1st Semester

Bananas for Panoramas

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Fort in Marigot, St. Maarten

Tylor

Tylor enjoying the view

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Shore Point Beach – St. Maarten

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Ye Olde Reflection Pool

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In the early stages of my medical aspirations, I was finishing up an undergraduate degree and working part time as a waitress in the snowy hills of the Stratton Mountain Ski Resort. There, I met a Harvard Medical student who divided his time between shifts at the mountain clinic and bussing tables. With each conversation I was amazed at how incredibly humble this man was. He had completed a molecular biology degree at Yale University and was just about to graduate from one of the top medical schools in the country in pursuit of a residency in neurosurgery. Yet here he was, taking a battery of sugar packets from misbehaved children and still reluctant to offer any information about his incredible journey for fear of sounding egotistical. I remember thinking; “Wow his parents must have really raised him right. All of these accomplishments and not an ounce of superiority”. After completing this semester, I’ve realized that medical school in itself is the humbling experience (not to say that his parents didn’t do an awesome job).

At AUC, more accomplished, experienced, and intelligent individuals constantly surround me. It can be discouraging, especially when others receive higher marks despite the excessive amount of time I put into my studies. Attempting to memorize the material will not suffice. The answers you seek in an examination will not be regurgitated material from your short-term memory. It takes practice to be able to incorporate the information into a different context and not simply recognize it from a PowerPoint slide. For each course, a different method was required, but it always helped to discuss difficult concepts amongst friends (BRS questions for anatomy, tutoring slides for MCB).

Anatomy lab is one characteristic of 1st semester that sets it apart from all others (Rohen’s Anatomy was extremely helpful here, otherwise I had no idea what I was looking at). I feel I have gained an astounding life experience that not many can share. It was in lab that I had the chance to hold a human brain in my hands and see the delicate network of the Circle of Willis. Its difficult to grasp that this was once a living person capable of love, happiness, and distress. As I moved his intestines aside to localize particular organs, I wondered about the birthday cakes or romantic glasses of wine no longer able to pass through his digestive system. How could any of these individuals truly comprehend how exposed their bodies would be to the world? Did they realize that as they were taken apart, their tattoos or fingernail polish would remain long after death?

I took two cumulative shelf examinations at the end of the semester for MCB and Anatomy. Unfortunately, by this point, I was completely burned out (probably due to lack of exercise – that will change next semester) and could not gather enough motivation to sit down and study my little heart out. This resulted in a couple grades I deserved; nothing horrible, but nothing to be proud of either. I’m just hoping I can still make Dean’s List. At the moment, I’m too lazy to calculate my actual average (every course is weighed differently) but I’m assuming it’s around an 87. I’ll know soon enough I guess. 4 days to study for each cumulative shelf doesn’t seem like a lot, but believe me, it is. After desperately trying to utilize every minute for the previous Block examinations, I found myself in the odd position of not knowing what to do with all of this free time, which resulted in some bad decisions – Netflix for example. At least I know not to make the same mistake next semester.

The pressure to perform can drive you mad. Medical school is a homeless guy searching for treasure in the middle of the rain and finding a bag of gold coins – then slowly finding out they’re all filled with chocolate. Even though he’s heartbroken he can’t complain cause he was hungry in the first place. A wise man will be happy because he has received that which he was longing for the whole time. A fool would discard the coins out of disgust, or possibly because they think they will find something better. Perhaps they didn’t even think finding gold was possible until they tasted a little bit of what it would be like. But realistically, gold is a fool’s search. For you cannot possibly think that a bag of gold is just waiting for you to discover it. Rather embrace all that you have in front of you and rejoice in your accomplishments and relations, no matter you meek you think they are.

Smiles,

CG

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Last Day of Anatomy Lab *tear

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Anatomy Lab 2014!

Anatomy Lab 2014!

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Are you Hardy-Weinberg Equilibrium? Cause you’ll always be the one.

741ec6bf3b76bc6656ad933a4e4f6a7b       Uno Dos Tres Cuatro!

I experienced an odd feeling today. As I strolled out of my last Block examination for Semester 1, I wracked my brain for what was next on the agenda. Then I realized – I have nothing left to learn (for the next 29 days anyway!). Although I still have cumulative Anatomy and Molecular Cell Biology exams to look forward to, Tylor convinced me to take tonight off and decompress. That was probably the best idea ever because my brain is FRIED. 4796550237ab68fabdcbd1907e28159dAfter each MCB block exam, the upperclassman would murmur – “oh you thought this last exam was hard? How cute! Just wait until block 4. Holey moley they were not kidding, but at least I scored higher than block 3! I will say that out of all of the MCB blocks, this exam was the most medically relevant, with a focus in genetics. It was neat to see how the knowledge we learned could be applied to real world scenarios.

