They call it Bar'ville, KY

Barbourville, KY is pronounced Bar'ville by those who live around here. No need to waste your time with a superfluous syllable. That pretty much mirrors the demeanors of the people here in Bar'ville too. Yes we have your stereotypical toothless folks on 'the draw' (drawing a disability paycheck) from the 'hollers' but if you can look past that they are just simple, good, hard working people that all know each other and looked out for each other in times of need - big or small. Or they like just to gossip about you. ;-) Some are a little leery of strangers - especially the ones who have a Northern Yank accent like mine and others seemed genuinely accepting and pleased that I would want and love to be here in southern Kentucky. I was even complimented several times by patients that I sounded just like a hillbilly (I wonder if they were hard of hearing) - that I sounded just like one of them. I think my accent changed in every room - if they had a thick accent, I picked it right up.

I came to Bar'ville to learn and an education I certainly received. Sometimes it wasn't medical in nature:

- I learned from patients how to breed pure bred dogs, how they all had to have three names in order to get registered.

- I learned that certain fish loved corn and if you put canned corn out in a lake the day before you fished and then used corn as your bait, you were guaranteed to catch yourself something good. This was especially helpful if you were going to be fishing at the "pay lakes". These are stocked lakes/ponds that you pay to go fishing in - and if you caught one of the big monster tagged fish - YOU got paid.

- I learned that the term "cousin" was a general term for someone of kin - not necessarily a child of your parent's sibling.

- I learned that you shouldn't assume that people who live in trailers can't afford a "proper" house - I was wisely informed by Robin (a nurse practioner that took me under her wing in the office) that "you don't build a house on your families' land until that land is in your name - just in case there was a feud."


- And that just because someone plays a fiddle (a violin played bluegrass style) or a banjo, you can't assume they aren’t smart in the traditional book sense;
there is an amazing young man here, Willie Sears, that plays in a bluegrass band with his pop, that postponed his entrance to med school to save money.

- Don’t assume that someone who tells you they don't smoke means that tobacco is not a habit - they are more likely to dip and even more likely to chew on a "twist" - both of which are far worse than smoking - for their "tabacca." Even that 70 year old mamaw sitting in the office chews on a twisted tobacco leaf and you will know it is she spits into a cup or wipes her teeth with a kleenex to get rid of the brown sludge that collects there. It's a habit that is like smoking 8 cigarettes at a time and much tougher to quite. And it is parents that introduce kids to smoking, dipping or chewing. And often at an age with only a single digit.


And of course, I learned all kinds of traditional medicine from Dr. Pedersen, the Canadian whose patients petitioned for him and his wife to get their visas to stay in the US over 15 years ago. Contrary to my fear, he never "pimped" me in the feared Socratic Method of teaching (where the doctor grills the student - digging them ever deeper into a hole where no question that is asked could he possibly know the answer to, done only to embarrass the student and show off the doc's own knowledge.) And to make matters better, all the staff at Knox Family Medicine treated me like family - offering to show me how to raise a crop and harvest it, how to get some good country common sense, how to enjoy a "pickin" (a get together of musicians to play bluegrass on someone's front porch), and of course how to take care of patients with that country common sense. With much patience I was shown how to administer injections, irrigate earwax, perform EKGs, and was rescued when I had no idea what to do (thank God Sabrina would say, "I will go get that aspirin for you while the EKG is hooked up.") I was never laughed at when I asked "what is an e-pip-en?" when clearly it was an Epi Pen for allergic reactions, nor was I made to feel embarrassed when I completely messed up in putting together a "sterile" biopsy tray - just told that we would review "sterile technique" together. Dr. Pedersen never got frustrated when I asked the same question over and over again.

But the bravest people were the patients. They never seemed concerned that theirs' was the first injection, pap smear, suture, j-tube placement, or biopsy I had ever done. In fact, they were always excited to let me practice on them (well, except for the woman who got my first pap smear, she clearly wasn't excited). They knew better than I did how to perform the procedure and would guide me along with either Dr. P, one of the nurses or one of the nurse practioners. They often said generously "well, you have to learn somehow!"

One of the most memorable things I learned was how to change a j-tube in someone's stomach. When changing said j-tube, many yucky secretions come out of that hole when they laugh or cough. So if you do not want to get blood and stomach acid on you, you had better cover up the hole. Dr. Pedersen and the patient knew this little tid bit- but laughed at my surprise when stuff came shooting out of it when the patient coughed ON PURPOSE! I know I will never forget that lesson.

While medical knowledge is necessary here, more respected and needed was common sense about good old life. Something I realized I sorely lack for these parts. I felt like I was always asking "huh?" and "how do you know that?" I learned that being in medicine in a small town such as Bar'ville, you don’t have to take a social history about someone's family because you knew the family and probably saw all them in the office at one time. Wives told on husbands, little kids on parents, grown kids on parents, and siblings on each other.

I learned some interesting mountain medical methods here too:

- You don't ask if someone is urinating ok, you ask I they have problems with their water works. You don’t ask how their diabetes is doing, you ask if they have sugar. If someone tells you they are having problems with their "ur" you better know if they mean "ear" or "urine" - you could end up looking in their "ur" when it is their "ur that is hurt'n." Nothing more embarrassing than asking a patient to pee in a cup and them look at you and ask "why?" when it is their "ur" that hurts - and then they point to their ear.

- And don’t be shocked if a woman walks in and tells you that the doc checked her "testes" last month and she wants to know how they are. Testes are tests, as in blood works, labs, CBCs and lipid panels.

- Here you just assume that the woman with the kid is "mamaw", not the mother - it is the grandmother that seems to raise most of the kids around here, even if the mom is right besides them.

- I learned that a home remedy for scabies is to put finger nail polish on the scabs.

- For warts: wipe them with a used dish rag and throw or burry the rag. When the rag falls apart, the wart will disappear.

- Got athlete's foot: use burnt transmission fluid.

- For leg cramps at night, put a bar of soap under your sheets.

- I was taught how to spot a coal miner just by walking into a room - they often have "traumatic tattoos" on their hands and faces - cuts in their skin that were filled with coal while working, becoming a permanent tattoo.

After a political discussion usually involving the war or health care with Dr. P, I came home to my antique barn, and stood at the front counter a long time, talking to the people who worked here: Bobby and Walt, the owners; Dee and Sherry who worked here; and Billy, Bobby's sister who visited often and befriended me instantly with her stories of her kidney transplant nearly a year ago (we had a scare these last two weeks over as her creatinine levels rose, indicating kidney failure. Her subsequent biopsies showed that all is fine though, much to our collective relief, although she is currently in Louisville hospital); and we cannot forget Jordan and Cas, Bobby's adorable nephews that she frequently looks after. They too have become like family to me. After visiting and seeing what new cool pieces of jewelery they bought that day for the shop, I wind my way through the antique table settings, prancing reindeer sitting atop a dismantled piano, and cases upon cases for red and white dishware. Eventually I would find my into my Marilyn Monroe room with its brown walls, and many Marilyn pictures and cool antique furnishings. I would sit on the porch overlooking the Knox County Cemetery and the corn fields of the adjacent farm - wondering how I got to be so blessed to be in a place like Bar'ville, KY.


