Tales from the beginning of 3rd Year, or more like 3rd Grade

In the name of justice and of defense of others, I have found myself divulging back to the days of what seems like the 3^rd grade when I would fight with and/or yell at kids for cutting in the lunch line, feeling desires to throw their lunch tray full of starchy food products in their faces, and going to persuasively tell the local baker that he will once again be giving my buddy bread in the morning because she must be fed.  With a lot of attitude, removal of my earings, some swinging of my neck, flailing of my arms, and mobilization of my Latino cohorts with Cesar Chavez' "Si, se puede," justice was served as I lectured these four Cuban medical students/teenagers on their lack of respect for our time spent waiting in the line as they continued to cut in the lunch line every day.  I had to restrain myself from grabbing hair and punching this super disrespectful Cuban gal in the neck, realizing that losing my scholarship over rice and beans is definitely not worth it.  At one time in the past, I definitely would  have felt at-will to put my fist into her wind-pipe, or better yet…now that I am a doctor…choking her out with my stethoscope.  Time is not money for them, but I have Capitalist roots ingrained in me and sometimes time still is equal to money for me, even in a socialistic country.   I am not sure what their rationale is, because of all people Cubans know how (or did) to form a line.  They are best the line-makers ever, derived from the necessity to wait in line for hours for anything whether it be a fresh inventory of chicken or, basically, anything that has been unavailable because of the U.S. blockade against Cuba.  In fact, you better watch out because if more than three or four Cubans are grouped together, a line might form because they have given the impression that there is something good to wait in-line for, but in reality they are simply standing on a sidewalk, grouped together.  You could be waiting in for nothing. And as far as the bread-maker goes, who knows--there was a bakery full of bread, but he did not want to sell any to Heather that morning, but he will now.

Almost two months back in Cuba, and I am settling back in to the heartbeat of Cuban life.  With the help of two Cuban men, two trips in a 1952 Plymouth, myself, Buddy/Heather, and mostly recently Fabiola who has just arrived with her giant bottle of  Cazadores tequila after taking her board exam, are settled into our apartment in Central Habana. Life is grand in my new pad--running water and electricity 24 hours/day, a real flushing toilet, and a washer and a bum/moocher of an owner who has became a permanent fixture on the sofa in the living room and feels at liberty to eat our food.  Do not worry--the motivation to continue receiving $120 (divided between the three of us) each month has persuaded him to leave his own home.  Either he goes or the money goes with us.  With a $120/month, I no longer have to flush the toilet with a bucket of water, nor do I have to wash my clothes on a washboard.  I no longer have to deal with the parasitic/draining noise of teenagers/future doctors partying until 3 a.m. on a school night, like I had to do when I was in the 1^st and 2^nd grade at the ELAM campus.  Heather and I have even managed to budget in having a señora cook for us during the week.  (See, Mom!! Remember when I told you, as a little girl, that one day that I would have a cook?!)  Most importantly, I have a space to call my very own.  With my new living space/favorable study environment and having all the books I need (thanks to my caretakers/donors) I am ready to take on my first board exam (STEP 1).   

