Saturday, February 28, 2009

Elective report for USyd

The desire to visit Papua New Guinea must have originated years ago, through a National Geographic episode or a SCUBA diving special, while I was still in the US. After starting school and seeing the elective reports of students who ended up in PNG, I finally had my reason to go. My interest led me to read some about the country, but really, I had no idea what I was getting in to. The stories from others often involved basic medical resources, obviously CT scans and advanced investigations were only available in Port Moresby, but the recurring theme was that while there you make due with what is available. When writing my elective application it was difficult to be very specific in terms of actual goals, I knew I would be in an isolated community, there were tropical diseases, trauma and births happen everywhere, and I had no real idea of what the hospital would be like.
Before I left I knew the people of Papua New Guinea were black, but I didn’t realize how much I would stand out as a tall Caucasian. When I arrived at the Port Moresby airport it took me a few moments to adjust to being in the minority. I no longer blended in with the crowd, but stood out and over almost everyone around me. The people in the airport probably didn’t think twice about it, since there is a decent sized Caucasian population, but I felt awkward and out of place. As I had an overnight layover I took the shuttle to my motel. Driving along it was incredible how many people were simply out walking, which I later found out was because of the large population of unemployed from outlying villages that take up residence in Port Moresby. Then driving through the suburbs, the massive walls topped with barbed wire around every house made me question my decision to be in such an area, but then we pulled through the motel gate, manned by security guards, to parking area in the middle of an oasis. The walls hid an amazing garden complete with swimming pool and barbeque. Things were looking up, although I was still discouraged from leaving the complex alone.
Returning to the airport I was more comfortable with my minority status, but still felt like an outsider, but then again why wouldn’t I, there I am the outsider. After an uneventful flight, I managed to settle in for my first night in Madang, which if less walls and barbed wire were an indicator, would be more hospitable. At the end of the day with the hospital close by and a big day expected tomorrow, drinking a beer, looking out over the ocean, I felt incredibly comfortable.
The next day I arrived to the hospital to check in, at which point I was given a tour. The Madang Hospital services Madang and outlying regions, it has thirty medical beds, thirty surgical beds, thirty pediatric beds, and about thirty obstetric beds. The emergency department has three active beds, three booths for observation, and various rooms that get used as needed. Originally, I had hoped to split my time between the emergency department and the delivery suite/obstetric ward, but the delivery suite was under renovations the entire time I was there, so I spent the majority of my time in the emergency department.
The emergency department is staffed with a resident or specialist from approximately 8 am till 5 pm, after which the doctor is on call. I say approximately because depending on who was working the start time could go as late as 10 am. During these hours in addition to running the emergencies, there was basically an outpatient clinic, where patients would see the doctor, the medical student (me), or a specially trained nurse. Outside of these hours the doctor is on call, if he was needed, a note was sent to his home by the ambulance driver, and the doctor would come in.
The average day therefore was split between working in the “clinic” seeing outpatient complaints and working in the actual emergency department seeing more emergent problems. The clinic ranged from headache to painful warts, and everything in between. After working for a week it became very obvious that malaria was the cause of much morbidity. Anyone presenting with fever, joint pain, headache, malaise, or delirium, had a blood slide made and was started on antimalarials. If things didn’t improve or if there was more going on additional tests could be ordered, but malaria was assumed be involved in a large proportion of the patients. It amazed me to find that malaria can cause such a wide variety of signs and symptoms. There were other conditions we saw in the clinic, appendicitis, TB, cancer, pregnancy, and arthritis, mostly diagnosed clinically, but also with the occasional use of roentographs, and the single U/S machine, which had to be hunted down from somewhere in the hospital. While in the clinic I quickly learned some of the important words in Pidgeon to help; vomiting, diarrhea, cough, blood, and pus along with phrases; take a deep breath, is there pain. Through my limited Pidgeon and most people having a basic knowledge of English, we, the medical students, were set loose on the locals to find out as much as possible then report to the supervising doctor. In addition to using antimalarials, which I had never used in Australia, it was interesting that chloramphenicol is still commonly used in Papua New Guinea, I was told, it’s cheap, it works and I haven’t seen any problems from using it. Needless to say I didn’t argue and prescribed as I was told. Something else that surprised me was the near absence of heart disease in the Papua New Guinea population, although with a shorter life span and minimal obesity, it shouldn’t have surprised me. The clinics were great and allowed me to see a wide range of patients with independence that forced me to think through cases and come up with a definitive plan.
The department also responded to emergent cases during and after clinic hours. As I had hoped, these cases allowed me ample opportunity to suture, cast, and assist with resus. Similar to the clinic there were many cases of malaria, although much more severe, which presented to the department. Additionally, it was common to see broken bones due to falling out of trees, lacerations from machetes, motor vehicle accidents, and snake bites. Weekends were especially interesting since, the doctor was on call, so there were a number of times where as a medical student I was looked on as being the most senior available until the doctor arrived (which could take 5 minutes to almost an hour.) The situation of a medical student as the most senior is dangerous. There were two specific instances, with very different outcomes. The first was a young woman who had come in with an overdose of chloroquine, the staff had seen her and put her in a bed. I go over to see her and she is not responding, not breathing, and there isn’t a pulse. The doctor had already been “called” because of the original presentation, so here I am in a resus with one other staff. We did CPR until the consultant arrived, who after a few more minutes, declared her dead. Afterward, he let me know adrenaline and diazepam were the treatment.
The second case was a traumatic injury secondary to arrow penetration. It was a normal evening in the emergency department, the doctor had gone home, and I was busy stitching up someone’s head, arm, or leg. I walked out past a man in a stretcher with none of the staff helping him, not uncommon, went to the office to grab something then returned to finish my suturing. About 5 minutes later, I came out to the man in the stretcher and try to get the story from his friends, unfortunately, their English is as bad as my pidgeon, and we don’t get very far. His friends, roughly transfer the man on the stretcher to a bed while I am trying, rather fruitlessly to protect the spine. Once he is on the bed, I realize he is not moving, breathing, nor alive. Calmly I walk in to the office and ask the medical and surgical residents to please come help me with the cardiac arrest in bed 2. They come out and we start CPR and we are about to intubate, when the laryngoscope light crosses his eyes it is obvious that he has been dead for a while. The residents get a better story from the friends, who elaborate that previously they had stopped at another medical center, where they had tried to resuscitate him, but unsuccessfully, and that the brother of the man on the stretcher, who had also been attacked was sick and they needed to bring him to the hospital. No longer in tunnel vision, I looked over and saw the brother, who was sitting in the corner, breathing at a machine gun pace, watching all the activity. The story I get about him is that he was hit with a rubber bullet to the back and was hit a couple times with a bar (later on, the real story, lost in translation, is that he was shot in the back with an arrow, which was removed before coming to the hospital.) Examining him, I have my first experience with hyperresonance to percussion, which I promptly ask the surgical resident to confirm, which she does, and then leaves. I’m not exactly sure how, but both of the residents have left, and we are now waiting for the emergency resident to arrive because of the note sent earlier. Oh yes, and although there is oxygen available, an 02 saturation monitor was not, until the doctor arrives with his own personal one. With a medical students clinical diagnosis of pneumothorax and the patient in obvious distress, I make quick trips to the office to look up needle thoracostomy in Tintinalli’s emergency medicine, then tube thoracostomy, before grabbing some 14 gauge needles and taking him to Xray. After returning from Xray, the emergency resident arrives, looks at the images, and says we’re putting in a chest tube, now. The underwater drain is made from tubing and a bottle that is taped shut, while we set up for the chest tube. The patient stays stable while I undertake the procedure with the doctor guiding me through. The chest tube drains 2 liters of blood throughout the evening, the patient recovered, and I celebrated my first chest tube.
The experience in Madang opened up a different perspective of medicine for me. The patients are truly appreciative. In Australia, the patients may or may not say thank you, but in Madang, everyone thanked you, and families thanked you for helping. It was quite an amazing feeling, having the people truly appreciate the work I had done, even after explaining I was a student. Also although the resources at times were limited we did everything possible to help, sometimes it wasn’t enough, but no matter what the people realized the doctor was doing everything he or she could. It was refreshing because even in my limited hospital experience in both Australia and the US, at times patients hide information, or give partial stories, with the perception we will judge and not help. This along with the incredible beauty that surrounds the island will make me return, eventually to give something back.