Of course I got out of the clinic and the antique barn to see a little of the natural wonders this place has to offer - there are plenty. I hiked from Cumberland Falls (one of only two places in the world with a moonbow - the other is Victoria Falls, Africa)to Laurel Lake Dam one weekend with Sarah Wheeler (UKPA class of 09). One of the best parts was crossing a small tributary to the Cumberland River and we see a man jumping off a 15' rock into the stream. And I mean stream. Where we were crossing it, the bridge was bridge out, and it was not more than 2 feet in any one place. Yet here he was driving off the rock. Since it was 90+ degrees we had to check it out. We snuck behind some trees, put on our bathing suites, placed out backpacks on a rock and climbed up a series of small, yet slippery waterfalls to the party. In no time flat we were diving off the same rock with little hesitation, into a small area that was 12 feet deep! Great way to cool off on the trail no doubt.

Blesses as I may be, and as much as I would like to stay right here, it appears that God has other plans for me (typical!). I am scheduled to move on to Danville, KY - a large town 40 miles south of Lexington to work with Dr. Barry Spoonamore in the operating room. A whole new chapter in this 13 month adventure awaits us so stay posted for the "Tales from the OR" edition of this blog. I know that my first day on surgery entails 2 colonoscopies (keep your butt and poo jokes to yourself, I am excited) and 2 laproscopic cholecystectomies (gall bladder removals).

Piedras Negras, Mexico

It is a border town across from Eagle Pass, Texas where many Americans companies manufacture goods such as car engines and seat belts. Most are employed for $5 a day in these factories but costs of items are no cheaper than here. So many go without health care and other needs. Women make a priority of cooking and watching the kids. A common story is that the husbands are in America or in jail. Health is not a priority. Things that are simple to manage here such as diabetes and high blood pressure are not even a priority there. They are aware that the problem exists but do not realize the long term ramifications of not seeking help. We often had to reduce the final outcome for them: your kids will not have a mother. This got them.

The most poignant patient I saw all week was on Monday. A 74 year old man came in on a crutch and with a cowboy hat on. He leaned in close and talked directly to me like a loving grandfather. He wore a smile on his face. He was interested in me even though we were there to talk about him. He was gentile. He was warm and friendly and happy. He made me want to spend time with him. He came in because he was having problems with his eyes, he had difficulty seeing. After a physical exam of his eyes, we determined that he had cataracts. One eye was completely obliterated and the other was just starting. The problem was that in his "good eye" his optic nerve was atrophying. It was dying and there was nothing we could do about it. We had no meds. No surgery available. That is all I could tell him.

Cataracts are easy to fix here. Not so in Piedras Negras Mexico where food is the daily priority. This man was going to go blind and there was nothing we could do for him. I had to tell him exactly that through a translator. I was numb. Who am I to deliver such news? A student. A stranger who could not even be there to support him tomorrow. One simple sentence from me and his future is changed. All I could do was pray for him which I did, but I have never felt like something was so inadequate. I was numb. He got up and cried and I didn’t know what to do. I vaguely understood that I ruined his day, his happiness, his everything in one sentence. He was going to have to go home and tell his wife this news. He walked out on his crutch, cowboy hat in his hand. His happiness so readily apparent before, now nowhere to be seen. I sat back down, helpless, and called for the next patient.

Now, I sit here and cry. I could not even show this man compassion in the moment he needed it because I was so stunned at the pronouncement. I am now a thousand miles away and cannot even go back and apologize, check in on him, help him in some way, any way. I am ashamed at how easy it was to deliver this bad news. All I can do is pray for him, his wife, and for me to not miss another opportunity to love someone better next time this happens.

God & Solitare

Last night I was playing solitare on my PDA as I do most nights to turn off my brain before going to sleep. Strange drugs and diseases running through your brain does not help you fall asleep. In the past I turned on the "cumulative scoring" option (in vagas style solitare, it costs $52/game and you get 3 bucks back for every card you put up on top). I liked to see how much debt I would be in if I were playing for real. By the end of last semester I was over $15,000 in the red.

The problem is, I do this in real life. I keep a cumulative score of my sins: the times I didn't listen to the Holy Spirit, didn't act and love like Jesus, the times I felt like I was avoiding God, being selfish, didn't get into the Word, enjoyed my "guilty pleasures" in disperportionate amounts, skipped church, etc. And I "know" in my mind that God doesn't keep this tally, but somehow in my heart I felt like I had to. That I had to get the balance at least back to $0 in order to come before Him. That there was no way I could really be repentant with at $15,000 debt. Because if I was really repentant I would not have played solitare in the first place (solitare is just the metaphore here guys). It is impossible in both solitare and in our spiritual lives to not be bankrupt most of the time.

This morning, for the first time in a long time, I actually had the desire to get up, get my coffee, and sit at my dinning room table and open my Bible. I pulled out my BSF study and read Romans 9:30-32:

Israel's Unbelief
30What then shall we say? That the Gentiles, who did not pursue righteousness, have obtained it, a righteousness that is by faith; 31but Israel, who pursued a law of righteousness, has not attained it. 32Why not? Because they pursued it not by faith but as if it were by works.

I am trying to ATTAIN my rightousness. It has been given to me and I have already OBTAINED it. I am legalistic toward myself, though I try to deny it and know how against the cross it is. I feel that I have to work harder, be less lazy in order for God to look upon me and say "well done my good anf faithful sevant." But I am not being faithful. And I can never work hard enough to earn it.

Knowing all this, I am still trying to get my head and my heart to align on this. Any Biblical advice my dear friends? Any encouragement? I know Paul's "I do the things I do not want to do, yet the things I want to do I do not do" always seems to bring some peace. But I am frustrated with myself presently.

I have turned off the cumulative score keeping. Every new game it starts back over at -$52. When I win a game I wish it were still on cumulative. But I know that overall I would never remain in the black for long. Much the same with my days. It is awesome that God resets the counter for me every day. And He does it with endless patience. He knows He needs it with me. Hopefully some day, I will faithfully accept this as fact and rejoice in it all my days.

Paz to you mi amigos.

New Year's Reflections and Road Trip Fun

Every New Year brings reflections and fun. Mine was no exception!

Good times in GA and SC!!
I went road tripping to Atlanta, GA with Alicia (my good friend from my Bible study) to see her college friends, Big Dave and Lauren. In Atlanta, we watched the peach drop on NYE, went to the Georgia aquarium, played darts, and learned some new dance steps and turns for the hustle and swing, and experienced a town that has almost as many golf cart paths as regular streets (including special parking at various stores!). Big Dave was in all his glory - he was the only guy with 8 lovely single ladies on NYE!! So much to do and so little time!

We left for South Carolina to return Dave to his home in Beaufort - a great cozy and quaint home about 4 blocks from the water. The palmetto trees and spanish moss made you feel like you were in another era. It was breath taking and I think I am in love with that area. Not to mention that while we were there we never wore a coat, we went to the beach, walked around with our shoes off in the ocean, climbed to the top of a light house (164 stairs!),


And we couldn't resist having a little K fun - Yep, Big Dave (sneekily) signed me up to sing Patsy Cline's Walkin' After Midnight - and after much resistance from me, thankfully he was also kind enough to sing it with me. I have never done karaoke before, but now I can scratch that off my life's to-do list. I might even do it again some day. ;-)

I also learned about the Gullah culture and language of the sea islands and low country of SC - a culture influenced by the plantation and slave days. The plantations that were on the islands were so well protected and isolated (there were no bridges in those days to get from island to mainland) that the slaves just remained there once slavery was over and they recieved their land during emancipation, the strong african culture remained - complete with a creole language and traditions. Today, women are the community leaders among the Gullah and are the ones to interact with the government and speak up for their community.

