God I Love Medical School

February 24, 2007

More funny lines from Veritography (in the middle of a month of tests):

Last night, I was trying to memorize my dreams. I’ve never been able to remember my dreams. But right now my brain is so wired for intake of data that any experience I have is something I assume I’m going to be tested on later.

Cat said it right: Studying in medical school is like having sex while you are drunk. You never actually finish, you just keep going until it’s not worth it anymore.

God I love medical school.

Reason to go to Medical School: AIDS in Africa

December 12, 2006

Prevalence rates of AIDS in AfricaI’m in medical school (partly) because I can’t shut my brain off and need to constantly be assuming information.  Boredom is a fate worse than death and this field is the balm.  So aside from reading about Infectious Diseases for my Pathophysiology exam this Thursday, I’m also reading the blogs of Cosmologists, Financial Advisors, Politics, and Economists.  Today, we have synergy.

In Infectious Diseases, I’ve just learned about the rates for sexual exposure to HIV among different groups.

  • Male exposes Female (1/200 – 1/2000)
  • Female exposes Male (1/700 – 1/3000)
  • Male exposes Male (1/10 – 1/1,600)

Do those look low to you?  These rates are not sufficiently high to either cause or sustain an epidemic!  So how the hell are these epidemics sustained in Africa?  The hypothesis provided in my notes:

  • HIV transmission rates are too low to explaoin the epidemic
  • HIV transmission is intermittently amplified by increasing genital tract shedding
  • Amplified transmission is critical to the spread of HIV

So imagine my absolute excitement to find this article by the famous economist, Emily Osler!  Three Things You Don’t Know About AIDS in Africa.

  1. It’s the wrong disease to attack
  2. It won’t disappear until poverty does
  3. There is less of it than we thought, but it’s spreading as fast as ever

I encourage you to read it for yourself.  But we’re not done yet.  If you really want to stretch your mind, you have to surround yourself with mind-stretching ideas.  That’s where TED comes in.  Technology Education Design is an annual conference that brings together remarkable people from around the world into one space to share something valuable: their ideas.  I subscribe to the TEDTalks Podcast and often listen to these 20 minute videos again and again (if you don’t use iTunes, you can listen to them on the web here).  And thanks to this wonderful resource, I’ve learned about Larry Brilliant.  He is a physician and his life story is remarkable including living in India for 10 years studying under a Hindu sage, becoming a diplomat for the United Nations, and in his capacity as an epidemiologist he presiding over the last case of smallpox on the planet.  In his talk (you can listen to it here) he describes the effort it took to hunt down the disease, door to door, over and over, for years.  He’s amazing, and it will take people like him to actually take what we are learning about the spread of AIDS in Africa and actually turn that information into eradication.

And I wouldn’t have put any of this together if I had decided to study something else.

Med School Metaphor: Pancakes Every Morning

November 1, 2006

Pancakes Every MorningI have a lot to learn. By Friday, anyway. I have a Pharmacology exam followed by a Pathophysiology exam this coming Monday. Once again, I find myself behind. It’s the funny kind of behind where you look at the stack of notes on your desk (2″ of one, 3″ of the other) and sort of chuckle. “Ha. This is going to be funny.” Cue despair.

Looking at it now, I’m tempted to start the passive bragging of impossible odds. “You have no idea how hard it is,” I’d say. “Medical school is like trying to take a drink from a fire hose,” I’d brag.

And that’s total bullshit. Read the rest of this entry »

Role Models

October 23, 2006

I remember getting up early on Sunday mornings to watch The Human Body on PBS. I remember watching blood shoot through vessels on a microscope, bundles of sticks dancing inside cells as they split in two, and sperm swimming furiously. I remember seeing the “Miracle of Life” Nova special and being absolutely mesmerized.

I remember skinning my knee as a small child and asking my Dad how a scab forms. Sitting there, watching him put the band-aid on, I was waiting for a story about the clotting cascade and other interstitial magic. He answered, “The blood dries and you have a scab.” I was incredibly disappointed.

As a kid, I never knew that I wanted to be a doctor. I was pretty sure that I didn’t want to be one, but I knew that I loved science. My family knew it too and encouraged me. I still remember a Thanksgiving dinner when I was waist-high to the adults, walking around, desperately asking everyone if they wanted to know how clouds created lightening or why the sky was blue. I had memorized the explanations from the fantastic book “Ask me Why?” and they were worth more to me than gold. I don’t know if he remembers it, but after watching several of my aunts turn me down with “not now”, my uncle Laurence (MD) indulged me. I always liked him after that.

