this video should speak straight to you. Don't be afraid. Work hard. If you want something hard enough, and you work hard enough and you don't give up, YOU CAN DO IT! Seriously! I did it. You can do it too.

Here's the video:

Last week of 1st semester

Hey guys,

Sorry for the radio silence. Med school kicked into super-sonic high gear lately, and I've barely had time to breathe. We had a major problem with our community, they were going to close the health center where we go!! But by sheer luck, we managed to talk to the right person at the right time and prevent it from closing (major win!!!)

I also had my mom for a visit, which is great, but eats up a lot of my time and it's not what you want, 10 days before finals. 

This week we have a million things to turn in, I'm currently on a bus to the community where we're giving a workshop to the school about sexuality (community has high rate of teenage pregnancies) and next week we get our "continuous evaluation" grades which will in part determine whether we have to take giant monster cumulative exam in  July or not. 

To say I'm stressed out is an understatement. 

But such is the joy and the pain of med school. Work hard. Help people. Sleep when you can. And we already accomplished more than I ever thought we would, with the health center. 

All in all, my first semester of med school flew by. It's tough, but that was expected. I'm loving it. 

Cross your fingers for me, so things go well on finals!!! :) 

The thing about stress...

We've been seeing a lot of things about stress lately, and how much it affects your quality of life, mental health and physical health in general. In Uruguay, the leading cause of death for those above 40 years old is cardiovascular problems.

Well, high levels of stress cause high blood pressure, increased heart rate and even mess with your cholesterol levels. Stress also disrupts sleep, which is what the body needs to recuperate and keep us healthy and sane. And I guess there's no need to mention that stress also damages our mental health and influence our lifestyles in a negative manner (people who smoke and/or drink, usually smoke and/or drink more when they're stressed, don't have time to exercise or relax, etc.)

For the two weeks before my exam, I was very stressed. I wrote about this a couple of posts down, but I didn't give many clear examples. You guys, I was really stressed. I was yelling at people for no reason. I was not sleeping well, which made me tired and cranky on top of stressed. It was not good. And the worst part was that I knew I really didn't have to be that worried about the exam, because I had been studying and knew the material, but I could not reassure myself.

So this time, I am trying to do things differently. I have 3 1/2 weeks before my second midterm, and my goal is to not become a horrible stressed out person. I made myself a schedule and I'm keeping strictly to it. It includes time to relax, time to go for a walk/run, time to see friends. Obviously, it includes lots of time for studying. But I think that if I keep to my schedule and remember that my study techniques apparently work (so far, cross your fingers!), I can keep the stress at bay and make it through the exam and on to my month off in July (here's hoping!).

This schedule, of course, may not be the "stress cure" for everyone, but I think it might work for me. I just want to encourage each of you, whether you're a med student, doctor, nurse, or nothing at all related to medicine, but as all human beings, still vulnerable to the stress of life: Try different things and see what works for you. There are lots of different things that can help with stress management, and definitely improve your health and quality of life. Your present and future self will thank you. Chances are, your friends and family will too. 

The day after...

the midterm exam, that is. It was a beautiful day, sunny, not a cloud in the sky. Warm. The exam took me 2 1/2hrs (we had 3 1/2hrs total, so ample margin!) and started at 9, so I got home around noon. Changed into a bikini and a beach dress, grabbed a book and some sunscreen, and spend the afternoon on the beach, **reading a book** that had nothing to do with medicine! (Only my med-student friends will understand what this means. Oh, it was heaven!

Then I slept for about 10hrs.

And then, I got on a bus to go to Valizas, a place on the coast of Uruguay, which only has wild beaches and barely any houses or people. It was 36hrs of walking through nature, collecting delicious edible mushrooms, cooking, talking to friends, and generally just relaxing. I even turned off my cell phone for the 36hrs, in order to really disconnect from school. I knew they would be posting the answers to the exam soon, and I didn't want to see that.

Came home late at night and very tired, so I slept like a rock (for 5hrs!) and got up the next morning to start all over again. That's when I finally checked my answers and realized I had done very well on the exam. :)

Now, until the next exam, I have a little breathing space. It's only a month, but I'll take it! 

A moment of truth...

So here we go... 

I think **one** of the reasons I didn't go to med school earlier, is because I was afraid I'd never get in. I'd never make it, so I might as well not try. 

When I was a freshman in college, I was the TA for my chemistry class, and I got a C in one of the lab write ups. The teacher, an old German dude, came to me when I was working in his office and said "you think you can get into med school with C's? You can't. You'll never make it." Folks, it was a lab write up. I did NOT get a C in that class, but the damage was already done. His words stuck with me to this day, 15 years later. 

I eventually changed my life and decided to pursue a career in something completely unrelated to medicine. It was not because of what that professor said, but I am *sure* I would not have given up so quickly, if I hadn't had his words echoing in my head and that horrible feeling that I just couldn't make the cut. 