There is not enough words to express how much fun Alicia and I had with Dave and Lauren. Hopefully the pictures do it a little bit of justice! Hopefully the grandiose plans we made to meet up in Chicago in June for a cooking class will materialize!!

Reflections:
Everyone knows that I talk of going, living and serving in Africa, Latin America, Alaska, you name it. I want to live a life where I let God work through me and I concider that to be the "greatest adventure" possible.

I am enthusiastic about my future. I talk about it. They are "my plans." Apparently when I talk about these plans, others think there is no room for them in my life - that these plans make me unavailable for future "stuff" (relationships, etc).

During my travels around Atlanta, GA and Beaufort, SC this week, I was confronted by someone about this. I can't remember the exact statement made but it was something to the effect of "You have your life so mapped out, how does another person [specifically a significant other] fit into it?"

That comment hit me like a ton of bricks because it is the exact opposite of what I desire for my life. When asked later what my top 3 desires for my life are, I included having a family. You need a significant other to do that and according to the person I was talking with, I do not communicate that I am willing to make room for another.

My 14 hour drive home from SC made me think "What have I done? How did I get here? Do I have two conflicting desires? Have I been communicating to others (ok, potential romantic interests) that I have no room for them and their plans in my already well planned out life?

That scared me because it is not what I truely want. I realized that I do this on purpose for two reasons:

1) I am just trying to communicate a Godly desire of going where He calls. I have no idea where that will be, but that I am not tied to the American dream that blocks my ears from hearing where he wants me to go. Maybe he wants me right here, maybe he wants me in Africa. I don't know, but I am trying to surrender to where ever that is.

2) I say these plans with such force and conviction to build a wall of protection around myself. I render myself unavailable. I seem to be saying that my plans are made, therefor they should not bother pursuing me. If they don't pursue, I can't be rejected, and therefor I cannot be hurt and dissapointed.

God's plans for my life, where ever they lead, would not and should not block out others. My plans, however may try to prevent me from rejection and hurt. And I know better than anyone else, I run as fast as I can away from rejection and hurt, even if it means that I have to settle for less than my ultimate hopes/desires.

So where do I go from here? I have no idea - but if you the reader have some Biblical wisdom, I sure could use it. I know that it is good to have a mate, and I deffinitly want that aspect of life, not just the traveling missionary adventures.

I hope your NYE was as good as mine and that we will have a year that will challenge us and grow us closer to how God wants us.

Yours, Jess

Death of a PA Student

To Whom It May Concern:

I cannot study for another Pharm test,
Although I have truely have tried my best.
I cannot elicit another H&P,
OLD CARTS is just not for me.
And all those uses for Propranalol?
I really just can't care at all.
This PA student has given in,
Please give my body to Gary Ginn.

I guess in heaven is where I would rather be,
All my love,
Tennessee

Southern Style Birthday

Q: So how does one celebrate their 31st birthday when they are south of the Mason Dixon line?

A: They don a black cowboy hat and ride a mechanical bull. Hey, I don't make the rules, I just occassionally follow the interesting ones.

The human body is a bleach factory

Strange medical fact #1:
Your body makes and uses hydrogen peroxide (H2O2) which, with the help of Iron (Fe+), converts the H2O2 to clorox (OCl+) in order to attack inflamation - yes, clorox, as in the bleach.

Strange medical fact #2:
Men can have a tumor that looks like a pregnancy - it will often have hair, teeth, nails and other identifyable human tissues. But don't worry it not really a pregnancy - it is called a teratoma. This tumor is from the guy's own cells that went crazy dividing into things that it wasn't supposed to divide into (normally skin cells can only become skin cells and stomach lining cells can only give rise to other stomach lining cells.) There is a class of cells that can become anything - the infamous stem cells. These stem cells go crazy in the man's body and become hair, teeth, nails, organs, etc. Gross, eh?

A day in the life of a PA student:

- It is now semester three.

- At least half of my classmates are taking Xanex and Lexapro for anxiety.

- My blood pressure has actually become "prehypertensive" aka - high.

- I am a hypochondriac (either I have the disease I am studying that week or someone I know has the disease de jour).

- I wake up saying crazy things like "acanthosis nigricans" (a darkening of the skin seen in diabetic patients).

- We drew blood on our fellow students with virtually no training. We saw it done once and we were handed needles and vials and told to "go for it."

- I am able to read/write whole sentences in acronyms or crazy medical words (with airport consulting in my prior life, everything has a three letter code and whole memos could be written using them.)

- I think these words and acronyms are only used to make people in the medical profession sound smart. Take for instance the condition hepatosplenomegaly. Sounds like you might only have 6 months to live right? Well, it is just an enlarged liver and spleen. See, not so hard, but is sure sounds more impressive as one word. This is why we have high student loans. It is all one big vocabulary education. But we can't talk to patients with this language - they wouldn't understand a thing. So we have translate it all back to plain English. So who are we actually impressing with these words? Other medical folks! What's the good in that? It sounds cool when you are in public and talking to each other and others overhear - but that is about all. ;-)

But don't feel too bad for me. During our whopping two week break, I went to Cancun and had a private underwater tour of the 2nd largest reef in the world (the Great Meso American Reef) with some Mexican fisherman, saw Chichen Itza - pronounced kind of like "chicken pizza" (one of the largest ancient Mayan ruin sites), I flipped a jet ski on the Ohio River that was worth about 10 times the value of my car, and I learned to ride a horse bareback and witnessed what a horse ferrier does - they are the guys that shoe a horse. Did I also mention that I am heading to Xtapa, Mexico for Thanksgiving? I tailgate for UK games, volunteer at medical clinics booths at various events, study way too much, read up on new drugs in my "free time" for "fun", attend pharmaceutical rep dinners (usually at shwank restaurants that my student budget cannot afford), draw blood and take blood pressures at parties after having a few too many beers, and have forgotten how to speak plain English. I speak Southern or medical. Or medical with a southern accent. Take your pick.

Oh, and while out horseback riding with my classmate Marsee and her husband, Russell, I think I glimpsed my first meth lab here in the rural parts of KY:

New River Gorge

Clockwise from top: Dick (our friendly and burley river guide), the dashing Ashley Killender, moi, my man Myro, the famous (or soon to be) John Killender, Crazy Erin and last but not least, El Presidente, Chad. You really learn a lot about your friends when you face a class V rapid together - certainly nothing brings you closer and makes you appreciate them more when they all yell out to you when you fall out of the raft!

