You know it's a good night when...

You wake up in the middle of your tile floor because your alarm went off for yesterday's exam!

WOOOOOOOOOT END OF FOURTH TERM!!!!!!!!!!!!!!!!!!! I can't freaking believe it!!!

I also can't believe I ended up swimming off Prickly Bay. For those who try that, by the way, it is damn near impossible to get back onto the dock unless you happen to run into kind Trinis that let you use their boat because you're stuck in the water because the dock's too high.

Great great great GREAT night!!!!!!!!!!!!

And to those who managed to get me into the taxi post Bananas, thank you!

Last one up!

Man oh man... my last exam of fourth term is in 11 hours, and do I ever *not* have the impetus to study for it.

This week was started off by the last path exam, as mentioned, and in it being the last came one of the biggest feelings of relief of my natural class. The boogeyman of SGU is no more. Well, hopefully. It was pointed out to me that they're not going to post the grades until Friday at 4. Now, they usually don't post until the Friday afterward, ostensibly so you aren't distracted for your other exams.

So then why, 4 PM? Hmm... Friday before everyone leaves, post the scores at the end of the day, most people leaving this weekend, so there's no way anyone can contest anything. Clever, path department. And fairly typical of them.

I had my CPD lab exam on Wednesday and got the super duper nice examiner with the half-compliant, barely awake patient. And no, that wasn't his "condition"; that was actually the way he was. He also didn't have deep tendon reflexes, which is disheartening when you're trying to perform them for an examination, until the examiner informs you of this, and lets you beat on her with a reflex hammer.

But she was really sweet. Complimented me on my kit; asked me really fair questions, didn't do that "insane amount of pressure and criticizing your every move" thing which some of them do, and it really screws up people's mojo.

So that was good. But it still is hard to get up the effort to study for the written. Instead, I'm so overwhelmed by the fact that in a week I'm going to be in Berlin that it's hard to focus on anything else. I'm examed out. I'm tired of filling in scantrons, tired of my student ID number, tired of standard issue #2 mechanical pencils, and wish to increase my etOH content.

On the plus side, the frequency of exams is starting to reduce the catastrophizing I did previously upon their arrival. It's easy to completely freak out when you're in your first term ever of medical school, each exam is worth roughly 50% of your grade, and you haven't figured out yet whether you're smart enough to be in med school. By the end of fourth term, it's almost an "Oh my god, I don't care anymore" sort of vibe. "Let me drop a letter grade because I can't focus for an hour. It's all the same."

More and more, people are planning less for the exam itself, and more for how they're going to schedule their packing around the festivities planned for ending 5 and a half months of pretty hard work.

The lack of nutrition is probably also contributing. After discovering my milk had gone bad, I had dry frosted flakes for breakfast and then at dinner, discovered a packet of chicken flavored top ramen hiding behind my IGA shopping bags, so didn't have to go hungry. And I can't go to the store because there's too little time, yet I somehow have a ton of food that I don't have the base ingredients for. I could have an 8 course fine dining dinner if only I had that cup of milk, or that one egg or those two tablespoons of butter.

Pretty collegey, eh? Now... to endocrine or not to endocrine. That is the question...

No more path!!!

Wahhooooooooooooooo!!!!!!!!!!

Well, barring some horrid mishap, but no more path!!!!!! Test over! Now, to attempt to focus on CPD for the next week, which is no easy feat, and then no more fourth term!!!

As for the third path exam... not as bad as it could have been considering a lot of the rumors surrounding it. It's not typically considered as horrid as the second exam, but a lot of people have said it tends to be just as hard, or the like.

Though renal. Holy holy crap was there ever a lot of renal. Epic renal. Renal renal renal renal and again with the renal! You wouldn't see more renal if you shoved your head inside a kidney.

A visual metaphor

Or one hopes, at any rate. We're scrappy, we're tired, but we're still flying.