I don’t remember there being many science role models. There was Donatello (the smart Teenage Mutant Ninja Turtle cartoon character) and there was Beakman and Bill Nye the Science Guy (the adult cartoon characters). Sure, you could watch them and marvel at the greatness of science, but I never wanted to grow up to be anything like them. And that’s where my father comes in again.

My parents couldn’t agree on which movies were appropriate for me to watch. My father was by far the more lenient and I would sneak into the den to watch rentals with him. My first memory of a such a “sneak peek” was THE FLY. This was my introduction to the greatest film actor alive:

JEFF GOLDBLUM. Read the rest of this entry »

Why go to Medical School: La Soufriere

August 25, 2006

I am five years old and running, my arms out by my sides like a banking airplane, around the lip of La Soufriere, St. Vincent’s volcano. We’re 3,800 ft above sea level and too close to the edge. I have to throw three stones before one goes far enough to hit the bottom of the crater. 10 seconds. That’s how long you’d fall and tumble it you made a wrong move. It’s easier than you’d think since I’m inside a cloud right now and can’t see in any direction.

I wanted to be first. The hike is in three stages with 40ft bamboo reeds bending overhead and hundred-foot drops on either side. We walk into and out of clouds, past rivers of bubble-rock from the previous lava flows, and up loose stones and ash as the summit comes in sight and the pitch increases. We’ve kept together for the most part, but with the end so close it’s each man to his ability. I’m in the middle of the pack and decide to start running. My legs are burning and I’m blowing off huge volumes of CO2. I know I’m among my people when Alexander asks, “Where’d you get the extra ATP?” I start using my hands; it’s that steep. I’ve passed 60 yards at 20 degrees and have the lead by a yard or two. No one else wants to pass me as much as I want to be in front, so it’s just a matter of pacing now. But screw it: I start to run again. My legs are shaking and burning and I would feel miserable if it didn’t feel great. I summit and it’s flat and I start sprinting to the lip.

As a kid I remember being awed by heights. Standing at an edge where a fall meant death, I would let me toes hang over just to know that I could. I was trying to prove to myself that I wasn’t afraid. Still am. I sat on the lip with my bag and swung my legs over to lean forward and look straight down. It’s never stopped being exhilirating.

Over the lip you can see a massive mound in the crater. It looks like someone tried to plug the volcano. 20 years ago, it wasn’t there, but the constant pressure of gas underneath has caused it to bubble out and displace the lake that used to be. Along the side, even 100 meters up, you can smell the sulfur and feel the heat from the center. I’m told that there’s a rope that leads down from the lip. I’m too tired today, but next week I’ll give it a try.

I am so glad that I go to school in the Caribbean.

Why go to Medical School? We’re both crazy.

August 22, 2006

Walking out the doors of the Anatomy Lab a man is standing in front of me. His hands are busy around his waste, shuffling his penis back into his pants, smoothing the creases of his underwear and now pulling his pants up from his thighs. He’s looking at me like we’re both crazy.

“Yes?” was all I could offer, waiting for the punch-line.
“This wear de keep de bodies?” he asked.
“Say that again?”
“The dead bodies in there?” I’m racing through the reasons that he would ask this and why I would answer him. That’s when I see the name tag. This man is one of our volunteer patients at the Clinical Skills Lab. Since we don’t do genital exams this term I still can’t explain why he was undressed and half-across campus, but this is Grenada and I’ll have to let all of that slide. He’s probably harmless.
“Yes, this is where we keep the cadavers. Can I help you?” Turns out that he came over to find out how he could donate his body to the school once he died. His pants fall down again as I usher him into the Secretary’s office. I watch her eye’s bug and offer no explanation; I wouldn’t want to ruin it for her.
* * *
Going to school in the Caribbean is fantastic if you’ve got the right head on your shoulders. If you go to a restaurant and read the menu, you can’t kid yourself and think that what is on the menu is available. The menu is instead a list of things that were once available and may be available in the future. This is due either to a lack of ingredients, the staff is too busy to make your order, or the staff does not care to make your order. If you need a blown tire fixed, you can open up the Grenadian yellow pages (which might as well say, “no we don’t do that, call this guy” on every page) or you can go to the roundabout by Lance Aux Epines and look for a guy with a grey beard and a sock on his head named “Vincent.” Vincent, you are told, is a good guy.