Look at the picture closely: see us grit our teeth, stick out our tongues in Michael Jordan fashion in pure concentration mode, note the excitement mixed with apprehension on our faces. And we are going back to do it all again on the Upper Gaully in September! The Upper Gaully makes the New River Gorge look like childsplay. It comes complete with 14' waterfall drops and mile long Class V rapid sections. But none of this would be fun unless you have your friends from school with you - like I did! That way they can make fun of you when you make a complete arse of yourself on the river - like I did! They all saw me dazed and very confused more than once after coming up out of the water with that "what just happened?" look on my face. That and I am sure there was a big string of snot across my face. Water tends to make every oraface in your body secrete slime. Lovely.

The river is wild, it takes you down and laughs in your face, it doesn't care if you can't breath or if you have sprained ankles, or if you are disoriented when you finally pop up from under your raft. The river swallows you up, spits you out and then you find yourself begging for more. You surf in the hydraulics, you find yourself looking at your raft mates flying in all different directions as your raft approaches vertical (a position you never thought you could experience) just nanoseconds before you realize that you too are going to be tossed in the river, and land in the rapids in slow motion. We went through 21 rapids in 12 miles. Each rapid has a name and my favorites were: Pinball (you actually "stall" your raft up on a rock before dropping down into the rapid below), Double Z which when you finish you ride back up into it and surf the hydraulic and try to stay in it as long as you can, and finally Strippers - the rapid that is known to take your shorts off. Thank God no one fell out during that one!

What else made this weekend fun? A beautiful drive to WV punctuated by beating up and getting beat up by your adopted little bro on the car ride there (ahem, Chad), playing bullshit in a leaky tent with your class mates while it pours outside, cliff jumping, rafting Class V rapids, seeing a wall of water coming at your face, enjoying the 900'+ rock cliffs, hearing all the West Virginia jokes your guides know, eating a steak cooked on the campfire at the end of a long and tiresome day, roasting the perfect marshmellow, hanging out live with the classmates that you usually only get to see on the TV screen (MOREHEAD!) and learning a new trick for making biscuits on a stick in the fire (my new favorite camping food taught to me by Kev-O). The icing on the cake: someone else building a fabulous fire that you get to enjoy (props out to Kev-O, again). Pure joy.

So, who's up for joining us at the Gaully?

Daniel Boone Nat'l Forest / Red River Gorge

Biostatistics is over! I don't know how, but I managed to get an A. I am not sure I can tell you much about biostatisticss other than what a "p value" is and how to use it to reject a null hypothesis (and I am not going to try and explain it here in case you were worried - I just wanted to throw out the nomenclature to sounds all smart and stuff). After one day off, we are back in full swing with three classes over the next eight weeks. The only class of any interest will be pathophysiology. Basically, the study of human diseases, or "what happens when normal physiology gets whacked and off kilter". You know, physiology, the only class so far that I got a B. Grrr.

So, since this weekend had not been punctuated with exams, papers or assignments yet, I did what I always do: go hiking and camping solo (tangentialtal thought: why when I live in Chicago which is no where near anything friendly towards my outdoor interests, all my friends camped and hiked and did cool stuff. Now that I live at the doorstep of nature, I have no friends that want to come play? Ironic) Back to the update: This time I went to the Red River Gorge in the Daniel Boone National Forest. Climbers will know that this is (or was, b/c now the New River Gorge is all the rage) the premier climbing location to go to east of the Mississippi. I have planned to go to the Gorge for years and I finally made it (sorry Michelle!). But I just hiked and camped, no climbing (I am waiting for Michelle). Here are some of the highlights:

Attacked by crickets on the Big Turtle!
The Sheltowee Trace is a 278 mile trail that starts 10 miles south of the KY border in TN and ends at the northern KY/OH border. The entire length of the trail is blazed with a white turtle, since Sheltowee means Big Turtle. Based on my experiences this weekend, a cricket would be more appropriate. While hiking the ST in the Gorge area, I was attacked by thousands of killer crickets. OK, the real story is that there were many, many crickets hopping around and when I would get in the way of that hopping they would slam into my legs. So, I guess I wasn't attacked per se, nor were they trying to kill me, but there were so many hopping around that it actually sounded like it was raining. I remember hearing somewhere (probably the visitor's center) that Sheltowee was the name the Shawnee Native American's gave to Daniel Boone. But why they called Boone the Big Turtle is what I want to know. I don't think I would have been flattered.

Where is Jane?
While on this little hike, I came across a huge rock outcropping (at least 20-25 feet tall) and some swing ropes. On my way back, there were sunbathers on the rock and kids swinging off the rope and into the water. Much to my amazement, the sunbathers starting jumping off this huge rock and into the water. They did an assortment of back flips, back flops and random Tarzan-like moves. I was so tempted to shed my clothes and join them (I was wearing a bathing suit people - I knew it was going to be 94 degrees that day and I was going to be by a river - I was prepared!). I am not sure why I didn't join in on the fun, but I am definitely going back. Oh, interesting side note: one of the guys jumping off ropes and cliffs had the EXACT same Hebrew word (translated to Jesus the Messiah) tattooed on his ankle that I have tattooed on my wrist. I was floored. We also had the same reason for doing it in Hebrew: it is the Jewish scholarly and Biblical language, which is the root of our Christian beliefs. It was a good thing they matched so one of us wasn't walking around with "Don't forget to walk the dog" tattooed on our bodies.

Somehow the Red River just doesn't exude "wild"
So I am not sure where I got this perception that the Red River was this wild river with steep cliffs on either bank and crazy climbers scuttling up every crack and crevice that could be found and marked. But the river itself (at least what I saw of it) is tame and so low that kayakers had to hike lengthy distances in it because it was to shallow. There were the occasional outcroppings, but they were not the norm. Mostly it was just a muddy, slow, low stream easily waded through. All the cliffs are off in the rest of the forest, which is where you will find the hard-core climbers. There is something very cool about driving through the forest, looking up at a distant rock face and seeing microscopic climbers doing multipitch climbs. Total respect.

My philosophy of camping
I decided during this trip that campers like to bring their conveniences of home out to the woods with them. They come to "relax" and "get away form it all", yet they haul load after load from an SUV the size of some small countries to their site, laden down with everything from huge tents the size of the Taj Mahal, stoves on legs, home sized air mattresses, coolers of food and I kid you not here, a generator. Activity around the campsite related to setting up, cooking a meal, and going to get cleaned up at the showers. This causes one to think where is the relaxing in all this? Where is the getting away from it all? Perhaps we need a little lesson in simplicity and the real relaxation that it brings when we do not have to worry about our stuff or keeping ourselves occupied every minute of the day. Look at the trees and the stars, listen to the animals, stir the fire if you need to move around, and just enjoy the company of your friends or the solitude of your thoughts for a change.

Small world with a Kenyan connection
I left the Boone early enough to have time to shower, eat breakfast and go to church - something I was looking forward to after being out in the woods enjoying creation (and did I mention it is one mere hour away from my front door?). I saw in the bulletin a listing of folks that were going on mission trips in the summer. On the list was a woman going to Tenwick Hospital in Kenya. That is the exact same hospital my advisor is sending me to on my rotations! Of course I wanted to meet her if I could but I am new and don't really know anyone, so I was going to have to ask around to see if anyone could point her out to me. A few minutes later a couple sat down and during announcements I leaned over and asked if she had been going to the church a while and then asked if she knew Valerie Phebus. She looked at me and said, "I am her." Turns out that she is in the PA class of 06 at my school (so she is about to graduate)! We talked awhile after the service and she gave me her contact info so that I can pester her with questions when she gets back. How cool is that. Then this conference at a confrence I met an Indian man who grew up in Kenya. He was so excited that I was going to go that he gave me his sisters name and e-mail so I could look her up when I was there and stay with tem (apparentforeigny house forgien medical students all the time - as he and his entire family and children are all doctors). Where does his brother-in-law work? Did you guess it? He runs the hospital. Some say coincidence - I say not.