I feel like I have made that grand move to the big kids playground—that same feeling I got when I transitioned from 3^rd to 4^th grade, where the kids were bigger and the playground dynamic was more independent.  Oh wait…I get to walk off campus whenever I want to?  I am treated like an adult?!  Hospital Salvador Allende is the teaching hospital where I will be at for the next few years, gaining my clinical experience through my rotations.  It has been a social science experiment getting to know the hospital dynamic in Cuba.  Dealing with the stink-ass attitudes of the nurses, getting bossed around by the old ladies that clean the floor (how was I supposed to know that the floor was clean?).  Learning that HIPAA is completely non-existent, and patient privacy is a privilege.  But, I realize that sick patients are the same in any country.   Being medically trained in Cuba, I realize how valuable my given senses are, especially in the physical exam.  I mean, I actually have to touch patients and really, really know how to examine a patient.  Gloves are not necessary and my stethoscope always touches skin.  That is the Cuban way (or the U.S. way like 40 years ago)—relying on the physical exam to observe signs and symptoms that will lead to a diagnosis and not necessarily a reliance on labs and expensive, and often unnecessary, tests and procedures.  And there is evidence that their way works.  For instance, I am supposed to have time in the morgue every week to review pathology with fresh corpses, but there are never any bodies in the morgue.  It is like Cubans never die (in accordance with their superior life-expectancy age)!  I am responsible for two beds in the geriatrics ward.   For now, most of the wards have converted to treating patients with Dengue fever.  Sheez…every time a mosquito bites me I think I am going to contract Dengue.  I embrace the doctor-patient relationship with my Cuban patients.  They seem to have confidence in me, that I am their doctor/medical student.  It is ingrained in the medical culture here that medical students must learn/poke and prod the patient to become well-trained physicians.  Generally, most patients in the U.S. squirm and/or retreat when they see a medical student walk in the exam room.  With some of the clinical situations I have faced recently, I have to admit that I basically faked my way through the situation with sound judgment and educated guessing.  I suppose I did it well enough that I actually had two patients invite me to their house for dinner.  And then there was this one patient who found out it was my birthday and sang Happy Birthday to me in English.  The bitch-ass nurses, the other physicians, my patients, continue calling me "doctora," sometimes still catching me off-guard because I am like "who is that?"  And thus, I continue on with study-filled/sleepless nights becoming the best "doctora" that I can be.

Help me pack my suitcase for Cuba.

As many of you are accustomed to purchasing gifts for baby showers and weddings (and I am nowhere near to having either of these events), I am asking you to consider purchasing something from my amazon.com wishlist.  All of these items will be essential for the survival of my 3rd year, my first clinical year, at ELAM. If you could purchase these items before August 15, 2011, that would leave sufficient time to ship these items to me before my September 3 departure.  Thank you for your continued support.  You may click on the link below to access this list.

http://www.amazon.com/wishlist/1FRMSH7O5SV3I/ref=cm_sw_r_fa_ws_-a3nob153X1F9

Doctora!

Before we leave ELAM and enter the teaching hospital in September, we are required to know and be tested on our knowledge of the full physical exam, including all of the body systems.  Last week, our yellow-school bus of 47 was dumped off at our policlinic, wherein the emergency clinic was volun-told to administer our exam.  I looked around, and I saw doctors and nurses scrambling everywhere, a waiting- room full of patients, and I felt almost as if we were invading the policlinic as meager 2^nd year medical students.  Obviously, at the time, I felt there are more important matters to attend to, you know…like medical emergencies and patients, but not in Cuba.  They are educating us to be physicians, right?  While waiting for the attending physician to stop what he was doing to examine us, I took a seat in a quiet, dark spot down the hall to meditate and keep myself calm as we entered into the realm of performing the physical exam on a patient (a classmate), while the professor/physician scrutinized our every move to make sure that we are doing what we are supposed to be doing.  I was sitting there in meditation, when I hear “Doctora!”  I ignored the call.  Then I hear again “Doctora!”  I looked to my right, and then to my left and saw a super-dreamy physician down the hall looking in my direction.  I looked to my right and left once again.  He yelled again, “Doctora, are you part of the group here for their exam this morning?”  Then, I realized he was calling me “doctor.”  Who, me?!  So, I responded “Yes, professor.”  He was just calling me doctor.  Shit!!  He was calling ME doctor.  But, but…I’m just a little-grader 2^nd year medical student.  Nope…I’m doctor.  The attending physician stopped what he was doing, herded our group of 6 into the observation room, sitting there, waiting along the wall with the bright-metal bed pans.   This “doctor” was in awe of her rock-star professor/attending physician of an emergency clinic/cardiologist who within seconds identified a compensatory scoliosis on a patient whom I had observed as being “healthy, normal.”  Of course I had no idea what I was looking at. I performed the exam correctly for a grade of 5, but all I saw was a back with no major deformities or lesions.  Then, he carefully demonstrated to me the uniqueness of the case.  He discovered a subtle abnormality on what was supposed to be a healthy/normal patient, aka one of my cohorts.  So, once again I am reminded that I have so much to learn, but one day I hope to be a rock-star doctor, just like that dreamy-mass I saw in the shadow of the hall that reminded me that I am worthy to be called doctor [in-training].

P.S.  If any of you would like to send me some flight-money love, I am still in need of donations.