The end of fourth term is basically an exercise in stamina. Everyone's left, the island kind of forgets about us, places are closed early or have limited selections, our friends regale us with tales of their summers, and all the while, we go "Just four more exams. Just three more exams. Just 9 more days. Just x more hours." Most people have forgone the thought of an "A" for a hope of getting out alive; everyone has a grim look about them, and this term has explained to me just why, in first term, all the upper termers always looked so much older. Not by way of wrinkles or physical age, but just kind of a weariness that doesn't necessarily bely unhappiness (though sometimes it does), but utter exhaustion.

In the meantime, I'm trying to maintain the impetus to study, while what I *really* want to do varies back and forth between wanting to lie on my bed tucked under the comforter with the A/C on and the lights off and plan for the fact that I'm going to be in Berlin in less than two weeks, focus on hostels, plan my day trips, and pretty much do everything *except* study path and physical diagnosis. I'm in that period where I want an extra week to offset my laziness, but know I wouldn't do anything with it anyway, while at the same time, want it all to be over now, hell to the consequences so I can go get my Boston and Europe on.

The list of things I have to do before leaving grows longer as well. Clean, empty the fridge, pack, arrange my rent and stuff for while I'm gone, get the taxi, order the Eurail pass, clean more of my clothes, wonder if I've got enough and the right kind of food to make it until the end game. Tip my housekeeper. Plan plan plan. But that gets in the way of study study.

Yesterday, after determining yet again, that I don't have TB (woo hoo! They got the tests in!), I managed to rebirth the renal packet so that I feel pretty confident in it. Today's task is endocrine. Tomorrow and Sunday will be male, bone, and CNS, and forensics will be part 'attended lecture' and part 'spent four years in a morgue'.

It's been raining since last night, so the sky is gray, which I love. It's kind of a hard mix between wet and dry season. During dry season, it's hot all the time, the weather never changes, everything gets dusty, and all that lush jungle foliage surrounding you dies. There's no crabs around, the lizard populations wane, and it's just not as fun. On the other hand, during wet season, you can easily get drenched by unpredictable torrential downpours and while you get the crabs and lizards back, they bring with them the roaches and ants. What to do; what to do? But I welcome back wet season so long as it doesn't delay my plane.

Hang in there comrades; we're almost out.

Lawnjockey

Good gods I need a haircut.

My steam runneth outeth

And such-eth.

Arrrrrgggghhhh, the final stretch is the worst. On the plus side, the last CNS lecture closer was not only by a prof I like, but was 16 minutes long just to tie stuff up, which meant when I saw the length on Sonic I did my little happy dance.

Not really sure why seeing the length on Sonic affects my mood as if I'm tied in for each one until the bitter end, yet when I see 42 minute lectures, I cheer, and when I see 58 minute lecture ones, I groan, as if this somehow affects the amount of information I need to get or decreases my study time. I think, because the conclusion of each feels like progress, and that progress gets closer, as I tally down my "how many lectures I'm behind" count.

Now, I'm determining if the forensic path lectures next week will be the first time I've regularly attended lecture since midway through second term.

In my struggle to continue my streak of procrastination to increase panic mode as we close in, I did some laundry today, though it may have been a good thing, since my normal pre-exam mode thing is to leave it all until I am COMPLETELY out of clothes a day or two before the exam, which of course means I can't do laundry, and of course DOES mean having to sit the exams in my least gnarly pair of scrubs. Coming back from laundry, I saw two guys from my complex taking pictures of what I initially thought, was the pick up truck parked on our lawn. Turns out it was the bull NEXT to the pick up truck, who had wandered into our front yard to munch on the bushes and grass, so to prolong my attempts to not study, I tried to feed him a branch and he licked my hand, but rejected my offering. Picky bulls.

If I ever do get near one of those Looney Tunes style mean scary bulls, I am going to get killed to an extent that will make the coroner vomit. I just don't have the sense to be scared of the things because they look like... well... cows. And cows just don't look scary. Or fast. I'm sure those will be my final thoughts when one outruns me and sticks its horn into my skull.