OK, that is all for the update. Dive Rescue SCUBA training had to be put on hold - the ankle couldn't bear my weight and be able to haul an "unconscious" diver out of the water while both of us were wearing fins, tanks, etc. However white water rafting is being planned for sometime in July in the New River Gorge! School? I'm in school? I moved here to camp, hike and be outdoors.

Paz,

J

Cankle Update

After one week of much bruising, swelling, and sleepless nights due to increased pain, I decided to seek medical advice on my cankle (an ankle so big it is just an extension of the calf). The Dr. grabbed, twisted, slid, inverted and everted my ankle so much that I actually cried. I can hear him in his head saying, "Does she really need an x-ray or is she just faking the limp?" Well, I got three x-rays and we are break/fracture free. Just have to wear an air split for 1 month... sexy!

Hiking the AT20 miles down, 2,155 miles to go

Another exciting installment here from Lexington, KY. Now that cadaver lab is over, I have had to find other amusements for myself - because certainly telling you all statistics tidbits is not nearly as exciting. Although, I have learned the statistically best way to bet on horses. Seriously, the chair of the department of statistics is my bio stats professor and she imparted this wisdom during our last class session which was on probability. She said that you wait until about 2 minutes before the bets are closed for a race and then as soon as the Las Vegas odds come in you bet on the horse that had the largest odds change in favor of winning. She didn't explain how and why this is the best, but I take her word for it. Nothing like real-world examples on odds and probability stats to keep it relevant. ;-)

So what are the odds that if a person goes hiking on the Appalachian Trail (AT for those in the know, whose entire length is "blazed" by white rectangles to keep backpackers on the right path) by themselves, that they will remain alone for a period of more than 30 minutes? I can tell you from experience - the odds are not good so don't bet on it. Solitude is not a word you use to describe the AT during Memorial Day weekend. Monday I realized I had a three day weekend coming up and no plans. On a whim I decided to go hike the AT since I live relatively close to it now (6.5 hour drive vs. Over 13 from Chicago). I went to my favorite friendly outdoors outfitter, got some first hand advice on where to go and what to see (they pulled out all these maps, sat on the floor, spread them out and went to town telling me about all the cool things to see). I ended up buying a topo map of the Jefferson National Forest in VA. I planned a 22 mile loop, 20 miles of it on the AT itself. I hadn't even left the trail head parking lot when I met a couple that was there to do an overnight backpacking trip to celebrate their 34th wedding anniversary. Half of their route overlapped mine and so off we went together. Tom, the husband, was a Boy Scout Master and knew the area like the back of his hand. Armed with his knowledge and combined with his gift of story telling and my love to hear stories, I was entertained and educated on backpacking in this area for the first 5 hours of the hike. Within 500 yards on the trail, we ran into more hikers heading north (the common direction for most thru-hikers who are those crazy breed of folks that decide to hike the entire AT - all 2,175 miles of it, from Georgia to Maine, non-stop, which usually takes 4-6 months). I learned that thru-hikers have trail names. During the course of the weekend I met Librarian, Hog Harley, Hammock, Tree Frog, and Show-Me.

Backpacking (hiking with a 20-40 lb. back pack that contains all your food and gear to camp for several days/weeks in the wilderness without returning to civilization for supplies) is a subculture within those who love to be outdoors. But within the backpacking subculture there lies even more subcultures: those who hike the AT, especially those who thru-hike; those who use alcohol stoves rather than the traditional lightweight backpacking stoves (the bottoms of two soda cans fit together with some holes in it, in which you pour rubbing alcohol and light it on fire - only good for boiling water very slowly at low altitudes); then the even stranger subcultures are those who make their own alcohol stoves and other miscellaneous gear; and those who do not use traditional tents but tarp tents (I have no idea what this is as I have not actually seen one yet). I have never met a group of people that can talk about things in terms of how many ounces they weigh for SO long. But, if you had to backpack 2,175 miles with all you could possibly need on your back, you would make sure every ounce was absolutely necessary, too.

Some other neat things I learned about hiking in general - or specifically about the AT:

At specific points (trail heads and wilderness entrances) there is a "sign-in" box. You write your name (real or trail), date entered the area, methods of travel, number in party, etc. This is how the park service tracks hikers in case there is someone missing. Hikers also use this to track progress of other hikers - to see if someone has passed through and when - tracking how far behind someone they are as they often get to know each other on the trail.

Every 8-9 miles on the AT is an adirondack, a three sided log shelter with a raised platform that generally sleeps 6 hikers. Some are "double deckers" and are lovingly referred to as the Hyatt. You sleep in these if you don't have a tent. They are usually the social hot spots on the trail where you share food, borrow supplies, swap stories, compare ounces on equipment, admire homemade alcohol stoves. They also attract mice because this is where food is made, dropped, and stored. Mice will eat through your expensive backpack to find your nibbles - including toothpaste or anything else that has a scent. SO, everything comes out of the pack, gets hung up on "mice ropes" that are hung from the ceiling with coffee can lids on them to keep the mice from climbing down the ropes. Also in these adirondacks are notebooks that hikers write tips/info/thoughts in. Good water sources, mice issues, etc. One entry that made me smile was from an Aussie the night before I was there: "the moon was full and the night sky cloudless - I woke up in the middle of the night wondering who left the lights on it was so bright." People leave all kinds of things they no longer need in the adirondacks such as they tear out whole chapters of books they have read with notes on what shelter the next chapter will be in for those reading it after them (remember, a chapter in a book might weight several precious ounces, that once read, is no longer needed and therefore left behind).

There are sections of the Jefferson National Park that have wild ponies wandering around that you frequently stumble upon. But don't be fooled by the term wild. They are as tame as could be and are used to "pictures for food." I met up with and hiked the second half of my first day out with Tree Frog (or Nate in the real world). We came into the Balds (areas that are at a high enough elevation that there are no trees, just low shrubs, and so the top of the "mountain" is "bald" and affords a 360 degree view of the area) and there were the ponies. Nate was taking a picture of one and it walked right toward him and then sniffed in his backpack pockets for food! The ponies are kept in certain areas by these zig-zag corrals that hikers have to walk through each time they enter or exit the designated "wilderness areas".

