Mexico Medical Student |

I am so not happy with my neighborhood for constantly waking me up (more on why in a minute). I studied my ass off for my pathology exam only to find out that I needn’t have bothered if my objective was the highest grade I could get because 80% of the exam questions were all cut-and-pasted from the workbook that accompanies our text. I did go over those, because the prof said that some questions would come out of there, so I’d be dumb not to look that them, but more importantly, many of them are really tough questions that thoroughly test your understanding of the material. Pathology is one of the most, if not the most important class in the first two years, culminating everything one has had before, so I do feel somewhat cheated with our lazy professors. We have a guest lecturer now doing GI who knows his stuff inside and out; unfortunately, his lecture style could put a meth addict to sleep. As long as he submits his own test questions and they use them, it’ll be a good ride.

As for Halloween, it’s not really celebrated here. Thursday culminates Dia de los Muertos, which is a major holiday, combining both religious (95%+ Catholic here) and social/familial aspects of life. Last year, I lived across the street from school, so there were no kids hardly, but now I live in “suburbia” with kids in every house (my own too, shockingly). So how do the kids here celebrate? They get dressed up in costumes, go to peoples’ houses, and chant “Queremos Halloween! Queremos Halloween! Queremos Halloween!” (translation is the title of the post) Not happy with that, they sometimes will bang on the door or ring your doorbell incessantly, all while chanting over and over, house by house, group by group. This is what I need after staying up all night.

If you’re going to copy an American holiday, do it right, please. “Trick or Treat” doesn’t translate well, I know (most American kids wouldn’t be able to say what the “trick” has anything to do with anyway), so I move that people in all countries and languages just change it to “Please give me something for dressing up like this.”

And please don’t bang on the door.

Nothing profound will be in this post, I promise. I’m just trying to get my groove on studying. If you were to have asked me about predictions at the beginning of this semester, I would have said this is when I’d be having a blast: other than our ever-present [pre-]clinical (hands-on) classes, the only book-lernin’ classes are pharmacology and systemic pathology. Some beefy red meat there–the medical education equivalent of a 2″ high porterhouse.

Why then do I feel like a sickly vegetarian, not wanting to raise my LDL in hypercholesteremic ecstasy? Well, to be fair, it’s not that I don’t want to as much as I can’t seem to get it all in. To make matters worse, I can’t enjoy the juicy cutlet simply for what it is, because (in this all-too-worn-out analogy) I have to describe it, characterize it, classify it, file it away in a database comparing it to others, etc. In simple terms, I can’t leisurely turn the pages of the textbook and simply say, “Cool!” or “How interesting…”

Tomorrow’s exam is on vascular pathology (including all the vasculitides, athero/arteriosclerosis, aneurysms, etc.), the heart and pulmonary pathology. Basically everything cardiovascular, from the smallest capillaries to “oh shit, this aortic dissection sure came at a bad time”; all of the funky and sad congenital malformations of the heart and great vessels, heart failure, ischemic heart disease, cor pulmonale; and that leads into all the COPD, pulmonary blah blah. It’s all interconnected. And if there’s one thing I’ve learned from all of this, everything, and I mean everything will involve the kidney at some point or another, I guarandamntee you. The beans rear their little retroperitoneal heads everywhere.

See? I told you nothing fascinating was in this post. I’m just killing time. I’m tired of having to be a fact-spitting monkey almost as much as I love what it is I’m learning. After all, learning it for real (at least as best as I can with a screaming baby in the house, which–believe it or not–is probably still more conducive to studying than our poorly-managed library) is the only real reward I have to give myself at this point.

And I’m SOOO OK with not remembering that one little factoid that differentiates rare-ass disease #1 from even-more-rare disease #2. The gunners can fight for those bones; I prefer to enjoy a slightly more panoramic view.

Today is “physician’s day” in Mexico, and we found out late yesterday that we had to go to school. What a rip! The campus was like a ghost town–even the coffee shack was closed because all the Mexican students and teachers got the day off. All the International Program students, including the professors that teach us, had to come to school. I’m sure they were just as unhappy as we were.

It was nice not to fight for a parking space against a bunch of 19-year-olds who can’t drive, however.

