New Phone. Check.

First order of business was purchasing a new cell phone. Over these last two years, whenever I came back home between semesters, I had to revert back to the same flip phone I bought as a freshman in college. I had a "free" upgrade available so I decided to splurge on the new Samsung Galaxy S3 despite my mom's emphatic protestations to wait for the iphone 5. I think I made the right choice.

please notice my lovely St. Maarten-themed wallpaper

So Long St. Maarten

American Airlines Flight 2144 started the slow turn at the top of the runway preparing for takeoff. I took my last look of Maho Beach, the brilliant blue-green ocean, and the insane tourists who insisted on standing behind the jet blasts. A few others were lined on the cinder blocks out of harms way all waving goodbye. It wasn't until this moment that it really hit me that I was leaving St. Maarten and I wasn't coming back. As happy as I am to be returning to my family, boyfriend, and friends in New England I still felt an overwhelming sadness. It took everything I had to stop myself from crying and scaring the poor gentleman sitting next to me on the plane. I kept thinking to myself "it's the end of an era! This is the end of an era" since I often reference my existence back to Friends (The One Where Ross Hugs Rachel). There will never be another time in my life where I will be living on an island with all my friends studying medicine.  No more lecture hall everyday with my 120 classmates. We weren't all going to show up at the same club or lounge and just take it over. No more living in a bubble of perfect weather. No more running across to the casino and getting free money. No more Thai dates, no more $2 beers, no more Cuban cigars, no more Carousel, no more parking wherever we felt like, no more jogs to Tahoma/Beacon Hill, no more coffee shop happy hour, no more random conversations with the Sugarcane bartenders. I  could go on and on because there are so many little things that I loved.

When you spend everyday with the same people for nearly 2 years, you can't help but start feeling like they are your family. A few months ago, a friend of mine likened our experience to "going to war together". She added that maybe it was a strange analogy, but I completely understood her. We are tossed in a foreign country in a high stress environment and we have no choice but to lean on each other to get through it. You build a bond, strong bonds with those you study with and celebrate the good times with; carry on the traditions of birthdays, Thanksgiving, 4th of July, St. Patrick's Day; you cheer each other on to get through the grueling study hours and examinations. From my own personal take on things, I never felt like school was a competition here at AUC. I felt people did a lot to help each other out whether it came to group studying, tutoring, giving tips on professors, or trading notes and files. There's nothing I want more than for my classmates to do well, succeed, and kick ass in the Step and clinicals and secure great residency spots. For those who know me well and maybe even the few of you who have read my entire blog, I am an intensely loyal and proud person. You know I love my Patriots and Celtics, Boston, Rhode Island, and now I've come to love St. Maarten,  my AUC family and all my Caribbean med schoolness. Most of us who end up here have experienced rejection, but none have let that get in the way of what we wanted to do with our lives. It's that unwavering drive and determination and then recognizing that same struggle in one another that binds us all together. We are better for it. 

I can't speak for anyone but myself, but all I have to say is I *loved* my 20 months here in St. Maarten and I can't believe this chapter of my life is coming to a close. It seemed like just yesterday that I was a firstie and the 5ths were telling me to enjoy every second I had on the island because time flies and we're only together in one place for such a short period of time. I didn't believe them at the time, but they were right. Time flies when everyday is the same and I'm going to miss everyone and everything here. No matter what I do or where I end up, I will always carry a piece of St. Maarten with me and for that I am thankful.

And now for my anthem of the last 5 days on the island (I averaged roughly 4 hours of sleep)

Rotations at the St. Maarten Medical Center

Borrowed this from Benji's Blog

You finally get your first little taste of clinical medicine during 5th semester. The ICM department requires all fifth semester students to sign up for two rotations of your choosing and they can either be at the St. Maarten Medical Center in Philipsburg or the Mullet Bay Clinic right by school. There are one-hour rotations and four-hour rotations and the specialities available are as follows: Pediatrics, Family Medicine, Surgery, Anesthesiology, Emergency Medicine, Radiology, Dermatology. There may be a few more, but I can't remember them as of now. I ended up doing a one-hour rotation in pediatrics way back in early June and I just had my last rotation, a four-hour emergency medicine stint two weeks ago. Seeing that I am required to write a reflection of each of my experiences, I figured why not just make a new blog post out of it. The alternative would have been writing a poem, singing a song or doing an interpretive dance... And you think I'm kidding.