Not everyone that comes to Saint George’s University can take all of this. Sure it seems like a series of little things, but that’s what death by a thousand cuts is all about. I can’t imagine what it would be like working in any medical setting (or other high pressure situation) with the girl that stomps her feet when her luggage doesn’t arrive on time or the guy that loses his mind whenever we have a Grenadian Traffic Jam.* It’s nice knowing that in my future professional life, seeing “SGU” on a resume will mean that they couldn’t have made it through while holding on to those attitudes.

The person that does come here, takes everything in stride, and thrives is just the type of person I want by my side if things fall apart.

*Grenadian Traffic Jam: In Grenada, people often stop their cars in the middle of a two lane road to open the trunk and begin selling lemonade. Drivers then weave by to stop, chat and buy a drink. You’re going to be late, wherever you were going. Honking doesn’t help.

Severed Vacation

August 17, 2006

facial nerve illustration I do not enjoy vacation. Studying medicine makes me feel so useful that I go into withdrawal outside of it. Reading Atlas Shrugged with all my spare time doesn’t help matters any. I try everything I can. I cut my vacation short by starting a week late, electing to stay in Grenada to dissect cadavers for research. I cut another week by going to Milwaukee for the Annual Congress of Clinical Anatomists. I lose a week to a Michigan trip with my family, and I leave that early to spend a week at the University of Alabama at Birmingham (UAB). Why? To dissect for research, of course.

Working at UAB is my first time in the South and it’s everything with fresh eyes. Southerners chew gum lazily. Without wind, you’re under a heavy hot blanket. When walking for coffee in scrubs, everyone says, “Good morning, Doctor.” It’s pleasant.

I am at the UAB with other members of my group to finish dissecting projects in the hours between the classes of their first year students. We have complete access to 35 bodies and we all feel like kids in the dead people store. Each of us has come a long way from those first heady days of Anatomy Lab. After all, we have chosen to be here without threat of a grade.

We’re cutting into people? I don’t want to; I’ll just watch. I’m glad they put bags over their heads. Should we name her? That’s disrespectful! No it’s not. I’m naming her ‘mittens’. Should we say a prayer first? Oh, god. Give me the goddamn scalpel, Amen. How’s that?

For all the posturing, it was a special thing to watch my hand cut into someone for the first time. It was my hand that did it, by the way. I had nothing to do with it. After so many bodies, it losses its specialness. When it’s time to work, you approach, address the body, and then dive in for cleaning and measurement. A few minutes later you zip up your work and it’s time for the next axilla.

Most of us have been the ones quick through the door when it came to cutting, the ones that called for the scalpels. But here at UAB, it is a little different. Their cadavers are fresher, fixed with less formalin, smelling less, more robust. It feels like walking into a house so clean that you kick of your shoes even though that’s never been your custom.

Most of the students that flew down can give a few days or a week. We would stay longer but our classes are starting in a couple days, a few thousand miles away in the Caribbean.  A few students say, “screw it”  and decide to miss a few days of the first week, this being such a great opportunity for work.  It’s only because I decided to stay that I get this morning call,

“Marios, what am I dissecting this morning?”
“Severed head.”
Choking, “What was that?”
“Ask Vince to show you the severed head. Skeletonize the Facial nerve and clean away all fat and fascia.” Hearing my held breath, “Tophy, you okay?”
“Fine Marios. Just fine.”
“Congratulations. It’ll be fun. You’ll do fine.”

I find Vince. He takes me into the cooler where they keep the fresh cadavers. These people died a few days ago or a few weeks ago and have donated their bodies to the university. At UAB, there is abundance. I wheel a small bin into the prosection room and remove the lid. Thomas is staring straight at me.

I reach down to pick him up and can’t at first. Not expecting the extra weight, I give my arms a moment to recruit more fibers before he moves.  I hold him in the air while another student helps me clamp the vise grips into either side of his head. Of his head. I adjust the lights, pull up a stool, and grab my scalpel.

I can’t do it.

I push his cheek and it moves. I try to draw the backhand of the blade against his scalp to mark my incision and I scratch some of his skin. Before, I thought that cutting a fixed cadaver was the great big leap, and I was wrong. I stare at Thomas some more.

If you’re going to be a surgeon, you have to do this. How many people get to work on a fresh cadaver? What opportunity are you wasting?! Do it, topher. DO IT!