UPDATE, Saturday: OK, thanks to Dr. Iñarritu’s comment below, I looked into the situation. As he said, it was indeed the 23rd of October that is physician’s day here, but on our campus it was celebrated along with “students’ day” in general, at our school’s main campus on Friday, the 27th. That’s why I was confused, because people were saying they were celebrating “Doctor’s Day,” etc. when it was actually rolled into more of a local student celebration. Mexicans love days off (who doesn’t!?) and I’ve even written about it before. In the U.S., there’d be more days off except to get a paid vacation costs money, not just in salary but in productivity overall. Here, things are so much more relaxed that it doesn’t even factor in.

Regarding going to school here, it seems that the more I study and learn from textbooks, the more I seem to get further away from what actually gets tested. Today’s pharmacology exam was a classic example. I did relatively well, so this isn’t a sour grapes post, but with each exam, particularly this semester, I am feeling more and more like I’m on Jeopardy being asked trivia questions than proving my knowledge of [insert class]. I messed up a few things today to be sure, and that’s my fault, but I know for a fact that certain drugs that are given high importance in this class aren’t in active clinical use (sometimes even stated in class notes, “almost never used due to toxic effects”). Whatever we learn from “older” drugs is often still useful to understand new ones, so I’m not complaining about having to know them (although nit-picky questions about side effects about drugs that aren’t used is a bit ridiculous). However, to say, “When a patient presents with X, always use Y,” when you know “Y” is neither a commonly prescribed drug nor “absolute” for monotherapy, it’s tough to hold back the frustration of a golden opportunity lost to provide relevant clinical information. This isn’t necessarily the norm in this particular class, but it is for our schooling overall. You betcha.

It’s no consolation, unfortunately, that the USMLE Step 1 is no less a minefield. The only difference between questions on 2nd year classes here and USMLE is the how airtight and solid the question is (exactly one right answer, clearly worded, etc). Due to language issues and no proper vetting system, bad questions linger around through the years in a way that would never happen on USMLE. However, the idea that you’ll be tested over the outlying fringe material disproportionately, is something I’m reluctantly beginning to accept as a way of life (at least until I’m holding that score report from the USMLE saying I passed and can put a lot of this shit behind me).

You know what I’d love on exams? Essay questions. Obviously, I’m at no loss for words in general but the ability to crystallize divergent information into a reasonably concise answer (for time, if not for space on the page) with lucidity and relevance graded second behind the correctness of the information — now THAT, mis amigos, would be exam bliss for me. Because even if I just have to accept the fact that I can’t answer the question, you’d bet your ass I’d go home and look it up, learn it FOR GOOD, ready to be pimped on that question for life. You lay the nakedness of the holes in your knowledge bare when you’re looking at a blank piece of paper, not knowing how to formulate the answer, but in doing so, there’d be a drive to pick up the pieces and move on, do better, to understand rather than regurgitate. When I walk out of a 70-100+ question multiple-choice test, I can’t even remember what all the questions were that I had issues with much less what the answer choices to choose from were. What better mental preparation for one’s clinical years can there be than essay questions? You’re utilizing the same parts of the brain–higher-level association, memory recall, language centers, etc.–as you would when doing a differential diagnosis or explaining pros/cons of treatment options with a patient. Patients want their doctors to be able to think like doctors, leveraging their vast knowledge/resources, but relate to them as people, not fellow doctors, putting things in clear terms.

Everyone tells me things get better when I get to my clinical years. I just wonder what more sacrifices of time and sanity need to be made until then just to learn how to play the game and dance like a little monkey when the cruel organ grinder begins his melancholy tune.

From the Bling h₂O website (written with ‘h’ because the apparently the Hollywood elite don’t know that there are no lowercase letters in the periodic table):

Bling H2O [note the inconsistency of the logotype presentation] is the inspiration of Kevin G. Boyd, Hollywood writer-producer. While working on various studio lots where image is of the utmost importance he noticed that you could tell a lot about a person by the bottled water they carried. [I suppose my Kirkland H₂O would label be as a janitor.]

[Bling's] mission was to offer a product with an exquisite face to match exquisite taste. The product is strategically positioned to target the expanding super-luxury consumer market. Initially introduced to hand-selected athletes and actors, Bling H2O is now excitedly expanding it’s availability… Bling h₂O is pop-culture in a bottle. But it’s not for everyone, just those that Bling.

Bling H2O comes in Limited Edition, corked, 750ml, recyclable frosted glass bottles, exquisitely handcrafted with Swarovski Crystals.