Pediatrics

I ended up rotating with one of my good friends and two other AUC students for this one. The four of us plus a team of nursing students pretty much ran around with Dr. O for an hour going from room to room learning about each of the patients inside. We started off in the neonatal intensive care unit and saw a some really tiny, tiny babies. They were premature and needed to be put in incubators since they didn't have enough body fat to keep themselves warm. We then looked at another baby and Dr. O asked us what was different about him. After a few minutes we determined that he had Down's Syndrome. It can be tough diagnosing it at such an early age, but there are some tell-tale signs physicians can look for like the "sandal gap deformity" where there is a wide gap between the big toe and the rest of the toes. You can also see excess nuchal skin of the neck (also seen in Turner's Syndrome), Brushfield spots in the eyes (little white deposits of connective tissue in the iris arranged in a concentric ring). Not always, but sometimes the infants can have the "typical" facial features of Down's syndrome like the flat nasal bridge, and upslanting of the palpebral fissures. And usually a lot of these newborns are hypotonic, requiring a lot more support from examiners to hold up their head and shoulders, while the arms just flop back with gravity.   

Nuchal Skin Fold

Sandal Gap deformity

Brushfield Spots

After leaving the neonates we then went and saw some of the older children with their parents. I can't remember much of what we saw during this time, but I do remember two children in particular. One was a little boy who was diagnosed with asthma. I just remember seeing him sitting outside in the tripod position with his labored breathing. Dr. O pointed out the movement of the child's chest while he was breathing. It was just going in and out very rapidly, which is typical to see when someone is having an asthma attack.  The last patient I remember distinctly was a young teenage girl who had Sickle Cell disease. This also happened to be my first real pimping experience and I failed miserably. Dr. O asked me how someone gets Sickle Cell Anemia and I nervously and not-coherently started getting into the genetics about the glutamate to valine mutation and the recessiveness of the disease and all this other stuff when he cut me short and said he was only looking for "it comes from the parents". That was my "oh" moment and I felt a little silly. I'm not sure how I'm going to handle pimping during rotations when I can barely form a cohesive sentence to a simple question like that. Dr. O then asked what kind of medication you give to Sickle patients and the answer was hydroxyurea. It's funny he asked that because literally two hours later during pharm, our professor taught us about hydroxyurea in class. It's used because it increases fetal hemoglobin production in Sickle Cell patients, thereby reducing the dependence on HbS. The same question also appeared on our final exam, and I knew it without thinking thanks to Dr. O. It's funny how much easier learning material is when you can actually see it in a clinical setting. I think that was my main take away point from my peds rotation. Actually seeing patients with certain conditions just stays with you; Reading it from a book.... not so much. Seeing it and then going home to read about it and reinforce it-- even better. I can't help but get excited for clinicals for this very reason.    

Emergency Medicine

I heard that this rotation was hit or miss in terms of how many cases you would see. It was definitely a miss for me, but it was no fault of anyone, just the luck of the draw. Maybe part of the problem is that I went to the emergency department for four hours on a very sleepy Sunday afternoon... I probably shouldn't have expected much. I was the only AUC student for this rotation and basically just followed Dr. B around as she saw a couple cut and dry situations. One guy was brought in by his wife because he fell on his shoulder while playing soccer. Treatment? Sling and a pain killer. Another lady came in because she fell down and sprained her ankle. Treatment? Pain killer. There was an older girl who came in for a terrible migraine. Treatment? Turn the lights off, comfort her, and let her rest. There was an Italian couple that wandered in with a pushy third friend who served as our translator. The woman was on Warfarin but had been having vaginal bleeds for the last week so they were looking for an INR to measure her coagulation. 

The most interesting event of the day ended up being my last case of the rotation and it was when a 6 year old boy was brought in by his grandmother because of a cut on his head. Apparently he had been cut by glass and he required stitches. I had never seen anyone get stitches before and I didn't want to be in the way so I stood a good 10 feet from the table watching in horror as Dr. B sewed the little boy's head up while he squirmed around. The cut was superficial and only needed 4 stitches, but I'm just not used to seeing blood. My recurring thought was what if she sticks him accidentally in the skull? I was standing so far away one of the nurses physically grabbed me by the arm and pulled me right up to the table and was like you need to watch this! And I'm glad he did because after I got over my initial fear of seeing a needle go into someone's head, it was actually pretty cool watching Dr. B at work. After seeing that relatively simple procedure, I think I may actually be able to stitch someone up myself now. Any takers?

Related Articles:
Benji ended up doing Surgery and Emergency Medicine during his 5th semester. To read his experiences click below!
My Day in the O.R. (caribbeanmedstudent.com)
My First Taste of Emergency Medicine (caribbeanmedstudent.com)