PNG diary (till got lazy)

PNG elective

December 15, 2008
After arriving in Port Moresby I felt immediately uncomfortable. It has been a while and I had totally forgotten what it felt like to be in the complete minority. I was a tall white man amongst a very large population of Papuans. I had forgotten how people do look at me just a little bit different when I am the outsider, and very obvious about it, really no good way to blend in. Deciding to save a couple hundred Kina I went with the less expensive accommodation, after all I was only going to be there for the night. Then as I catch the shuttle and everywhere people are walking around, I do mean everywhere, people were just out. It was around 2pm too, so midday. Decided it would be better not to ask the shuttle driver why everyone wasn’t at work. Then as we get to neighborhoods there is barbed wire on every fence around every house. Yeah that made me a whole lot more comfortable. We get to the Comfort Inn, the guards open the massive barb wired gate and we pull in. Checking in goes smoothly, the front dude is very nice and shows me to my room. The place is quite gorgeous, a pool, and local plants growing all around a courtyard. OK room, air con, which is wonderful. Then I ask if it is safe to go to the grocery store, which the front desk dude assures me it absolutely is, but do you want an escort, to which I say no, because he said it was perfectly safe. As I walked, I passed an open area with stands selling stuff, not exactly sure what, I didn’t take the time to check because I felt like I had the last Ice cream bar at fat camp. Much more attention than I am usedc to getting and or really want to get. Nothing happened, but it was a strange feeling.