This stuff costs $35 a bottle, $420 for a case of 12 (no savings for you!). For water. The same stuff that falls freely from the sky.

I am imagining the genius of Mr. Boyd, as his little minimum wage army armed with glue guns, dab cheap-ass Swarovski knock-off crystals onto these frosted bottles before filling them with water from the hose outside his LA house. Apparently Paris Hilton uses these to give to her dog, Tinkerbell. That’s about all you need to know.

You see, this kind of ridiculous excess is why people from impoverished, oppresed 3rd-world nations see the United States and hate us so much. But it’s ok: we have good will messengers like Madonna, who will adopt/steal their children one at a time.

(what does this have to do with medicine and/or Mexico? absof-inglutely nothing. I’m just procrastinating studying for a pharmacology exam. )

Probably one of, if not the, most common cleaning products in Mexico is Fabuloso. It used to come in only purple and had a distinctive, deodorizing scent. It was such a “fabulous” product, that family members on the border would always come back from a trip across with some before it was also available in the US. Well, it’s been stateside for a while, and now that the packaging looks like a bottled beverage (here too), and that it now comes in several scents and colors (flavors?), ED visits for people who have mistakenly ingested Fabuloso have been on the rise, especially in Texas:

In less than four months, the Texas Poison Center recorded 112 cases of accidental ingestion of Fabuloso, apparently because consumers mistook it as something good to drink, a sports beverage, for instance.

So reported Michael A. Miller, M.D., of the Darnall Medical Center in Fort Hood, Tex., at the American College of Emergency Physicians meeting here. Fortunately, he and colleagues added, the product is only a mild gastrointestinal irritant and is unlikely to cause any serious illness. One of the authors even tasted it, and found it “fruity with a pleasing aroma,” but with a bitter aftertaste.

“Apparently it’s a very good cleaning product,” said co-author Marc E. Levsky. M.D. “The issue with it is that it looks like a fruit beverage. It has a nice purple or orange color. It comes in a bunch of different colors, or aromas, and it’s packaged in a bottle that makes it look like Gatorade or Powerade.”

What shocked me the most was the fact that people wouldn’t immediatley spit it out. OK, so it doesn’t have that piquant burning sensation that Drano has or that je ne sais quoi that is so characteristic of Mr. Clean, but c’mon people, you GOTSTA know that it ain’t right after a swig or two!

(Thanks to Jenna for the link.)

I don’t know why I didn’t see this sooner, but Dr. Nick Genes (of Grand Rounds fame) wrote an original piece on Medscape about the value of blogging during medical school. To quote a portion:

But perhaps even more important is that medical student blogs are useful for students themselves. It’s therapeutic to record your feelings, to vent frustrations, and to register difficult experiences. This is the kind of activity that makes for a sensitive and caring doctor — probably the kind of doctor that most beginning students expect to be but forget about somewhere along the line. Blogging can help students remember. It’s also instructive because it allows us to chart our progress through the years. On those bleak days of surgery clerkship, it may be encouraging to look back and see how far you’ve come since the first squeamish posts about anatomy lab.

Finally, blogging can create opportunities and open up frontiers. Beyond the simple scenarios that have helped me — such as getting the inside scoop on hospitals during residency interview season — getting involved with the nascent medical blogosphere can help you sift through the Web’s educational resources (such as a collection of clinical cases and archived school lectures). It also can inspire student activism or show you what life is like in foreign med schools. Blogging might even open up doors into research.

That “foreign med schools” pseudo-link you see there would have had you arrive here, but it’s live on the real article, so thanks Dr. Nick for the link! Also, thanks for a great article. The “therapeutic” value of blogging is pretty obvious, especially for med students, professionals, or anyone else in a demanding, stressful field, but the more insightful commentary is about the connections one makes. Speaking personally, I have joined a community of medbloggers that I truly feel give far more to me than I give to them, and through them I learn about so many things every day. As students, it’s important to put down the textbooks for a while and soak in knowledge and experience directly at face value, not as merely the sum of a collection of finite, discrete processes. The sum of the parts is sometimes less than the whole. Every blogger represented in my sidebar and many others I have yet to discover has his/her own unique story to tell, and through them, I am enriched beyond my own experiences.