While I learned more than this, I am sure some of you are bored by now. It is a special breed of people who likhikingng/camping stories. But one last thing learned was that boy scouts are indeed always prepared. At mile 8, on day one, (12 miles and one day more to get back to where I left my car), I fell and sprained my ankle. The trail is hard work, many large rocks to navigate, etc. I hit a relatively easy part of the trail, got busy talking to Nate who also hiked at a much faster pace than I, and stopped watching where my feet where going. Boom. Down on all fours I went. I thought I broke my ankle but after a few adrenalin filled moments, I did a check and it was just very badly sprained. By the time I hiked the two miles to the shelter I was planning on staying in and got to the river to soak my foot in the cold water, it looked like I had a large lemon stuffed into my sock where my ankle should have been. I had never seen anything like it. With in an hour, I could no longer bear my weight on my ankle. I couldn't even walk to the bathroom (ok, tree). Obviously, this worried me as I had another day and 10 miles to go. There were no options but to hike out. But a boy scout came to my rescue. He had an ankle brace with him. Other boy scouts offered ace bandages too. In the morning, with brace on, right foot supported by a new found walking stick, and 1600 mg of ibuprofen in my system, off I went. All in all, it went much better than I could have expected (praise God). I got some bad blisters on my left foot due to the over compensation it had to do for the right foot being unable to carry weight and provide balance. But I made the ten miles in 5 hours. The icing on the cake? There were notes on my car from the various people I had hiked with in my two days on the AT (they had to pass my car to keep going north on the AT), all with e-mails addresses and contact info! So, I may not have gotten the solitude I went looking for, but I made some new great friends!

Oh, the AT in VA is beautiful - a true testimony to God's creative eye. So, I have 20 miles down and 2,155 miles to go. It may take years at this rate but I think I am hooked and am trying to figure out when I can get on the trail next - and trying to figure out how to make that darned alcohol stove for next time.

Paz,
Jess

Spring Break!

So I noticed it has been over a month since my last "adventures in Lexington" installment. A lot has happened since then: mid-term hell week came and went, my car was totaled, I spent my spring break in Chicago and St. Louis Frankensteining a new car, camped in the Natural Bridge State Park here in KY, spring sprung, and got back deep into the cadaver lab which is smelling worse and worse by the day.

Mid-Term Report Card
Mid-term hell week itself was not bad. It was the three weeks leading up to it that wore me out. Four exams in four days is brain numbing and then having to go to lectures afterwards for the new material was just ludicrous. In the class right after our last mid-term, the professor looked out at us and said, "Did you all just have a mid-term or something?" I kid you not. We were mush - it was like Charlie Brown's teacher going "wah, whah, whah, whah, wha." The final outcome: 3 As and 1 B. Not too bad.

Good Things From Bad
So you read right, my Ford was totaled. I took it in to get an estimate on repairs to the transmission and while the mechanic was out test driving it, he got hit. He was making a left turn and got slammed in the back end hard enough to spin him 180 degrees, knock his cell phone off his belt and send it sailing into the back seat. Since he was at fault and insurance follows the car, not the driver, my insurance was going to have to pay out for the other car and nothing on mine (no comprehensive coverage there for me). BUT, God is good, as it all unfolded, since the mechanic was driving it for business reasons, his business insurance paid me for my car and paid for the other woman's car. I got almost exactly the amount I need to pay for a semester of school that I was wondering where I was going to get the money for. AND, he said it would have cost about $1,700 to $2,000 to repair the transmission - which I didn't have to spend because I no longer have the car. Amazing.

O'Grady Chop Shop
So, after three weeks of being chauffeured around by my numero uno study partner, Chad, an old friend (Sean, in St. Louis) calls and says, "Hey, my sister got married and moved to China last week. You would be doing my dad a favor if you took her car off his hands." Hey hey! A free car! Little did I know that while it was "free", as in no money to purchase, sweat equity would be required in the form of five days of intense labor to getting it running, looking and smelling decent. Yes, you read right - smelling. Joe, Sean's sister, was not overly concerned with neatness. While she ran a house cleaning business, that skill did not transfer to her car. There were piles of moldy clothes, moldy food, cleaning supplies, three miscellaneous tires and rims, 30 empty packs of Merit and Basic cigarettes, spilled Chinese food, and beads from crafting stuck in the Chinese food. Not to mention that she wrote these neat little pearls of wisdom on tiny pieces of paper that could not be thrown away (they were pretty cool). So something that looked like trash, you found out was not. Even once the car got cleaned out and vacuumed, it still smelled like a cat had vomited, peed and then died in there. Sean's dad, Tom, and I took out the carpet and both front and rear seats (which had no vinyl left on them anyway). We replaced these with junkyard seats and carpet that were a thousand times better than what was in there. Not to bad. We lucked out in that the car we found at the Victory Auto Wreckers was the same make and year and color - but one model better. So it was a great up grade (folding rear seats!). After we tossed a bucket of water in the car to get as much of the mold out as we could, we bolted in the front driver's seat, threw everything else in the trunk and back area, and off I went to St. Louis. My mom followed me there to make sure I made it ok. After all, I could actually see the road beneath me as I drove. We took out the body plugs to let the water drain and to get the smell out. With no radio, that 4.5 hour drive was long. Once in St. Louis, Sean and I played chop shop for three days. Literally. The car went up on stands, tires off, all interior out, engine opened, etc. With the help of his friends and co-workers we welded, de-greased, re-greased, took apart and re-built this car. Little Ercel (it is a Toyota Tercel, but the Tercel on the back is missing the T, so we nicknamed her Ercel), is now running, looking and smelling good. The welding of the back seats in burned out any smell that remained and the Vanillaroma tree took care of the rest. The redeeming factor of little Ercel: she is a manual four speed. She is very fun to drive. And she is bright UK blue (I now bleed blue too) and looks good with her little UK sticker in the back window.

Natural Bridge State Park Backpacking Trip
Since my spring break was not very relaxing, I was looking forward to my beginning back packing trip to the Natural Bridge State Park. Chris Dettmann and I signed up weeks ago to learn how to back pack. We learned Leave No Trace (LNT) ethics, learned how to plan for a multi-day pack packing trip, how to pack our packs, and off we went! We hiked 11 miles in two days (only half days of hiking), leaving from the Natural Bridge State Park and hiking into the adjacent Daniel Boone National Forest and spent the night there with our group. We learned how to have a pan fire (no roaring bon fires that I love in LNT camping), learned that in order to do this LNT camping "right" one would have to rinse out their pots and pans with water and then either carry the water out with them or drink this "grey water" for the extra nutrients. Chris and I agreed that we were never going to be that hard core. Another crazy thing was brushing your teeth. You can't leave things in the back country that you did not find there - that is LNT - so what do you do with tooth paste? You either don't brush or you swallow. We cheated, we diluted with water and spit. Some things can be taken too far. And I was not going to not brush nor was I going to swallow the paste. I won’t tell if you won't! But other than some of that crazy stuff, we had a blast - in a space of minutes, we had warm sun, then fog, then a snow cloud came right over our ridge and we were enveloped in snow/ice pellets. Ten minutes later, sun while it snowed. During the day we were toasty while hiking , but freezing when we stopped. The overnight low was in the mid-twenties. The pan fire kept us warm if we were within two feet of it, but that can't be taken to bed with you. We saw some amazing natural bridges, salamander egg slime pod things (see photo at NBSP caption), frog egg ponds, amazing rhododendron forests (not you average potted plant that we are used to, but tree sized ones!), caves, burned out forest areas, and Jeeps off roading and crawling over these huge boulders. Those are amazing machines. We even hiked were it was too tight to take your pack - it had to be left behind. All of this within one hour of my home here. I will be going back.