Speaking of random violence, I saw the last half of 300. It was educational. First, I learned that while it's awesome to watch guys in leather speedos fight, it doesn't make for wildly effective battle protection. Second, I learned that Persians are easier to kill than stormtroopers, and a fair number of them that actually planned ahead and donned armor still managed to get slashed to bits with minimal effort by guys in leather speedos. I'm not sure who to be more embarrassed for. The Persian faction *did* demonstrate some poor planning by piercing everything though. As anyone with hoops or a belly ring that's been to a rock concert knows, this is extremely hazardous, and grows more so when your enemy likes to fight in close combat.

A bit more...

Since I generally complain about exams, but this one was special.

On the plus side, no one can fault the people doing the nutrition exam for not getting our grades out fast enough. I suspect this is because instead of actually reading the giant pile of challenges against what was an extremely poorly written, error-ridden test, they tossed all the challenge sheets into a paper shredder, since the assignment of this term's nutrition was turned over to the path people, and that is how they treat and address all student concerns.

And yes, I got lucky, so no, I'm not protesting on my own behalf. Unfortunately, for a HUGE number of students, including people who'd had 4.0s, people that had never failed a test, people who put forth an admirable bit of effort to try and give this class time in the midst of what is already a hellish term for us without needing extra help, were not so lucky.

This means a number of students now have to reschedule flights at great cost, deal with an "F" on their transcripts, have to deal with recovering from this exam or cope with an "F" for what was an unfairly written exam and keep their spirits up for upcoming exams. And we all have to deal with a department that feels absolutely no accountability whatsoever to the students it serves.

As students, particularly this term, we are constantly badgered about professionalism, and our duty as doctors. We are expected to show up on time, be accountable for our own actions, initially were expected to have a dress code without warning, and conduct ourselves in a manner befitting our future professions. It is not unreasonable to expect that those who instruct us be held to a similar standard.

Nutrition final

Well, that sucked.

And not sucked in a "gee, that was hard" sort of way. Sucked in a sort of poorly written, convoluted answers, tons of random memorized numbers, misdirection in the lectures, fairly deviant from the lecture objectives, sort of way.

Instead of focusing on the objectives, key concepts, and the like, instead we were tested on such critical things as being able to rearrange calories and kilojoules (which fortunately, I can do), memorize exact protein intakes, and a few cases, analyze a patient who's history promised complexity for which none was given. Example, how you assess and recommend for someone's vitamin D status depends largely on how much time they spend outside, their skin color, and their location, ie, you are going to give a different recommendation to a Caucasian bike messenger in San Diego than you are to a dark-skinned African-American woman who works the hospital night shift in Northern Missouri.

So that was really irritating. And now, I get to suck it up, lament the time I spent studying for that waste of a class when I could have been studying for path, which I now have two weeks to get caught up in, and prep for my PD quiz today, which also would have been time better spent.

Sad part is that in nutrition, I actually watched all the lectures, stayed pretty up on the material, and read all the lecture notes pretty carefully while taking notes, despite the fact that it was boring the crap out of me and making me long for the fascination of endocrine pathology, and I feel pretty much like it was for nothing.

Still crazy...

Nope, not from panic attacks. I like to mix up the crazy so no one knows what to expect. No one likes a predictable crazy person. It makes them seem almost sane.

Nah, this is more of the internal-doubting myself as a person form of crazy where I end up thinking strange things, and stranger than "electrical banana"... quite rightly

Today, despite the nutrition final on Monday, I've been procrastinating like hell (who me?) doing those last four lectures, which I chalked up to me being back to normal, so no harm no foul.

Until FINALLY, after like 8 hours to get through 4 lectures, not for the normal reasons but because my brain kept wandering off (also not unusual), I finished and figured I should try to stay on top of my path lectures so I don't wind up way behind right after the nutrition final.

*That* held my attention. And I was trying to figure out why... was it because I started path later and tend to thrive better in the late at night? Was it the fact that I don't have an exam on it on Monday so it (theoretically) doesn't cause as much stress because it's not directly hanging over me?