Calling all sugar daddies, sugar mamas, sugar friends aka care-takers

Calling all sugar daddies, sugar mamas, sugar friends, aka my care-takers. 

Hopefully, by the end of May I will be making my flight arrangements to fly back to the States.  I am hoping for some assistance in getting me back this summer.  Any donations, cash or air-miles you could offer are most greatly appreciated. Especially, if any of you might be able to spare a Southwest Rapid Rewards ticket.   I could fly from Ft. Lauderdale, Florida back to Sacramento for FREE!!!  You can make any donations through my Paypal link.

I have exciting plans for this summer.  I found out that I have been accepted to work once again at Highland Hospital in Oakland, CA!!  The dates for the internship will be from July 18 to August 12.  It’s such an honor to be able to return to work there again this summer.

Thank you again for all of your support, especially as I am starting to wrap up the end of this semester and preparing to come back “home” for this summer.  Never forget that you are investing in your future personal physician.  J

Spring Break Cuba 2011 Woooooooooooohooooo!!!!

Spring break, Cuba 2011 (Wooooooooooooo!!!) has started, and is almost coming to an end.  It started just like an MTV spring break, amongst my cubicle-mates, screaming, and mock-flashing each other.  I arrived into spring break, after a marathon of exams this past week that didn’t kill me and only made me stronger, that left me with the feeling of hating everything and everyone. But, don’t worry…I shook it off with the help of a super dance party until 3 a.m. on Friday night.  I walked into the school, like the 31-year old champion I am, standing in line at 3 a.m. with the rest of the revolutionary students at my school (and the baby-drunks rolling in at 3 a.m.) to wait in line for the prepared breakfast and packed lunch that the school prepared for the marchers who were celebrating the 50^th anniversary victory of the Bay of Pigs.  Professors were arriving for their obligatory presence at the victory march, but lunch sack in hand I hid in the darkness of the morning and made it in time to my bunk-bed for my floor-instructor to have seen me fully-showered and thinking I was being a good little patriot and heading to the march.  How did I celebrate???  By sleeping and guiltfully eating my cheesy bread sandwich and cookie the next morning, recapping the nights events over my cherished Peet’s coffee and reading my 1-month old San Francisco Chronicle like it was printed that very morning.  Damn…Heather and I high-fived each other the next morning because you know what…we still got it.   I am sure we gave those kids a lot to talk about (scandalous), but you know what…we are also the same two champions that are at the top of our classes, but still have the urge to act like the half-retards we once were in our 20s and can still be in our 30s. 

I’m enjoying the warm weather, the taste of cold beer on Cuban beaches, getting back into running, and of course having the best views of half-naked Brazilian boys outside our dorm room, the full view of wild animal kingdom cat-sex right outside my window, and the never-ending view of the Caribbean.    So, for now…my brain is turned off for a few days and will be back in full-gear to finish off my last 9 weeks at ELAM. Then, I will once again be flying to Ah-may-rica…crossing the Cuban/Mexican/U.S. customs borders to see my family and friends, and you know…bringing myself to tears of joy when I get to eat those nachos drenched in jalapenos at the Cancun airport. 

Survival

Mark Pollan wrote, in his book In the Defense of Food, that hot dogs are a staple survival food if you were ever stranded on a deserted island.  How ironic is it that I find myself also surviving on hotdogs as a staple form of protein and fat (and chicken lips and pig guts) on this island of Cuba?

The first week of my last 16 weeks of my semester was an overwhelming week of new classes--genetics, pharmacology, pathology, microbiology, community medicine, psychology, and P.E. (to make sure that we are getting some type of exercise).  Amongst hotdogs, I somehow survived on a total of 20 hours of sleep during the week with the aid of a bottom-less coffee mug and feeling soulful while getting my rhythmic booty-shake on to some Stevie Wonder.  Six out of my seven classes are being taught by physicians, including my pathology teacher who is the head of her department.  Their enthusiasm to teach and share their vast professional and life experience makes me realize I have still so much to learn.  Really?!  This week, I was once again invited by a renowned pediatric oncological surgeon to accompany him during his surgery days on any Thursday or Friday at his hospital.  I get this priceless education for free?!?!  Oh wait…I forgot I actually get paid by the Cuban government $4/month to study medicine.  Thank you, Cuba. 