I let the blade sink in and I begin to draw the curve of his hairline down to the front of his ear, then drop to the bend of his jaw and forward to the point of his chin. I pull the line upwards and around the mouth, into the sweep of his cheek where tears would have slid and then around his socket and up, until I meet again at the widow’s peak. He’s bleeding, not in force, but in an ooze that marks each position of a superficial vessel. It’s creeping me out.


His face flap is in the bucket. It took an hour to do, pulling up a corner and separating it from all the anchors of fascia. The beauty of dissecting is that you’re only as fast as your mind. I was trying to save every vessel and nerve fiber early on, terrified of doing harm, until I remembered that the Facial nerve has no cutaneous branches. At that point it became snip, snip. Finding the target nerves leaving the parotid gland was magic. Pulling against the fat to see all of the brilliant colors of muscle, nerve, artery and vein is something that my fixed cadavers could never do for me. I’m no longer bothered by how real this all is; I’m too busy being hypnotized. The nerves branch and split, branch and split until they are thinner than hairs and I can’t believe that I haven’t destroyed them yet. They’re so strong and wet and alive.

Gross, messy, scary, morbid.

Say what you want about dissecting the face of a man that died days ago. Just don’t leave these out:

Amazing, glistening, beautiful, perfect.

Why go to Medical School: Wednesday Afternoon

June 22, 2006

bone saw

It’s Wednesday morning. It’s Wednesday morning at 10:00 and I can’t stop coughing. I should be sleeping off a hangover with the rest of my class but instead I’m in the Anatomy lab with the doors closed.

My current research concerns the arteries within the mandible. Normally, you divide a person in half by saw and explore each half of the jaw. Congress is coming though, and we need a few spectacular pictures for my presentation. So, instead of the usual, I was handed a bone saw and then a cadaver. And then a flashback.

It stinks for weeks, all of these cats. I’m supposed to pick my senior classes by 5:00 today. I want senior year to be easy. I also want to dissect those stinking cats. Screw it; I’ll take AP BIO. It’s a year later and Jared just stole my tail. He has quite a collection, him and his bone cutter, stalking from table to table stealing the tails. I’ve been vigilant which is why it took him so long to defile my Mittens. I met Mittens in a plastic bag. She had been pre-skinned from wherever she came. Skinned except for her paws. Mittens.

We’re kids and we’re in high school and we’re dealing with death. Poorly. We’ve worked our way up to this: nematode, grasshopper, squid (which we then grilled and ate), frog, fetal pig, and now cat. There’s the kid that’s too sensitive and is very disturbed by our behavior. He doesn’t think it’s funny when we start quoting Lord of the Flies and dancing. We call him “Piggy.” I pull on the tendons of Mittens and have her kick in the air to “Da da da-dada, da da da-dada.” We cope by trying to upstage each other with our indifference. Like I said, we’re handling this poorly.

It’s the last week before the final and I’ve finished all of the dissections. With my free reign I dissect what’s left. I take apart the forelimbs and the scapula. I take off the hind limbs but can’t free the hips. I free the ribs and all that’s left is the crooked cane of the Central Nervous System and it’s protecting bones.

That’s what I’m looking at right now: an empty thorax, ribs intact but flailed, the vertebrae from L2 on up and his untouched head. No arms, no legs. Mittens. I’ve spent so much time in a book and away from the lab that I’ve lost my detachment. Holy shit, there’s a man cut in half on the table. But I have work to do and feeling uncomforable is a waste of time. I have tricks. I focus on one spot, one square inch where I have to cut away his skin so the saw can make contact. That one square inch isn’t he. It isn’t a person. It’s a square inch. I can cut a square inch.

The saw is dull. It’s motorized and oscillating by millimeters instead of spinning. Cough drawing Those tiny motions mean that it cuts bone but not flesh, and there are only two spots that still have teeth. It makes the work slow and heats the motor in my hands. I have to take breaks between my sweating lips and palms. Maybe you’ve never had to cut a circle around someone’s head, but know this: it’s dusty. That’s why I’m coughing. People that walk in through the far door start coughing as well, but they’re reacting to the smell of burnt bone. You have to have your face near the action to appreciate the soot.