Nah, it's because it's more interesting. Yes, that's right... nutrition, which I almost get 10 extra credit points on just for being female, since we're taught from birth to be obsessed with our weights, is WAY less interesting than endocrine pathology. To a point, where I couldn't even pay attention to it and resented the parts where it even got remotely difficult, yet path stays difficult, and MUCH better time getting through it. Maybe it's the threat of death.

What's doubly unfair in this is that though nutrition tends to be one of those subjects I'm suspicious of due to a nasty predilection to make things up without any kind of statistical support, they actually addressed and acknowledged that problem and presented areas where the research was sketchy, gave values on good studies, and all that stuff that perks me out of the "bad science" irritation I felt for most of public health (did you know that secondhand smoke kills over 10 billion orphaned periplegic nuns per year??). They even addressed that whole correlation not equaling causation thing that drives me absolutely bonkers.

I think the wonderfully impending Prague thing is also impinging on my minimal attention span. I bought my backpack, am checking out luggage cubes, am thinking of what stuff to bring, to pack, to eat, to be merry, whether I'll sleep on trains, or with earplugs and whether I'm going to be able I'll be able to muster enough broken Gerglish to buy a train ticket to Prague when I'm in Berlin. Are my vaccinations up to date enough? Will they penalize me for my body's stubborn refusal to develop varicella titers despite the fact that I was never able to get chickenpox as a child despite parental efforts, and have now gotten shot up with the vaccine about 5 times? Will the doctors like me? If a bleeding patient is screaming at me in Czech, will they be comforted by my ability to say "I'm American! I speak a little Czech! What time would you like to go to lunch?"?

Ya know... the important questions, unlike questions like "I wonder how badly I can tank a one unit class if I'm thinking about German beer during the final exam?"

Another final?

The nice thing about fourth term is it starts to kill that test anxiety by throwing them at you so often, you just stop thinking of them as being the catastrophic events that will make or break your entire future, as it seems in first term.

It also demonstrates an extreme ferocity of bad planning... for instance, I was lamenting that our clinical skills written exam was on a Monday that followed a week of killer exam, which then itself was followed on the same day by lecture, and then switching our lab schedules around on the same day.

Now, it's going to be demonstrated by our nutrition final on Monday, a fact I think a few of my colleagues are still unaware of, followed by pathology lectures, followed by a Clinical Skills quiz. On the plus side, the C/S department at least seems to not like the schedule either, but we've got real live patients coming in on Wednesday (versus our common practice of using each other), so we can't switch.

Yargh.

In other news, I'm doing my path slides now after struggling to remain caught up despite killer integrative, difficult "Gee, I wish I'd learned physiology" path lectures, along with nutrition lectures that suddenly decided to change from being fluffy bunny to being biochem difficulty in the last week before the final... oh, and we have an online path quiz to do that previous weekend.

See what I mean?

On the other hand, contrasted to most of my posts in second term, where I was in my deep depression and came across as if I wanted myself and everyone on the island to die in a fire, I seem to psych-wise, be doing okay, and have been kind of skating an optimism from third term that has turned to cautious optimism.

I think it stems from second term being largely misrepresented as an "easy term" because you have large breaks in the day rather than having your scheduled packed with labs, which is probably true for someone who attends lectures. This gave me a faulty impression of it, particularly since it involved immuno, which was incomprehensible for a number of reasons, and physio, which I still consider to be the most conceptually difficult class in medical school (yes, including pathology).

Fourth term, on the other hand, is given such a reputation as you progress through first second and third term, and is so long, that anything short of being pinned down while they drip boiling lead onto me is something of a relief.

My path group also helps, and seems to kind of make or break your psychology in fourth term to a degree.

You may have heard (good) advice on getting together with a path group that has similar study habits, if you're a good-grade person, go with other gunners, don't group with lazy people, etc.

I have found it more critical though, to be with path people you psychologically mesh with, so long as no one is pathologically lazy, because nothing will kill your will to live more than having to spend nearly every weekday with people you do nothing but argue with, criticize, and terminally dislike.