(posted from individual writings, 14-15 October)
So I’m here on my hotel room balcony looking at the Pacific Ocean (technically, the Bahia del Manzanillo). I have never been on a true Pacific beach. The closest I got was Monterey, CA, but that was 1) way too cold (even in May) to enjoy the water, and 2) not much beach to speak of, mainly rocks. Unfortuantely, it’s so cloudy and drizzly (as it was in Monterey) that I am not going to realize the thing I wanted more than anything here–to see the sunset on the water. I came by myself because of some stuff that happened w/Claudia, and she agreed I shouldn’t let that keep me home and encouraged me to salvage what little vacation I could get for the four day weekend I had, so came by myself while she tended to her stuff.

I mention this change of plans because I downgraded the original room to the simplest accomodations, since it’s just me. Now that I’m in the sencillo (simple) room, I can’t imagine that the more expensive room would have been worth the money given it would be simply bigger with a king or 2 double beds (never know which you’ll get). I knew that this place was not resort-like, but it was rated highly by TripAdvisor. So, apparently, TripAdvisor is populated with a bunch of hippie gringos who think that lack of amenities makes things more “Mexican,” and that the notion that the less “inclusive”, the more out-of-the-way, and the more “rustic” (=run down shithole) the place is, the more of a fulfilling “native” experience they’ll get, since, after all, if they wanted The Hyatt, they’d have stayed in the U.S. Screw that. If I wanted to be uncomfortable, I’d have stayed at home and done chores. What do these people have against comfort and amenities? What’s the deal with these empty-nesters looking for a kibbutz or a hostel anyway? I want the mint on my pillow, dammit!

OK, let me say something right out–I hate bugs. I don’t mean little-girl-screaming-hate bugs, I mean I hate having to deal with them. I don’t want them in my stuff, I expect to be able to put a bag of chips on the nightstand, pop out my laptop, sip some water or Diet Coke, continue munching as I watch the latest episode of the newly-started season of Battlestar Galactica with no interruptions, and within 30 minutes not find the bag not where I left it, seemingly moving on its own volition towards the door carried by an army of little black ants.

I consider a vacation just that–a VACATION. I don’t want to clean up, I want to be comfortable, I want the room to be as cold as I want–suitable for hanging sides of beef from metal hooks if I so choose–and I think the concept of vermin, even harmless ones, like the little black “crack ants” (so named by a friend and me because they move erratically without any discernable purpose except when carrying food) should be a distant memory considering I’m 1) paying to stay here, and 2) the room gets cleaned daily. And I’ll give them that–the room was immaculately clean–it’s just that these little six-legged beasts are relentless. One thinks to pack “Off” on an outdoor vacation, not “Raid.”

One day however, long after “MD” has been attached to my name and freed of all residencies and fellowships (and also providing the trip is medically cleared by my geriatrician at the time), I will hopefully afford to come back and stay here. I bet they don’t have ants. Pfft.

---

When I first got here, I wanted to run out to the beach and just jump in the ocean, but I realized of all things to forget at home, I forgot my friggin’ flip flops. How in the sam hell can one forget flip flops when going to the beach?! Anyway, so I just removed my socks, went with my tennis shoes, but as soon as I got to the sand, I took off the shoes and went walking barefoot, careful not to step on any sharp shells or the like. I got about, oh 50 yards, when I realized I was starting to breathe heavily. WTF?! It had been so long since I walked in sand. I think I just discovered a new exercise regimen! Strip the entirety of my little postage stamp of a back yard, then raze it flat and go another 4 feet or so lower. Fill it with sand. Watch all the tachyarrythmias induced by my simply walking around my sadistically sandy backyard. Wait for HR to come down from the 200s, convert myself w/paddles if necessary, then whip me out the door. Repeat. After a few months, I’ll be all buff before you can say “tachypnea.”

---

Right now I am La Huerta seafood restaurant, having to take off my glasses due to the sweat dripping on the glasses themselves as I type this…I can’t believe people live in this humidity. I look around, and the most I see is sweat/condensation beading on ppl’s foreheads. The locals are complaining, don’t get me wrong, but they don’t seem to be miserable. I’m almost at the point of needing gills to obtain the oxygen I need from this air. I am a city (or at least suburbian) dweller, plain and simple, so if it’s too hot/humid/etc. outside, I go inside where it’s climate controlled. That’s the point of being inside, no? I ordered ceviche as an appetizer. I have never had “dry” ceviche. What arrived was a shredded mix of fish cooked in lime, tomato and onion. No juicy cutlets of fish, no avocado, no yummy, fishy lime juice to slurp up in a cocktail glass when done. For shame.

