I'm posting quickly in the middle of my hematology lecture just to say how incredibly excited I am about the Global Health Electives -- in other words, the international clinical rotations! We finally got some information on them today, and although they sound like a lot of work (a lot of extra things to do before departure and after coming home that we don't have to do for other rotations), I am still SUPER excited. Our four main options are Tanzania, Ecuador, Sri Lanka, and American Samoa; there's also a 10-day Honduras option, but that's more of a general thing for the entire medical school (MD students, DPT students, nursing students, etc.) and it also sounds like it's part of a specific academic course... so I'm not really considering that one at all.

Anyway, they all sound incredible, but I think I've got it down to two, and they won't come as a surprise to anybody:

Tanzania. I'd be in Moshi, Tanzania, working in a hospital at the foot of Mt. Kilamanjaro. I have always wanted to do medical work in Africa, and this possibility is one of the things I was most excited about after my Duke interview last year. We get extensive prep beforehand, including some Swahili lessons -- yay! The two girls who went last year apparently had the time of their lives; I can't wait to talk to them. This is the most expensive rotation, but it's also something that I've wanted to do for as long as I can remember.

Ecuador. The biggest perk here for me is the Spanish exposure; you have to have had a certain amount of experience with the language in order to go. This site is a little different in terms of scheduling; we'd start in clinic around 7 or 8 in the morning and see patients until 2-3pm; after that, we'd have 2 or 3 hours of 'Medical Spanish' class each day. I have a very strong Spanish background which hasn't really been exercised much lately, and I know I'd 're-awaken' my Spanish really quickly if I were to be immersed in that environment for a while. That would be a really valuable skill as a practitioner here in the States. This is also the only rotation where I'd have the option of living with a host family, rather than in an apartment or hotel. Which might be annoying on those days when I want to come home after a long day and just be by myself -- but I think it would be really great in terms of being 'part of' the culture for the four weeks I'd be there rather than just 'observing' the culture.

The Blackboard section with all the details will be up in November, and the applications are due in January. Will update when I know more! :)

Just a quick update to say that I think I'm finally settling into the rhythm of this new life. It might sound odd, but I feel as though I'm doing less work and yet performing better. I'm not doing as much pre-reading as I was doing in the beginning, for a variety of reasons -- partly because physiology, which was the most reading-heavy class, is now over (more on that in a minute), and partly because I'm finding that I'm less intimidated by a subject if I listen and take notes in class first, and then go back and read only the bits that I don't understand. For example, I've had very little chemistry (mostly because I HATE IT), and so I almost had a heart attack upon opening the pharmacology book... but then the lecturer turned out to be so good that I found that I didn't actually need the book at all in order to study effectively and perform well on the test. This is turning out to be the norm (with the exception of immunology -- THAT, I needed the book for).

Anyway, this all means that I've actually had a little time lately to read my Kindle, go to dinner with the Pittsboro clan, go for a few runs, et cetera. Lots of others still seem majorly stressed about the amount of work that we have, and people are actually putting in regular 8+ hour days here at DPAP even on the weekends. Personally, I've never set foot in this building on a Saturday or Sunday and don't ever intend to -- unless there's some extenuating circumstance, like practicing for our 45-minute physical exams (which we will have to perform in about six weeks -- yikes!).

It's lunchtime now, and I'm posting this from a breakout room; 'my' little group of six people are sitting here, eating and working on our laptops. Nobody's really talking much today; it's gray and gloomy outside and I think everyone's a little subdued. We had our last physiology exam this morning, which means we've finished an entire textbook (700-plus pages) in 5 weeks. We've also already finished genetics and immunology, which means we're at the 70% mark as far as the material we have to cover in our Basic Medical Sciences course. All that's left are pathophysiology (which we started this morning after our exam -- the PowerPoint was 126 slides; we blew through it in 2 hours) and microbiology (which we'll start in about 30 minutes, as soon as lunch is over). I'm rocking a 93 average in that class right now after 7 exams, so we're in solid H (Honors) territory at the moment, but I've been told by multiple knowledgeable sources that microbiology is going to be ridiculously difficult and will probably be some of our lowest grades this year. I guess I'll find out in a few more minutes. The micro professor happens to be my advisor AND my small-group leader, so I'm pretty motivated to do well in her class -- but, that being said, I'll still be happy when we're done with the BMS course (by mid-October!) and something else -- probably Clinical Medicine -- can rise up to fill in the extra spaces in our schedule.