I finish my circle, insert a wedge and torque against the seam. It makes this wild cracking sound and I wonder what I’ve missed. I call in a professor who inserts the wedge, torques against the seam and explains to me that I am appreciating the sounds of the separating dura. wow. WOW! That’s amazing! He pulls off the top and instead of feeling jealous, I am amazed. That, right there, is a human brain and I’ve never seen one. I’m stupefied. That’s why I jostle the brain back and forward and wonder why it won’t come free. For a moment, I’m an idiot again. I forget that it’s connected to every corner of the body in one way or another and won’t jostle free of a damn thing.

The brain lifts in the front so you can cut the olfactory nerves. A dividing membrane travels front to back like a Mohawk splitting the brain into left and right. That gets cut. The Optic Chiasm, the trigeminal ganglion, the nerve gaggle entering the internal acoustic meatus, the membranous tent dividing the calvarium into the cerebellum’s part and the cortex’s part like two fighting siblings. All of it: cut. It wiggles free.

This is my own instant review of everything I’ve read but haven’t seen. Not really anyway, not like this. To finally free the brain, I have to cut the brainstem through the reticular formation. I have so much respect for the reticular formation. It’s the lizard part of our brain and it’s a geographical mess but beautiful all the same. And now it’s in my hands. I am holding this brain and rotating it, rattling off all the sulci, all the gyri. The arachnoid matter actually looks like a spider web. I can’t believe how lucky I am. I just can’t. If this man were alive, I know that pushing on this spot right here would make his lips go numb. This spot right here and he would collapse. This spot: fear. This spot: memory. It’s just amazing.

Another student involved with research walks into the room. I tell her what I’m doing and watch her beam. Now I get to watch her roll it in her hands, see the relationships, and slip it into and out of the skull. For the first time we really understand epidural hematomas and uncal herniations. Of COURSE that would kill you! Transtentorial herniation? That would be catastrophic!

So, why go to to medical school? Because you’ve never been afraid of blood. Because cutting into something that was once alive bothers you, but not too much. Because of all the places you could ever be, it’s a place where you’re with people that can share and celebrate something as awesome as the human brain even when you had to tear it from someone’s head. Because maybe, on a Wednesday afternoon, you’re biggest problem could be holding a saw to someone’s skull and choking on the dust.

But smiling.

Why Go to Medical School? Reason #2

May 30, 2006

toilet There’s been a fair amount written about the true cost of medical school. A quick survey includes:

1) quarter of a million dollars, down the crapper.
2) 4 years for the privilege of losing another 3-5 years
3) previous relationship
4) previous waist (3 and 4 may be related)
5) all previous hobbies and interests
6) ability to have non-medical conversations (include with 3 & 5)

And we slug it out, each of us, for the dream of becoming competent. I find little solace living with the knowledge that everything I have learned I will likely forget, and that everything I really NEED to know I won’t see until years 3, 4, or beyond. Ergo: nothing I am learning now is making me competent. Makes it hard to give a GODDAMN about osteomalacia.

So I’m fighting back. I’m going to save each and every person out there from doing this for the wrong reasons. How, you ask? I am going to start posting here all of the useful things that I am learning in medical school. Things that will change your life, every day. After reading these, the best medical gems, do you still want to come learn the boring stuff?

This is the first installment:

Working Title: Reason #2
Alternate Title: The Grace of Defecation.

First, let’s start with a little Anatomy. You’re a tube with limbs. You’re mouth is connected directly to your anus. Along the way it bubbles and flares into your stomach, small intestine and large intestine. Your large intestine is also known as the “colon.” I didn’t know that before coming to med school, and thought the colon was it’s own organ just like the mysterious “prostate,” which I thought meant “lying down.”

Everything you eat is slowly sucked dry of the nutrition and turned into waste. It’s this sloppy green paste that’s found in the small intestine. Then the colon takes over and the magic begins. The colon sucks the paste dry and ages it, like the worst wine imaginable, into a brown solid. The colon fills with this and stores it until it’s convenient to void it, and aren’t you glad for that small courtesy?

ascending transverse descending sigmoid colon drawing

This is my drawing of the colon (Fig. 1). It bubbles and squeezes and pushes the waste through the Ascending Colon on the right, it travels along the upper deck of the Transverse Colon, and then it slides on down the Descending Colon. You’ll notice that the Descending Colon is a little “off aim” from the rectum, that is, it isn’t a straight shot. That connecting segment is the Sigmoid (S-shaped) Colon and its little kink is the life-saver. Without that, it would be much more difficult to restrain your bowel movement (BM). At last, we have the anal sphincters. You didn’t know there were two, did you? Yup, the inner sphincter is under your body’s control. Like any Control Tower, it doesn’t let anything take off until it sees a need. The outer anal sphincter is under your conscious control and has to wait for ground clearance. Once that clearance is granted, it’s the pilot’s decision for go/no-go.