I finally scored in the mid 90’s on an anatomy exam! This block focused on upper and lower extremities. It was awesome because they let you take your body with you to the test, which means that when you want to confirm an answer, all you need to do is flex or extend that extremity and you can feel the muscle groups at work.

The countdown to Christmas has arrived in St. Maarten and what the island lacks in snow, it makes up for with Christmas decorations! I took a picture of a festive Porto Cupecoy while Tylor and I were grocery shopping today.

Christmas Tree     Sugar maples shade a quiet country road on the Gonyaw farm during winter.

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Isn’t it gorgeous? Its hard to believe that I’ll be looking across snow covered pastures instead of warm sunbathed water in a handful of days. Its currently 79 degrees here in St. Maarten and a prickly 13 degrees in my hometown in Vermont. Yikes. For some reason, this Vermont picture reminds me of the scene from Beauty and The Beast when Belle’s father decides to take the wrong road to the invention convention.

Finishing up my last block exam of the semester is not the only thing that is new and exciting! Let me introduce my new vehicular transport system: THE CHARIOT OF FIRE. Hopefully she’ll last us for the rest of our time here!

Chariot of Fire

Smiles,

CG

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Why can’t you take a turkey to church?

They use fowl language

Unknownok moving on..

Thanksgiving has finally arrived! Gobble Gobble.

For my U.S. counterparts, I believe Thanksgiving is the first break where students can drop their heavy books and spend some quality time with their families. Unfortunately, AUC’s little island does not recognize this holiday, but that’s ok because according to my friend Blanca, we only have 22 days until its our turn to relax!

In medical school, its easy to lose sight of what you should be thankful for when countless pages of lecture material are thrust into your arms. Infinitely straining at your computer screen and trying to make sense of an essentially new medical language does not provide the ideal platform for recognizing the details we take for granted. I would like to take a moment and reflect on all I am thankful for, starting with Tylor’s and my amazing family. I am thankful for my dad and two little sisters, who send me charming texts that bring me back to reality when I become lost and overwhelmed. I am so grateful that our family dynamic has remained strong even over such a great distance. I am thankful for the love of my life (well for the past 6.5 years anyway), Mr. Tylor Purdy, who has been my rock through this entire journey. I am a person who loves consistency and resists change and I know, beyond a shadow of a doubt, that I could not have endured this venture alone. I am thankful for his mom, and my mom, Miss. Erika Floriani, who is one of the most compassionate and altruistic individuals I have ever known (besides my own father of course). She has taken me on as her own daughter and has been there with love and support every step of the way. I will always be eternally grateful to our families and close friends who have gotten me through this process and enriched my life in more ways then they can imagine.

Love,

CG

P.S. I’d like to give a shout out to these beautiful people for tolerating me! Love you guys!

Halloween 2014 with Ben, Blanca, and Diana

Halloween 2014 with Ben, Blanca, and Diana

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The Post Block III Blues

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Well, Block III examinations at AUC have come and gone, and yes, I’m still here – a little brain dead, but still here nonetheless. Block III once again included Anatomy, Molecular Cell Biology, and Histology, but guess what?! That was my last histology exam ever!! That’s right. The last histology exam accounted for over 40% of our total grade, so naturally, everyone was in a state of panic. Fortunately, Dr. D was a fantastic instructor and very straight-forward with the material. By the end of it all, I earned a 90 in the class and was able to honor histology! Wooo!.

Now that histology is over, we get smacked with another class – embryology. Its actually great timing because my best friend back home, Katherine, is in the middle of her first pregnancy and I’m the godmother! She recently found out she is having a baby boy and even though I wish I were there to watch her belly grow, I get to learn about what’s happening inside her every step of the way.

With these examinations, I feel like there are always topics in which no matter how hard I study, I am not performing to the best of my ability. There are so many fine details (especially with MCB!) and I’m beginning to realize that you simply cannot learn them all. I tend to focus on those details and lose the big picture, and I believe this technique is holding me back. Although I did not end up with less than an 80 on these last block exams, I must adopt a new method to truly excel.

These last couple weeks in Anatomy we have been focusing on the Abdomen, Pelvis, and Perineum. Its very eerie to probe around in a deceased person’s gastrointestinal system. Intestines look almost alien and its hard to believe that every single one of us looks that way on the inside. Its also incredible how everything fits into one small cavity! I mean, starting from the duodenum and ending at the descending colon, your intestines are 6.5 meters long! That is almost as long as a double decker bus! Its just amazing to me how the human body is constructed and I feel so privileged to see this miracle first hand.