The list of clinical rotations is up on the student section of the PA website, and I've been perusing them occasionally. I'm sure they'll change by the time this year's class is actually choosing our sites -- some will fall off and others will magically appear -- but it's nice to be able to get an idea. We have ten required rotations: Primary Care and Internal Medicine (both of which are two months long; the rest are only one month), OB-GYN, Surgery, Pediatrics, Emergency, Psychiatry, two electives, and EBM (for which we get a month to write a mini-thesis). I think I've decided on my two electives: Special Care Nursery (which should be no surprise to anybody) and Global Health Elective (which should also be no surprise). The only two international sites listed at the moment are American Samoa and Tanzania, but I've heard rumors of Ecuador as well. We'll see how that all shakes out. At the moment, I'm jonesing for Tanzania, but it depends on what's offered and what kind of site we'd be at. Ecuador would be great for re-awakening all that dormant Spanish at the back of my brain.

As far as the required rotations, I've actually got a pretty good idea of where I'd like to be for most of those as well. We have to do at least two in 'medically underserved' areas, and guess what counts as underserved -- Wilmington! As in, the beach. There are a couple of primary care rotations there that are pretty close to where Liz's stepdad's condo is, so I could stay there for free and live at the beach for two months while doing my primary care rotation, which sounds like a total blast. I'd also really like to do a rotation in Asheville, and there are several options there, but I'm not sure which one will pan out yet. It's like a crossword puzzle -- options for one site will influence my choices for other sites. But here are my tentative thoughts so far:

Primary Care -- 2 months at the beach, working in a private practice. M-F, 8-5... what's not to like? :)
Internal Medicine -- not sure yet; there are lots of possibilities in Durham as well as one at the VA in Asheville. Hoping for something with regular hours.
Pediatrics -- St. Jude is a possibility, as is a children's hospital in Asheville and a couple of private practices in Durham, Raleigh, and (for fun) Denver, CO.
Psychiatry -- lots of options; hopefully a private outpatient clinic; this is the rotation I'm most apprehensive about.
Emergency -- Duke ER (this is our only choice)
Surgery -- really hoping for Duke Transplant Surgery, but could also go to Asheville (to the VA again) or even to a couple of places in Connecticut.
OB-GYN -- not sure yet, but I definitely want to be at a hospital (or somewhere similar) so that I can be involved in deliveries!
Elective 1 -- Duke Special Care Nursery
Elective 2 -- Tanzania or Ecuador
EBM -- here in Durham, obviously. :) Anybody got any burning ideas for paper topics?

I'll keep you posted... time to go start microbiology now. :)

A Day in the Life of a Duke PA Student

6:00am -- The alarm goes off. I'm out the door by 6:30 and pulling my folding bike out of my car trunk (where it lives so I don't have to drag it up and down 2 flights of stairs every day). I unfold it and set off toward downtown Durham. I get to bike on the greenway for almost the entire trip, with no traffic to contend with, so I feel only slightly guilty about channeling my inner Dutchwoman and popping my earbuds in. It's such a nice way to start the day -- just me, a pink sunrise, and Josh Groban or Wicked on the iPod...

7:40am -- I arrive at school. Class doesn't start until 8:10, but getting here early gives me time to visit my locker, tidy up from my hourlong ride, chat with some classmates, and brew some coffee from our class's communal stash.