Now let’s talk technique. The pressure of building feces is usually enough to have the BM. Untrained children know this. That’s not why you’re reading this. You’re reading this because you are a professional, and professionals keep current with the latest journals. In the event that you have passed the golden two minutes and are losing hope for this BM, there are tricks both mechanical and chemical.

Mechanical: Remember Fig. 1? Like any hand-held maze with a single marble, the trick is to coax the feces down the chute. The order is crucial. First, lean hard to your left (Fig. 2). This ensures that any marbles in the upper deck are packed into the Descending Colon. Hold that position, shake a little, use your best judgment. When you are satisfied, bank a hard right (Fig. 3). This maneuver will hopefully un-kink and straighten the Sigmoid Colon, ensuring a straight shot and maximum pressure against the Control-Tower-Sphincter. Hopefully, you get clearance.

lean to the left and then the right drawing

thoracic and abdominal cavity drawing

If this does not work,you have reserves. Your abdomen is filled with your guts and sits below your lungs and heart (Fig. 4). Your abdomen is also shrink-wrapped in muscles. Both can be used to advantage. Most everyone knows that crunching up your abs and leaning forward helps.

Both moves compress the abdomen and build up pressure. But without incorporating the lungs, it’s like throwing a fist flat-footed. You’ve GOT to put your weight behind that punch! You do this using the Valsalva maneuver. It was originally developed to help push pus out of the ear. We’re going to modify it.

Valsalva maneuver

Because you’re chest is next to your abdomen, building up pressure in one builds pressure in the other. That’s why a punch in the stomach (increase in abdominal pressure) knocks the wind out of you. That’s why building pressure in your chest is going to knock the poop out of you. To build up pressure in your chest, take a deep breath, close your throat (or pinch your mouth and nose), and SQUEEZE! Try to forcibly exhale against your closed throat, press your elbows against your sides, crunch your abs and lean to the right. If you’d rather use a more familiar tack: blow your nose (Fig 5). Hopefully, your best efforts will bear fruit.

That was graphic, right? Now that we’re done with mechanical, let’s talk chemical. Certain foods help us void. I remember the first time in my life when something was “stuck” in there. My father brought me a bowl of Cheerios. I was six years old and didn’t know any better. While fiber and other ruffage (think leafy greens) helps keep us regular, it’s more preventative than curative. For the right here and right now, you’ll need some caffeine. Caffeine is a stimulant and a diuretic (makes our urine clear). Clears the mind; sharpens the senses. It also accelerates the colon’s normal shuffling action. Unfortunately, our coffee mugs are usually out of reach, and it’s a little embarassing to call a coworker or family member for a cup. I’ll never forget the time I ran out of toilet paper at a friend’s house. “There’s more underneath the sink!,” he yelled. I leaned over to throw the door open and there, next to a fresh role of Downy, was a single can of RedBull. This was a man who knew what he was doing. I’ve kept an emergency can by my thrown ever since.

red bull can

So that’s my advice. Rock left, then right. Blow your nose. Have an emergency can of Red Bull. I just saved you $45,000.

Having read this, I know that each of you is thinking: “What is wrong with this person? Who sits down to write a manifesto on the bowel? With pictures? I can’t believe I just spent 5 minutes reading that.” To which I respond, “Try, just try, to forget it. Also, you’re welcome.”

Disclaimer: I have not conducted barium studies to verify my shuffling bowel theory. I am not a nutritionist or a gastroenterologist.

Go to Prague

April 1, 2006

For current, updated information about attending SGU, review of SGU textbooks, and access to more SGU resources, please visit the Welcome to Grenada site.



Go to Prague! As a January student, I went after my first term and knew nothing. Enjoyed the hell out of it. If you start in January and wait till the end of 4th term (2nd year) to go, you’ll be squeezing the dates a little close together. I recommend as a freshman. If you’re an August student, you get one crack at it: after 2nd term. This is probably the perfect time to go.

**The Official Prague Selective website is run by Martin Stransky**

Get your friends together and rent a cheap apartment or stay in a 4-bed hostel suite. You chose your own level of grit. If you’re a vegetarian, eat a face. If you’re a recovering alcoholic, relapse. Prague is beer and meat and beautiful people and you shouldn’t miss any of it.