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Surviving My 1st Hurricane – also Block 2 exams

Hurricane Gonzalo over St. Maarten

Hurricane Gonzalo over the Caribbean

Well I survived my very first category I hurricane, Hurricane Gonzalo, as it passed over our little island Monday night! I have to admit, as a native Vermonter I had no idea what to expect – the closest I’ve been to a hurricane was through the Weather Channel on my television. Tylor and I followed the example of our fellow islanders and bought some non-perishable items, which came in handy when we lost power for 2 days. Sure, the lack of electricity and minimal flooding was not ideal, but every unfortunate circumstance has a silver lining and with Hurricane Gonzalo, it was the timing.

Why was the timing so great you ask? Well I’ll tell you. Our block exams happened to be scheduled on the same Monday Hurricane Gonzalo paid us a visit, which means that the school shut down for not one, but two days! Because of this, AUC students gained an extra 2 days to study!

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Once again, I was tested in Molecular Cell Biology, Anatomy, and Histology.

I feel most comfortable in Molecular Cell Biology because of my undergraduate major and the instruction I received from some amazing professors along the way. For this block, students were tested in RNA metabolism, Protein Metabolism, Regulation of Gene expression, and Recombinant DNA. You have just one written exam for MCB during each block which consists of 35 questions to show them what you know. I was happy to learn that I scored a 94%.

Example Question from Recombinant DNA techniques and Biotechnology:

Gyrate atrophy (258870) is a rare autosomal recessive genetic disorder caused by a deficiency of ornithine aminotransferase. Affected individuals experience progressive chorioretinal degeneration. The gene for ornithine aminotransferase has been cloned, its structure has been determined, and mutations in affected individuals have been extensively studied. Which of the mutations listed below best fits with test results showing normal Southern Blots with probes from all ornithine aminotransferase exons but absent enzymatic activity?

A) duplication of entire gene

B) Two-kb deletion in coding region of gene

C) Two-kb insertion in coding region of gene

D) Deletion of entire gene

E) Missense mutation

In histology, we were tested on the integument (skin), mammary gland, eye, ear, blood vessels + heart, and the respiratory system. The histology examination consists of a practical grade, where you identify 10 images pulled from any of the lectures, as well as a written examination. I believe there were 50 questions, and I scored another 94%.

Example Question from Mammary Gland:

All of the following statements describe the lactiferous in a resting mammary gland, EXCEPT:

A) Intralobular ducts drain into interlobular ducts which join to form a single secretory (lactiferous) duct from each lobe

B) Lactiferous ducts from different lobes converge to enter the base of the nipple

C) Expanded and widened segments are termed lactiferous sinuses

D) The role of lactiferous sinuses is to act as reservoirs for milk in the lactating breast

E) All are true

Anatomy is definitely my weakest subject. This block covered the Skull (and trauma), Cranial nerves, Face and Scalp, Triangles of the Neck, Root of the Neck, Fossae, the Orbit, Pharynx/Esophagus, Nasal and oral regions, Larynx, and the Ear. THERE IS SO MUCH INFORMATION. Learning the pathways of the cranial nerves alone, as well as the affects of a lesion at a particular location was one of the most time consuming tasks I have ever undertaken. Below is a BASIC outline of the cranial nerve pathways, including sensory, motor, and parasympathetic functions. There are many details missing from this, but I wanted to organize the fundamentals in my mind. The upper right hand corner demonstrates the consequences of lesions in different locations involving only the facial and trigeminal nerves, which can result in various conditions such as Bell’s Palsy, Hyperacusis, hearing and balance issues, loss of taste, dry mouth and palate, etc. For example, if there was a lesion at the External Auditory Meatus (where cranial nerve VII and VIII exit), this would result in hearing and balance issues, Bell’s Palsy, and Hyperacusis because cranial nerve VIII is responsible for hearing and balance, the stapedius muscle (innervated by cranial nerve VII) usually dampens sound, and the facial nerve motor innervation to the muscles of the face is now lost.

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Sorry I became distracted for a moment there. Back on the topic of anatomy examinations. The Friday before Block exams, I got together with some really smart friends of mine, Diana included, and we hammered out some anatomy. By the end of that night, I was feeling good, but I made the mistake of not looking at the material again. You see, the thing about Anatomy is that there are so many fine details that you must comb through it consistently. The Anatomy Block Exam is divided into 3 parts: an anatomy practical, where you identify structures on the cadavers, an anatomy quiz, and an anatomy written exam (computer based). After all was said and done, I scored an 80%, which dropped my overall Anatomy grade. I know this is not a terrible score, but it was difficult to see after putting so much time and effort into something. However, this block is notorious for being the most difficult, so hopefully my grade will only improve from here!

Example Question from Cranial Nerves

A 44-year old man with “crocodile tears syndrome” has spontaneous lacrimation during eating because of misdirection of regenerating autonomic nerve fibers. Which of the following nerves has been injured?