8:10am -- We launch into our first two-hour block, which is almost always physiology. If it's Monday, we have an exam; if it's Tuesday, Wednesday, or Thursday, we have a lecture (which, most recently, involves the cardiovascular system). Fridays are entirely different; half the day is spent doing small-group work and practicing physical diagnosis skills, which is normally a lot of fun, while the other half is spent in the cadaver lab. My group has named our cadaver 'Arthur'; I didn't feel that I could be respectful about cutting him until he had a name. :)

9:10am -- ten-minute break to stretch, visit the bathroom, and refill our coffee.

10:10am -- The second two-hour block begins. This is almost always spent in lecture, either a single two-hour lecture or two separate one-hour lectures. Lately, we've been doing a lot of anatomy during this time block. The program really tries to tie all our areas of study together, i.e. if we're spending one class studying the physiology of how the heart works, we're using our other classes to study the anatomy of the organ, what the symptoms of cardiac problems can be, what various heart murmurs can sound like, etc.

11:10am -- ten-minute break

12:00pm -- Lunch! 5-10 of my friends and I usually grab our lunches from the fridge and retreat to a breakout room (small-group room). Sometimes we study or do schoolwork, but most of the time we just eat, talk, check Facebook, make phone calls, and do informal 'cross-checks', just to make sure we're all conscious of all the readings, assignments, and exams that are on the horizon. My classmates are all incredibly brilliant, amazing, hilarious people, and I feel so privileged to count myself among them.

1:10pm -- The first two-hour block of the afternoon. Lately, this time slot has often been filled with History & Physical Diagnosis class, which is one of my favorites. This is where we start to connect the anatomy and physiology that we're learning to the actual clinical signs, symptoms, and diseases that we'll have to be familiar with. We're still in the very early stages of this, but I love it.

2:10pm -- ten-minute break

3:10pm -- Last two-hour block of the day. No way to predict what will fill this space. Sometimes it's a two-hour lecture, other times two one-hour lectures, other times something entirely different, like last week's phlebotomy practicum, where we learned to draw blood. (Many of us were experienced in that area already, but it was still a lot of fun!) Other times, we have small-group work, a program-specific 'housekeeping' discussion, or even (dare I say it?) an early dismissal day. Even when we do get out early, though, there's always so much to do that half the time I end up staying at the building anyway.

5:00pm -- Class is over for the day. Lots of people stay at the building to get a jump on studying, but I always go home. I work well at the building during the day, but when 5pm comes around, I need to be able to shift gears. I get on my bike, pick some music, and ride home.

6:00pm -- I arrive home, fold up my bike, and put it back into my car. I'm usually drenched in sweat by this point -- August and early September in NC are still pretty brutal -- so the first thing I do is take a shower.

6:30pm -- I'm clean and settled in. Since I biked to school, I no longer have to worry about a workout, either. Time to find something to eat and cozy up with my textbooks. The amount of work varies from day to day, but there's always something to do, and usually several somethings. For example, I always have at least one or two chapters' worth of pre-reading to do, in preparation for the next day's lecture -- we're not 'required' to do that per se, but I've found that the material sinks in a lot better for me if it feels vaguely familiar when I see it in class. Also, our professors provide us with lists of objectives -- general concepts to learn for exams -- and sometimes sample problem sets as well; I usually use the PowerPoint lecture and the textbook to slowly work my way through these sheets, writing down all the answers in excruciating detail, then use them to study from. This system has been working well for me so far.

9:00pm -- Depending on how the workflow is going, I try to stop at some point during the evening to spend some time with Liz, read a few chapters of a pleasure book, watch a movie, or take a bath.

10:00pm -- I pack my lunch, pick out my clothes, and pack my bag. If I do it now, I won't be stressed in the morning.

10:30pm -- Bedtime -- at least, if I'm planning to ride my bike the next morning. I can sleep an hour later if I drive to school, but I try to only do that once or twice a week -- usually Monday mornings (when we have an exam first thing) or Friday mornings (when I have to get straight onto the bus for cadaver lab over at the main hospital).

This schedule is constantly changing, and no two days are alike. This is a little stressful for my Type-A personality, but I'm doing my best to adapt. :)