Well, as you know school is back in full swing. Next round of big exams is two weeks away. Big paper due on the Kenyan health care system and how they are dealing with the HIV/AIDS and malaria issues. But he fun part is that I am signed up for an Outdoors Adventures Medical Club. We will be doing trips and learning how to do outdoor emergency medicine. And next semester I am signed up for an elective class (on top of the 14 credit hours I have to take!) called Medical Missions and get to go to the largest medical missions convention in the US - it is right here is Louisville next year. Good times.

So, four weeks left this semester, the trees are budding, the state parks are calling, I have only 6 classes this summer, so come on down!!!

Jess

Bloody Valentine's

OK, since I wrote just a few days ago, this one should be short. But, since I just had the best Valentine's day ever, I had to share. Pretty much none of this e-mail is safe for those who are sensitive. Skip to last paragraph if you need to (but then the e-mail is rather boring). So here goes:

Today, I was up to my elbows in the chest cavity - well, maybe just mid-forearms. I had to cut off the rib cage with an electric autopsy saw, remove the front part of my cadaver's chest and cut out both lungs. It is amazing how the chest cavity just pops off like the hood of a car. Since neither of the other girls wanted to have this duty, I zealously took it on… I wondered if there was something wrong with my enthusiasm but I was assured by my professors that I was perfectly normal - among a certain crowd. ;-) So a few things I learned today:

Even though an electric saw (think of an electric pizza cutter with a serrated blade) can cut through bone like butter, it cannot cut through flesh and muscle.

That bone, when getting cut, smells like Fritos.

The lungs are HUGE. Find your clavicle - go ahead - you have the uppermost part of your lung under that! Yes, they come up into the neck shoulder region.

Now a word from the stop smoking campaign. The lungs of a smoker are as dense as bricks and just as heavy. Parts of them just die and atrophy in the body and leave black marks on the surrounding cavity. They are black and heavy, the feel nothing like the healthy tissue (kind of spongy) of the other cadavers. And the tumors are astounding. They exist inside and outside the lungs. They grow on the muscle that your lungs sit on - they spread everywhere. It wasn't the black lungs that got me, it was the accompanying tumors that couldn't get over. Where flesh should have been smooth it was like someone put a layer of large rocks under the muscle in the entire chest cavity. I can't even begin to describe this in words that don’t sound cliché. But seeing it puts a whole new perspective on things.

Oh, and the most ironic and mildly sick part of my dissection today (and I find most humorous since it was Valentine's day): I had to remove all the skin off the abdominal region down into the "inguinal" region. This is where the male plumbing comes through abdominal muscles to enter the... Um… family jewel chest. Yeah - the place where a hernia is likely to happen in little boys. I actually saw a female with a hernia today in that same region - that is rare. So, I had my face and fingers in my cadaver's um… family jewel chest today. Joy! We do have to dissect everything and they mean everything. We don’t get embarrassed about it in front of the other students (last week we had to cut a female breast in half) , but relaying it to you all makes me remember that it is not normal… but all joking aside, it is very fascinating how this area develops. Did you know that the testes, during development are actually located in the lower back?

And as for my latest exam: pretty much the entire class failed the physiology exam we had on Monday - class average was a 65 (and nothing below a 70 is passing). I got a 70. Mild anxiety attack there but not surprised. There are 2 more exams for this class - hopefully it will get better. I studied at least 30 hours for that exam. Oy vey.

Ok, Happy Valentine's Day and I hope you all enjoyed the update!!

Jess

Over the First Hill and Charging the Second

After weeks of studying 5-9 hours a day, eating more Fazoli's and Panera than I care to think about (they have free wi-fi and let you study there for hours for little money), the first big one is over. The cadaver portion was a lot easier than I thought and the written portion was a LOT harder than I thought. I wouldn't have been surprised to get a C overall, but would have been happier with a B. The whole thing took from 1pm to about 6pm. Then we all hit up BW3 for a little hot wing action where one of our classmates, Adam-Paul, took on the Blazin' Wing Challenge to eat 12 of their hottest wings in 6 minutes. He had to sign a waver that if he got sick, he couldn't sue them. He did it in just over three minutes. We were impressed, but the timekeeper at BW3 said she had seen it done in just over two. We were proud none less. See attached photo and caption at the bottom of this message.

So, you want some interesting educational/cadaver tidbits? That is what everyone seems to enjoy. So, if you are sensitive, you know what to do - skip this section!

Did you know that the bones we study on (not the ones in the cadaver, but the ones that are clean and in drawers) are 1) real, 2) "cleaned" by grubs and beetles by some outfit in Egypt? Yep, they toss these bones with muscle, ligaments, tendons, fat, veins, etc into a container, toss a few hungry beetles in with them and a few days later, voila! Clean bones. Finger lick'n good I tell you.

That the muscle on a cadaver starts to look like dried out beef jerky after it has been dissected and left out with out being properly moistened?

That the viens, still many with coagulated blood in them, look like dried out worms after a rain storm comes and then the sun fries them on the cement. It is not pretty.

That the longer the cadavers sit in their stainless steel bread boxes (called clam shells), the worse they smell? We drain off about 1-2 gallons of fluid from them every few days. We add about 1/2 gallon of cadaver moistening fluid, which by the way, smells like ben gay, every time we close them up to try and keep them moist.

That their joints are getting really stiff and so they are often stuck in really bizarre and unnatural positions. It is not uncommon to have to shove their arms and legs into the clam shell as you are closing it because they keep popping back into those weird positions...

We came into the lab one day to discover that several of the bodies had had one leg sawed off so that we can see a cross section of the hip. Their legs were not laid on the table in the same direction, so it was a little freaky at first.

There really is such a thing as a "dead weight". Our little guy weighs a ton. All the people at my table are tiny girls so when we try to lift him, flip him over - and he is slippery (remember the chicken fat stories I shared) - it often doesn't go well. Not to mention that his entire upper limbs and chest/back is completely dissected so it is hard to keep the arms in a normal position. One of the other cadavers is so heavy that they have to have lab assistance to change her position. One of her breast weighted over 8 pounds (we had to cut them off in the beginning of the semester). Last time they flipped her, one of her prosected breasts flopped onto the floor (they had to keep them) and left a huge greasy mess.

One time, we had to put a chest block under him to raise him up and when wee put him back down on it, all his ribs cracked from the weight of his own body. It was the grossest sound ever - reminded me of when I crack two of my ribs canoeing but many times worse.

OK, I think that is all the stories I have for now. Next test: physiology - in 6 days - which no one has looked at because the anatomy had us all freaked out. I now know more about the physiology behind Viagra than I ever wanted to know. The instructors are all research folks so there is a LOT of practical application in every class. ;-) But in all seriousness - I have learned a ton from them and it is a lot of fun. Though we all tell really nerdy jokes the more we learn.
Oh, by the way, grades were posted this morning - I got an A on the fist exam. It was a low A, but an A none the less. I will take it. And I would like to thank my study partner - Chad - for all his patience with my brief crying spell in the lab because I couldn't for the life of me remember the muscle attachments of the flexors of the upper arm. Yes, it is stressful and the strangest things set folks off. ;-)

Later,
Jess

Work Hard, Play Harder

Hey all!

I have been in class a full two weeks and some change and let me tell you - I am about 6 feet underwater (which is about 2 inches over my head) and see a tsunami coming my way! What have I gotten myself into?