---

For unknown, random reasons, I often think what a wonderful advantage it is to speak Spanish. So many of my classmates don’t want to for whatever odd reason (why come here, then?), but they resist. I can go anywhere, do anything, conduct business, negotiate prices, etc. in a foreign country. That’s cool. I take it for granted by now, but every now and then, I see myself from the 3rd person (it’s the haldol, probably..heh), saying, “Dude, you’re in a foreign country!” Then the Bill and Ted voice goes away, and I resume my normal activities.

---

Both the worker at the hotel and my waiter said this kind of heat and humidity is uncharacteristic. Ever since the Hurricane John, things haven’t been right, they said. It’s so bad, I can’t even take decent pictures, it’s so overcast. I feel like a lame tourist, taking what shots I can take from inside my truck or from a covered restaurant deck, etc. It’s not like me–I’m the kind that goes up a hill, puts the camera on a stick–whatever it takes to get that “perfect” shot, but a photographer (I use that term loosely on myself) can’t create a shot that simply isn’t there. Nature 1, Rico 0.

OK, my 2nd margarita arrived. It’s so strong, I think I can light the top of it and leave it to illuminate this gray day. Barring that, I’m sure it’s disinfectant properties are not to be questioned. Nature 1, Rico 1.

---

“Huachinango” (wah-chee-NAN-go, red snapper) is one of my favorite Spanish words. I am mentioning this now, because a beautifully filleted specimen, head and spine artfully presented, has just arrived at my table. Huachinango is just one badass-sounding word. Cacahuate (ka-ka-WAH-teh, peanut) is probably my most favorite, though. Most Náuhatl (Aztec) words are insane to pronounce and/or spell. Popocatépetl, for example, is the largest volcano in Mexico, is one I have yet to conquer, but I think that’s a mental block. I shocked myself after-the-fact by saying, without even thinking, farmacodinamicamente (pharmacodynamically) to our pharm prof in a sentence while asking a question after class the other day, and that’s 9 syllables!

Speaking of Aztec names, I routinely torture my mother by saying that my firstborn son will be named Cuauhtémoc (kwow-TEH-mock) since, in spite of her and my entire family’s Mexican heritage, she doesn’t like things too Mexican. Don’t be confused, she’s consistently inconsistent, such as liking chiles that aren’t hot and fish that doesn’t taste fishy. Having a baby named Cuauhtémoc Huitzilopochtli (born in the heart of Mexico, no less) would drive her to drink.

---

The water is a place of healing for me. It always has been. I love the water, especially the ocean. I have lived near a major body of water all my life–South Padre Island, Galveston (in spite of the horrible beaches), and the Chesepeake Bay–all were within an hour’s drive for 90+% of my life. Now I have a bit further to go, but it’s still a day trip at least. I don’t need to be on a beach–in fact, I prefer to be on a rock(s), listening to the seagulls, watching the sand life as the tides ebb and flow. The roar of the sea speaks to me in a language I don’t understand but that I feel. Even a lake’s serene, glassy surface has its own hidden power lying underneath. Both the little high-pitched lappings at the lake’s edge and the undulating roar of a massive ocean evoke the primal memories of our fluid-filled beginnings, bringing that maternal comfort that makes one feel that somehow, some way, things will turn out okay.

I’m in Manzanillo, Mexico on a mini beach vacation. I’m writing up a storm in my beachfront hotel room because the heat and humidity is not fit for human habiation. It’s wetter in my clothes than in the ocean. I didn’t know that >100% humidity was chemically possible, but I’m proved wrong yet again.

When I get home, I’ll post all the updates, provided I don’t short my laptop from the buckets of condensation pooling off my body as I type…

For the second time in two months, Grand Rounds comes back to Mexico with today’s edition at Unbounded Medicine run by Dr. Jon Mikel Iñarritu, a recently graduated physician waiting to be accepted into a surgery residency. Read his pre-rounds interview for more. I wish my Spanish was as good as his English, but I especially wish my site was as informative as his. Bookmark this site–you won’t be disappointed. ¡Felicidades Jon!