Crocs by Day...Cowboy Boots by Night

While most of my cohorts were traveling around the country during these past few weeks that we have had away from classes, I was perfectly happy sitting in my 3x6 space snacking on popcorn and sipping on my version of a Cuban latte studying systemic pathology.  Am I getting old or what?  Actually, maybe it’s just me being so focused on my reason for being here and loving medicine so much, that I chose to be that homebody who is perfectly content with sitting in my gifted, oversized San Bruno Fire Dept t-shirt, snacking on popcorn, drinking coffee, studying hours on-end simply because the material intrigues me.  I wouldn’t have spent my 3-weeks of no class-time any other way.  Now, I am transitioning into my last semester of my basic medical sciences here at ELAM.  Then, it’s off to the teaching hospital Salvador Allende in La Habana for 4 years where I will gain all of my hands-on clinical experience.  God…I can’t wait, but at the same time I am beginning to appreciate how I really have been taken care of at the ELAM campus.  My job here is to study, and I get paid for it.  We have “tias” who work at the school who cook for us and clean up after us (when there is not a soap opera on or it’s not nap time).  This is where I really begin to learn about medicine.  I will begin to integrate the physiology, embryology, histology, and clinical theory I have received over this past 1.5 years and begin to integrate it into pathology.  Understanding disease!!!  I guess if you don’t get excited about it as I am, then nobody will.  Actually, my buddy Heather will.  You know, she’s my cohort from Texas who has become a hood ornament on my bike, actually more like a bumper sticker since she rides behind me.  I am so blessed to have found a cohort and a friend who compliments me like she does.  I realized that even though I might not necessarily befriend everyone in my program, I hope that in 4.5 years my cohorts and I will support each other as we begin transitioning back into a system that we have all rejected.  Whether we like it or not, we have formed a family—a big, multi-racial, bi-polar, dysfunctional family.  We will look to one another for a network of support, as we begin working in the U.S. healthcare system that is not founded upon the ideal that health is a human right.

So, this Valentine’s Day, I will be starting a new semester, saying hello again to my Crocs and lab coat and hopefully soon will have an occasion to rock my red cowboy boots again.  Oh yeah…much love to you on this Valentine’s Day.   By the way, I’m so grateful that I don’t have to deal with the commercialization of Valentine’s Day anymore.  Phew! 

January 2011--Really?! Hairy Pork Fat, Again????

1.7.11

And…life goes on here in Cuba.  My first meal back, I was in quarantine, and was reminded of Cuba-love when I discovered a little special hairy-pork fat in my bean water.  Aaaawww….Cuba.  I cried from laughter and disgust.  Now, I am trying to put my mind at that super bad-ass study capacity I had before I left for vacation and continuing to take care of myself physically, mentally, and emotionally.

Right now, I am taking time from studying for my second set of final exams coming up this week (yee-haw…I got a 5 on my clinical final last week).  I am reflecting on my almost 3-weeks of vacation back in Cali.  Flying home, landing at the Houston airport, teary eyed that I was on my way home for Christmas, just like all the military that were swarming the George Bush International airport.  I went from the coziness of lattes, super hot & endless showers, the warmth of hugs and hearing the voices of dear friends and family, back to the warmth of the Caribbean sun, and cold showers and very far from everything that I know as familiar in the U.S. (except for what I can pack into my suitcase).  I saw the beauty of Christmas and the holidays, which I had previously become blind to.  I felt grateful for all that I had, and tried as much as I could to avoid the filthy, festering, invasiveness of exploitative capitalism that tends to cause that extremely stressful feeling that we always dread at Christmas time.  Every penny that I had was spent on getting me home for Christmas and it was so worth it.  Like I mentioned before, I needed to come home to feel recharged and rejuvenated, to have priceless- memories like watching Melia open that package of batteries on Christmas morning and screeching “What?!?!,” making tacos and Sarah-ized margaritas in my complimentary Cazadores tequila belt buckle, from ingredients bought at the best Mexican super market in all of East Palo Alto with the raddest murse I know; having endless mommy/daughter time on the cozy couches; seeing and feeling the snow in Tahoe,  laughing about Carson shit-hole; reuniting with and meeting super-special people that the universe has sent to me.  Thank you again for taking care of me while I was at home.