And my path group is generally awesome, laid back, and gets along well, which does a great deal to ease my stress, so thanks, path group. We also have people that readily volunteer to do the administrative work, which is a relief, because if you think I'm lazy on study methods, just wait until you see the degree of half assery I do at arranging things.

This is not to try to gloss over how nasty fourth term is, and it's breaking the spirits of many, largely by just running us out of stamina, but for any going back and reading me, it does have the potential to get better.

I'm also feeling that calm sort of adjustment to island life that I was gawking at in 4/5/6th termers back when I was a wee first termers. Things like... we received an email that they're going to start getting all the stray dogs off campus, and they've reminded the police (who didn't know) that having unleashed yard dogs wander around, form packs, and occasionally attack people, is actually illegal. I figured "Eh, most of the dogs around here are easily scared off, and when I walk in areas that aren't as good, I tend to carry a big rock around to throw at any that aren't easily dissuaded." When I saw upper termers roaming around with rocks and sticks earlier on, I figured they were faux weapons to guard against *people*. Silly me.

Today, I treated myself to take out food, which was a combination of Indian and Chinese food, the latter of which was pulled out of a plastic container by hand, and I was advised to microwave everything when I got home so it would be warm. My response? "Mmm! Chinese food!"

Not bad either.

I know now to not only watch out for dog doo (see above), but also unconsciously avoid cow doo and goat doo when I'm walking on the sidewalk home from school.

I know the disinterested "move along" wave when reggae buses honk at me for a ride when I'm walking home.

I'm learning the flight schedules. Liat's had more of its evening flights leave on time, and when you're out near the Chinese embassy, British Airways always turns and flies over so close you feel like they're gonna skim your forehead.

I'm learning the best sunset points, and that locals with bottles and line can catch way more fish from them in forty-five minutes than I have in my entire life.

I'm learning that my shower is actually warmer when I just don't even bother turning on the switch for the heating coil.

I've gotten the perfect arc shot on tossing matches into the sink from where I light my stove rather than nailing the floor or my drying rack.

So it's coming. It's coming. Hopefully understanding endocrine will come as well.

Who am I?

After fighting with my attacks of sloth, I determined last evening (after yet again, killing time) that today would be a productive one. I've made this promise to myself many times, which usually means I'm going to be somewhere between marginally productive and moderately productive, which will also involve killing somewhere between 4-6 hours of pure, not-really-enjoyable, unadulterated procrastination. This differs somewhat from my just "screw it, I'm recreating" periods where at least I'm enjoying my time off and doing stuff that is more representative of living on an island in the Caribbean rather than watching Dharma and Greg reruns (I'm not proud).

Today, on the other hand, I got up at my normal late time, and then proceeded to do 8 nutrition lectures, 1 path lecture, my dishes while listening to path review lectures, and my laundry.

This is so confusing... it's like I don't know who I am anymore.

On the other hand though, minus the laundry, dishes, and more note-writing-pause-frequently path lecture, the addition of Sonic Foundry to my life means that all this productivity essentially consisted of me lying on the couch watching "tv" for about 10 hours, while periodically shoving a can of corn under my right scapula because I've actually strained a muscle due to *taking notes* and am trying to work the kink out without having to learn to be ambidextrous.

Wanna feel out of shape? Injure yourself more while studying than you do while hiking through a rainforest.

On the plus side, I'm not alone. The people without study-related back pain are probably in the minority; I know a few people who've started on sciatic sciatica from having to sit for so long (I've carefully avoided that one by rotating between couch, chair and bed so that all parts of my body are being equally abused), neck strain, muscle aches, hypertension, hypoglycemia. Essentially, despite 8 nutrition lectures, the most I've learned is that the worst thing you can possibly do to your health short of injecting heroin and bacon fat through a dirty needle into your eye socket, is attend medical school.

BUT I have clean clothes! And some nutrition may have been sinking in because on Friday, I stocked up my backpack with stuff from fruit/veg guy to try to attempt to wean off my fully vitamin-free diet of simple carbohydrates largely prepared by tossing in a microwave with water (top ramen, I'm looking in your direction).