Well, I can't resist a cadaver update (sensitive types skip this part):
We have removed all the skin off our cadavers from about mid-chest to neck and down the upper limbs (aka arms) on the front and back (aka anterior and posterior sides). We are getting used to the fat and various other slimy things that are in your body when you get old. Cleaning off bursa tissue from the elbow area of our cadaver was a noteworthy treat. Bursa is a highly viscous 'lubricant' that is normally in all your joints to allow your muscles, bones, ligaments, nerves, veins, and arteries move on and around each other without causing friction. Think cherry gelatin made with 7-up. Well, in old folks it leaks out of the joints (ever seen an older person with "inflamed" knees who says "my bursitis is acting up"?) and adheres to the superficial skin layers and has to be removed to see the muscle tissue. There is something about the way it feels, the way the scalpel cuts it away, they way it releases little air bubbles as you touch it - I almost puked.

Safe to read again:
But other than the bursa nastiness, our current dissection has allowed us the privilege of reflecting muscles to investigate the wild world of the cervical and brachial plexuses (aka, big bundles of nerves that break off and go to many places - somewhat like an electrical circuit box junction); we have memorized the axillary nerves, arteries, veins and associated anastamosis and what they do and where they go; we have memorized the muscles, tendons, ligaments, all their attachment locations on the bones; not to mention each bone has dozens of bumps, grooves, and fossas that all need to be known cold. A portion of our test will include a human bone in front of us with a piece of tape on it to mark a spot off and the question will read: "what nerve innervates the muscle that attaches here?" You have 60 seconds to figure it out and write it down. We have had to make up every pneumonic possible to remember the hundreds of structures we see in the cadaver, on the CT scans and X-rays, and on the cross sections of the body (if you have ever seen the body stairwell at the Museum of Science and Industry in Chicago, you know exactly what I am looking at for hours a day). "C3, 4 and 5 keep the diaphragm alive!", "Real Truckers Drink Cold Beer" (for the organization of the brachial plexus), "Sue The Lawyer, Save A Patient (for the 6 branches of a 2" section of your axillary artery that comes out of your axilla, or armpit). And this was the easy stuff. Every time I get up for a little air, another wave comes crashing in over my head. By the time I understand the Greek/Latin (literally, you wonder if they are speaking English) I heard in lecture one day, the next lecture is going in one ear and jumbling up everything I thought I knew! Think Charlie Brown's teacher from the cartoons - wha, wha, wha, whaa, wha! Thank God for the weekends! Seriously, I have never studied so much and classes haven’t even hit full stride yet. I am spending about 25+ hours week (usually 15-18 just on Friday-Saturday) outside of class studying, going into the cadaver lab, talking to instructors, looking up stuff on-line, meeting with students, pulling out my hair, smelling like formaldehyde and finding bits of body tissue in my hair when I get home. I am so swamped that I didn't notice that my gas light came on and I ran out of gas - again. At least there is no time to procrastinate. ;-)

At orientation the administrators reminded us not to let ourselves burn out: "Here memorize thousands of things, nothing below a B is passing, you loose your scholarship if you fall below a 3.25, but don't forget to have fun!" And now, I understand what they mean. Last night I was studying with Chad - my numero uno study partner. We were reviewing all the stuff mentioned above and we hit a brick wall like a speeding train whose conductor was on crack. Our brains turned to a mush similar to the bursa we removed and we couldn't stop laughing out loud at ourselves - sentences and words came out backwards and made no sense. It is lost in translation to be sure, but suffice it to say there was a dentist in the café and he came over and knew exactly what had happened to us. Dentists have to go through the same class but to a much more difficult level. There is a sense of community with anyone who is in any medical field. We meet them everywhere and they know exactly what we are studying. We called it quits - it was 9 pm on a Saturday night after all - and went and had an adult beverage with some other classmates to release the tension. A cold beer never tasted so good. So, yeah you read it right folks, 2.5 weeks into PA school and Jessica had to end the 1.3 year "no alcohol" fast. A frosty Corona with lime never tasted so dang good. One beer is considered getting crazy - watch out Lexington!

It is good being a student. Though I am poor, there are all kinds of discounts and free things your hideous student ID card is good for: Friday night included free tickets to the Lexington Philharmonic (and they were quite good!) and Saturday afternoon included a $5 ticket to see the UK Wildcats beat South Carolina. There is nothing like being in the student section in the Rupp Arena to watch one of the winningest NCAA teams play (although right now they are doing terrible and are not even on the March Madness bracket which is the first time in the history of the school)… no pacemakers needed there - though you won't have a voice when you leave and your hands will be sore from clapping. Sunday included a trek to Memorial Hall (the original building of UK) for our convocation ceremony and to see the class of '07 get their white coats which signifies the beginning of them going on rotations in the hospitals. In one year that will be me - oy vey! If I survive that is. I noticed that the list of the folks receiving their white coats was a few short of the 54 that started the program one year ago… several have dropped out.

FYI - since I have been here, I have not donned my hat, scarf or gloves. On about 40% of the days, I even take off my light fleece by mid-day. But, it does snow here - and attached is a picture as evidence. One day last week there were "winter storm advisories" - we got maybe one to two inches of snow that was gone in 24 hours. Southerners.

Well, hope all is well in your respective corners of the world… I love to get notes from y'all letting me know what is going on with you… it makes me feel like I am still in the loop! Miss you all!

Jessica

In Lexington - at last

"It was the best of times, it was the worst of times." This Dicken's quote is accurate for my move to Lexington:

Friday: I got a call from Jennifer, my new house mate - the house in Lexington and her car had been broken into. Apparently, the UPS sticker from my printer delivery tipped them off no one was home. Printer was not stolen.

Sunday: The van the Schaaps so kindly lent to me for this trip so I wouldn’t have to rent a van got broken into Christmas morning in front of my Chicago apartment. The back window was completely busted out.

Monday: Just south of Indianapolis the Schaap's van "check engine" light came on. I got off at the next major exit and at the top of the ramp, the van died. Got it started again but every time I came to a stop, it died. Luckily there was a firestone right at that exit and they were still open. We rented a hotel to spend the night in Indi.

Tuesday: By noon the firestone folks still had not ran any tests on the van, so we rented a Budget cargo van, unloaded the Schaap van and transferred everything to the Budget van and went on our way to Lexington. We got into Lex 23 hours later than we originally anticipated…

Wednesday: We have to take the Budget van back to Indi (couldn't do a one way to Lex) by noon and pray that the Schaap van is fixed by then so my mom and Ana can return to Chicago. Otherwise, they have to come back to Lex with me to wait for the Schaap van to be ready… keep your fingers crossed!

Although it sounds bad, it was so ridiculous, that we actually have had a good time. We have not been too stressed or worried (there were definitely moments though!). Help from Jim to pack the van in Chicago was a life saver, the van dying right in front of firestone was a great blessing, the firestone folks were really nice and they helped us unpack and repack the vans, Jennifer here in Lexington had a great meal prepared for us when we got here, Mr. Schaap didn't even bat an eyelash when we told him about the break in and the busted out rear window. Now we just have to figure out how to get Ana and my mom home! ;-)

Hope you enjoyed these tales from the road… and I hope everyone had a great Christmas.