Smiling beer

Before you head over, go online and buy the DK Publishing Top 10 Eyewitness Guide to Prague. I lived by this book and it did not disappoint. Useful Czech phrases in the back. Also, don’t ever call it “Czechoslovakia.” The Czech Republic and Slovakia are quite separate now.

The set up of your selective is simple: Once a week you meet as a class with Dr. Stransky (the guy throwing this party) above Club N11. Besides being a big deal in Prague, he said one of my favorite things: “In life, it’s good to be best, but it’s better to be first.” He owns the club N11 and will host a part there pretty early into the selective. As I remember, the first day you meet Dr. Stransky, learn about the program and what your rotations are going to be. Wear professional clothes. For guys this means shirt and tie. Do not be the guy with tennis shoes, an untucked shirt and a poorly-knotted tie. Ladies, wear comfortable shoes and a nice dress or skirt. Once you have your assignment, you meet in front of the N11 club with a bunch of other students, and someone working for Dr. Stransky takes your group onto the metro system for your destination. Remember it, because you’ll have to do it yourself every day after. Your destination will change every week, so you’ll repeat this process every Monday morning. Some people start rotations at 8:00am, some at 9:30. Everyone checks out by 5:00.

Each rotation at each hospital is different. For example, my Neuro rotation consisted of locking us in a room and letting a tape play (half the time), talking with Czech medical students so that they could practice their English (1/4th the time) and seeing a bunch of really interesting cases for the rest of it. If you understand 1 and 1/2 syndrome and the workings of nystagmus, you’re golden. My Cardio rotation consisted of puting on a heavy-ass vest and standing in the room while the doctors snaked line up everyone’s femoral artery into the heart. We watched all of it on angiogram. It was great, except for the vest and the revolving door nature of it all. My Orthopedic surgery rotation was my favorite. The doctors and nurses do not care what you do, so long as you don’t hurt anybody. You change into their scrubs and gowns (their locker room) and just pick a surgery. Axilla surgery in room 1, hip replacement in room 2, and so on. I went to see a hip replacement and got blood all over me, which was AWESOME! Loved that rotation. At the end of the week you meet up above N11 with Dr. Stransky, see a patient, and talk about the week. Wash Rinse Repeat.

Neuro Selective SGU

You’re in Europe, the center of it, so you’ll want to travel. I know people that made it out of Prague to go to Germany, Italy, what have you. It’s hard though. You have to be at the hospitals on Monday and Friday. Once you factor in the time of transit to and from another country, you are really cutting things close to say nothing of a slow train or a broken one. To get the credit for the class, you have to have perfect attendance. That said, some of the doctors will sign your sheet for the week regardless of your attendance and I don’t know of anyone that did the selective and didn’t get credit. So who knows. Travel at your own peril I guess.

The weather in Prague swings. Bringing nothing but summer clothes with something nice for the hospital is not going to cut it. Bring a sweater, a jacket, something. Also, it rains in Prague. Don’t be that wet guy without a raincoat.

Speaking of clothing, you should probably buy the greatest pair of shoes on the planet before getting on that plane. Everyone wonders why the people in Europe are so skinny? Not me. They walk everywhere, never stopping, always walking. So if you buy a pair of shoes that pinches your toe or drags on your heal ever so slightly, that’ll be a gapping hole bleeding through your socks by the end of the third day. And since you’re walking everywhere all the time, it will NEVER have a chance to heal. So just avoid that whole mess and buy yourself something nice.

The nightlife is great. Try to avoid the comfort of your two favorite clubs every night and see as much as you can. Joe’s Cafe was a great one, and no trip to Prague can possibly be complete without a few trips to the Duplex. Enjoy the dancers and the air horn.

All in all, I hope you really enjoy Prague. Their subway system is larger than anything I’ve ever seen, and you’ll have a great time getting lost even though their are only three subway lines. Every set of directions you’ll ever give will be in terms of Tesco. It will take you a week to discover Andel. You’ll buy a bottle of water, take one sip and spit it out, and forever after ask for “Voda, neperlive.” (Voh-dah, nay-per-leh-veh) Make sure you’re friends with someone who takes a lot of pictures; you’d be surprised how quickly you forget how great it was.


I wrote home when I was there, and I’ve included those posts. If you have any questions, please post them and I’ll add where it’s empty.

In Prague

Prague, Part Dva