So I graduated, got a job in Germany, (one of those real, grown up jobs) and started to settle into "grown up" life. Until I realized I wasn't happy. That my job did not make me happy. That I was not making the world a better place, and if I wasn't there, at my job, nobody would even notice. 

That realization came when I was 29 years old. Not an easy moment to face, even in the best circumstances... 

So I had a mini life-crises, questioned everything, and realized that the only consistent dream I had ever had, was to become a doctor. And thought it was insane. Crazy. No way could I do it now! 

Luckily, I have a couple of really good friends, who heard my rants, held me while I cried, and assured me that yes, I could do it. That if it was really what I wanted, not only *could* I do it, but I *should* do it! 

That brings us to today. Getting into med school is not easy, and it actually took me a little while from when I made the decision to this day. I am in my first year of medical school. Until today, I wasn't really sure I could make it. Today that has changed. I belong here. I am not only going to be a doctor, I'm going to be a great doctor. Dr. F (the chem teacher)'s words may have done a lot of damage, but they weere not true. I'm here. I made it. And I'm not nearly done! 

Watch out world! :) 

There's a song that fits perfectly with this post: "Let it be" by Superchick -- check it out! 

Three weeks in...

Sorry folks, there's a bit of an adaptation to be made at the beginning of anything, and Medical School definitely requires a bit of adapting. 

But here I am. I made it through the first three weeks, and I'm happy. So far, honestly, there's nothing really difficult, there's only a LOT of stuff. They throw everything at us, and a giant bibliography for every class, that we have to read, summarize, and post on the online forums for each class. That is also graded. Then we have homework. Then we have one exam a week, on Fridays, which are a compilation of everything we learned that week in all classes. 

We're learning a lot of concepts in public health, like equality in healthcare, the right to Health, the determinating factors of Health. And bioethics. Also, communication technics for how to conduct an interview (HPI). In a week we actually get to conduct our first interview with a member of the community (not a paid actor!) where we'll be working with health education, primary care, prevention, etc. They really do throw us straight into the deep end to see if we can swim. 

But I was expecting this. And I must say, I really like that we have a test at the end of each week, because it helps me to keep on top of things with somewhat manageable amounts of material, as opposed to having thousands of pages and concepts to go through at the end of the month. Hopefully I'm not forgetting things right after the test! (I'm not, actually!) 

So, that's what's going on this side of the world. How are you all doing? How was your beginning in Med School?

Why medical school?

I guess this is the first question you might ask of someone when you hear they want to go to medical school. It's definitely on a lot of med school interviews (probably all!).

So here's the thing: I have always wanted to be a doctor. Since I was 3 years old and could barely formulate a full sentence, I already knew I wanted to be a doctor, and incredibly, that has never changed. I tried to put it aside, I pursued other interests, other careers, graduated from college, learned a few languages, lived all over Europe and the US, traveled all over the world. Nothing was good enough.

About 3 years ago I realized that nothing I did was going to be good enough, if it wasn't medicine. I decided to bite the bullet and go for it. Of course, then came the questions:
Do I have what it takes? Am I good enough? Am I too old?

However, I am  going for it, and will be officially starting Medical School in March 2015, in Uruguay (my home country). I was supposed to start March 2014, but bureaucracy got in the way again.


So what are my reasons? Why do I want to go to med school? Why become a doctor and not anything else?

The normal answer is "because I want to help people". Yes,  I do want to help people. But that's not nearly all. I’m fascinated by it all. By the human body. By the fact that the large majority of people, if they take the slightest amount of care (i.e. don’t eat lard everyday and move around a bit instead of being a couch potato), don’t have many problems and live a reasonably healthy 60 or 70 years. Our bodies are incredibly good at keeping themselves healthy and regenerating.

Beyond that, I’m bored with most everything else. I’m not a math person… it’s not that I mind it particularly, but it’s not my thing. I want to do something meaningful, I don’t want to work just to get money, or fill the pockets of someone else. I want to do something that makes a real difference in the world TODAY. I like reading and writing and researching. I enjoy it for a time. Then I get bored. Does this make any real difference in anybody’s life? If I wasn’t sitting here correcting research papers, would it make a difference? would somebody live or die based on me going to work today? no. Nobody cares. There’s no purpose.

I guess what I want is for my life to count for something. I want to use whatever talents or knowledge I have to make a real difference in someone’s life *today.* Not tomorrow. Not in a general “I managed to pass a law that makes people pay less taxes.” No, I want something that I can see. That I can measure. Something concrete: they were in pain, now they’re not. They almost died, now they’re doing well. I need to know that I’m not just taking up space and oxygen in this world, but that my existence benefited humanity.

I guess that’s why I want to be a doctor.


This chart over at A Cartoon Guide to Becoming a Doctor hits it squarely on the head:

I cannot imagine doing anything else...