A) Facial nerve proximal to the geniculate ganglion

B) Auriculotemporal nerve

C) Chorda tympani in the infratemporal fossa

D) Facial nerve at the stylomastoid foramen

E) Lacrimal nerve

Explanation: “Crocodile tears syndrome” (lacrimation during eating) is caused by a lesion of the facial nerve proximal to the geniculate ganglion resulting from misdirection of regenerating parasympathetic fibers, which formerly innervated the salivary glands, to the lacrimal glands. An injury to the auriculotemporal nerve may result in Frey’s syndrome (sweating while eating), which results from misdirection of regenerating parasympathetic and sympathetic fibers. The chorda tympani carries preganglionic parasympathetic fibers to the submandibular ganglion and taste fibers to the anterior two thirds of the tongue. The facial nerve innervates the muscles of facial expression. The terminal part of the lacrimal nerve contains postganglionic parasympathetic fibers for lacrimation. 

Here’s an iguana I saw next to my apartment on the way back from Block Exams – that thing was HUGE.

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That night, Tylor and I went to a sushi restaurant, Bamboo with Diana and James. Here we are!

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I feel like I’m in a good place right now and I’m excited to go to the beach for a relaxing day with my Man-friend tomorrow!

EDIT: Hurricane Gonzalo a couple days later..

Nasa Image of Hurricane Gonzalo heading towards Bermuda

Nasa Image of Hurricane Gonzalo heading towards Bermuda

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Relaxing day in Baie Rouge

The Saturday after block exams, Diana and I decided to venture over to the French side of the island and spend time with our lovely man-friends. We visited the fish market in Marigot, then made our way over to Baie Rouge, a lovely little beach a few minutes away. There, we relaxed, snorkeled, and talked about topics NOT RELATED TO MEDICAL SCHOOL. It was amazing. Here’s some pictures!

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Phlebotomy Workshop

A couple weekends ago, my friend Diana and I attended a club fair and signed up for AMSA – American Medical Student Association. One of the perks of being a member is cheap access to clinically important workshops like Phlebotomy, suturing, and additional opportunities to collect vital signs from “patients”. Multiple workshops are offered every semester and if you miss one, no big deal – you can simply attend next semester! Diana and I decided to test the bounds of our friendship by drawing blood from each other FOR THE FIRST TIME in the Phlebotomy Workshop. I was terrified, but thankfully we were both successful. I didn’t even cry.

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Block 1 Exams

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Well my first block exam has passed and I survived. There were 3 classes involved: Histology, Anatomy (Back, Thorax, Heart), and Molecular Cell Biology. Histology is the microscopic study of the anatomy of tissues, Anatomy is the study of the structure of the human body, and Molecular Cell Biology is the study of the molecules within cells and the understanding of the interactions between them. My day starts at 8:00 am in the new auditorium and these classes run back-to-back with 10 minute breaks in between them. I grab some food at around 11:30, then come back to campus for Anatomy Lab from 1-3. Because we have such a large September class this year, the labs are split into 2 groups: The first from 1-3 and the second from 3-5. These labs are further separated into 2 more groups – wet lab (with the cadavers) and dry lab.

For the first block, each exam was weighted differently in each course. Molecular cell biology was 13% (of our grade), Anatomy (including the practical where you label structures on the cadavers) was 11%, and Histology was 26%. Because of these percentages, I invested more time into Histology and Molecular Cell Biology and my scores reflected this. I did relatively well for Block 1 in general, but there is DEFINITELY room for improvement, especially in Anatomy. I know I need to spend more time going over the clinically oriented details of anatomy instead of just memorizing the locations of bones/muscles and their neurovascular structures.

For example:

An 83 year old man with a typical coronary circulation has been suffering from an embolism of the circumflex branch of the left coronary artery. This condition would result in ischemia of which of the following areas of the heart?

A) Anterior part of the left ventricle

B) Anterior interventricular region

C) Posterior interventricular region

D) Poster part of the left ventricle

E) Anterior part of the right ventricle

With this question, you would need to know that the circumflex branch of the left coronary artery supplies the posterior portion of the left ventricle. The anterior interventricular artery supplies the anterior aspects of the right and left ventricles and the anterior interventricular septum. As I mentioned before, its not enough  to simply memorize structures in the body. You truly need to understand how they relate to their surroundings and how specific areas would respond to trauma. The difficultly with this arises from the sheer volume of information that is thrown at you on a daily basis. I feel like this time has been used mainly to find an effective studying routine and I believe I have one. Hopefully by the next block exam I will have improved my weaknesses and will be ready to slaughter any medical exam that dares to approach me. BRING IT ON.

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