Now, back to studying and striving for 5s!!

Update[1.20.11]:  So, I finished my final exams!!  As shitty and stressful as things can seem to be for me, today I was feeling pretty damn grateful after I finished my theoretical exam.  Here I was, in a tank top, jeans, and flip-flops, pumping my good buddy Heather on my Cuban jalopy bike, on our way to drink some $0.50 beers on the ocean front and to celebrate a new beginning on a beautiful, sunny day.  I know that very moment would never happen if I was going to medical school in the U.S.   So…yes…I get beat up by the difficulty of life here, by the feeling that I somehow can relate to being in general population of jail, aka Communistic bureaucracy, but my get out of jail free card got me the memories of a sweet Caribbean-front view, the company of my just-as-crazy-as-I-am cohorts to share with me a monumental day, and of course being like “what the heck?!” as I watched two Cuban street dogs chasing a goat right across my path of the bungalow we were sitting at.

Now, I have a link to a  Paypal account so it is easier to send me cash-mownay!

Please remember that, during these next 4.5 years, any gifts you can give me on my quest to become a revolutionary doctor for our community is super appreciated.  My scholarship includes tuition, room, and board, but the below-mentioned items are not covered by my scholarship but help maintain my mental, physical, and emotional health.

$5=1 hr. Of internet

$10=calling card to call home

$20=1 month of groceries (veggies, fruits, coffee, etc.)

$400=one-way travel to/from California from/to Havana

$750=fee for my first board exam which I will take in September 2012.

Feelin' Pork Love on Thanksgiving

Sitting on my bed on Thanksgiving, opting out of the “traditional” dinner at a local church, to savor reading about the clinical pharmacology of sedative and hypnotic drugs while listening to “Blue Bonnet” (sang by an Austin, Texas folk singer Raina Rose introduced to me by one of my bad-ass cohorts named Heather that keeps me smiling, laughing, and on my toes).  Not the most traditional Thanksgiving, but I am feeling thankful for these two burritos made by my Belizian friends that I slammed, that were doused in enough gifted-Tapatio to give me an ulcer and will make me regret drinking it like soup, tomorrow.  I am now in that state of I ate so much that I am going to pass out that you must all be feeling after eating all that turkey.  Me…feeling grateful for the feeling of being full.  Seriously, last week I made myself laugh to the point of tears when one of my cohorts asked me: “Sarah…why do we do this to ourselves???”--referring to our state of hunger after being served bean water with bean skin and hairy pork fat for the second day in a row).  My response…” So that we can throw our hairy pork fat at the puma-like cats with the giant balls in the cafeteria.”  I guess if you don’t laugh about this, then you just don’t understand.  I wish you could spend one day in my life here.  I find myself looking for the humor in it all.  Perhaps it is my coping mechanism of being in extremely stressful circumstances, and somehow making it through it all and coming out stronger and stronger every day.  For example, a month ago a hurricane hit the island and my bed was in a pond of water, all of my sheets, books, soaked from the rain that pounded in through the windows.  No electricity, but lots of water and tremendous wind (weather this Cali girl is definitely not used to).  I studied for my mid-term with my flashlight and still managed to get a 5.  To tell you the truth I just wanted to curl up in my wet bed and cry and give up—to fall asleep and hoping that it all goes away.  But, I somehow keep going.  Not sure how I continue to keep doing it.  Just when I think I am at a breaking-point, I cheer myself on by telling myself that if I make it through this day then…..

 Oh yes…I am on the volleyball team here, training with 18-20 year olds, noticing the changes in my now 31-year old body. Dang… it doesn’t recuperate like it used to.  My running muscles are so different than my volleyball muscles.  Ouch!

I do have to brag about the weather!!  Hahahaha….neener, neener, neener.  You are all cold, and I am toasty without a sweat mustache at the end of November!!!!  The weather and my being here with my nerdy buddy Heather give me something to be very thankful for on this Thanksgiving.

Oh wait…I feel very thankful for (but very offended at first) having a baby pig named after me.  Yes…her name is Sarita.  Too bad her 6-month destiny will be to be that hairy pork fat that I now call “pork love” which is served in the cafeteria.