December 16, 2008
The next day I flew to Madang, a quick one hour flight, through a bit of rough skies, but a good flight. My plan: get a cab to Hospital. Reality: No cabs to be seen. I hate to admit this, but I singled out the white guy and asked him for help. Fortunately he is a professor at the college which is across from the hospital and he would be happy to drop me off (Divine Word: gotta love the Christians and their need to help) Of course when I arrive at the hospital around 5pm the only place open is the emergency department who of course have no idea who I am or what I’m doing. But they are very nice and help me get the ambulance to take me to the hotel down the street, good I saved money before cause of course only room available is 360 Kina. Oh well, it was easy and absolutely gorgeous. On the water, pool, bar, restaurant and although not actually settled was able to relax and enjoy a beer.

December 17, 2008
Up early and head to hospital. Got accommodation, there is a family living under it I think, but bed, shower, and kitchen, what else do I need, the family is just a bonus I guess. Head to ED because that is why I am here. It is bare bones. Mostly older equipment, I was told today they ran out of sterile gloves recently, but they do what they can, which is a lot it sounds like. Suture up a knife lac on the top of a 15 year old kid, reused ECG buttons to trace a younger guys heart, and oh yes, helped hold a kids head down while the 2 cm forehead lac was sutured. Almost forgot to mention that to help stop the bleeding the mother had held a kerosene (yes kerosene) soaked rag against it. Not sure how much it helped with the bleeding but it certainly calmed the kid down. The mom brought the rag in to the suture room and by the end I was pretty calm too. Kid wasn’t, but who can blame him, one internal and 3 external stitches. Also helped plaster a Monteggia fracture-dislocation, which will go to theatre tomorrow morning. Not a bad day.

Still feeling a little awkward about going around, will need to suck it up and go to town tomorrow, on local bus…Am told it is safe, just don’t be out after dark, and if mugged, it’s not cause I’m white, it can happen to anyone. Should be good, will have time in hospital, and may not have much else to do but study at night. Will also have to check out diving situation for the weekends.

Thursday December 18, 2008
Pretty mellow. Sutured a nearly avulsed L pointer finger with distal phalangeal # after doing a digital block. Pretty much on my own. Suture needle was too small, but still managed. Also watched 2 plantar warts removed. Both under LA (local anaesthetic) totally would be theatre material in OZ or US. ED “reg” is happy to do them though, pretty major excisions. Also saw a lady come in with delayed 2nd stage of labor, most thought baby would be dead, but U/S showed heart beat, so they took her in for an emergency C section. The locals are very tolerant of pain so far, they will put up with a whole lot without any complaints. Very stark contrast to Nepean, where I have seen grown men damn near cry or withdraw in pain from a mere 30 gauge needle for LA. Did manage to go to town to get groceries, still not feeling super comfortable. Nancy the housing lady said she would take me to the proper markets later on this week if I want. Should be much better selection, I don’t think grocery stores are used like we use them.

Friday, December 19, 2008

Girls (Kate and Edwina) showed up today after running away from a dysfunctional Wewak. The staff here were very helpful in terms of letting them come and finding them a place to stay. Not a whole lot done in ED. Couple of #’s that needed plastering. Felt the doughy abdomen of TB infected mesentery, incision and drainage of infected insect bite to finger after digital block (on my own), attempted to drain 4 cm mass on 60+ year old woman’s lower thoracic back region. No LA, but lady very tolerant, especially since I didn’t actually drain anything. Asked Dr. VA opinion and he just got artery clip and went in deeper, old lady screaming, no pus, but he says she will be happy because she knows he did something since it hurt à Pain = Treatment. Wouldn’t go over too well in Sydney. Am working on pidgeon, couple of phrases here and there. Mostly if said slow words are derived from English and kind of make since. If fever and unwell = Malaria here. Given treatment, then follow up if not better. Took girls to Madang lodge for beer and dinner. We were walking back when white couple pulled over and offered a ride for the 3 blocks, they encouraged us not to ever walk around at night, especially Friday, even in a group. Interesting contrast from the locals opinion of don’t walk alone at night. Is always good to get outsiders opinion, locals don’t want to think it isn’t safe, plus, it is safe for them.

Sunday, May 27, 2007

Been on the Down Low

Not many people have heard from me for the last 4 months (and haven't blogged for longer). Was busy getting my ass kicked by neuro. School has been pretty intense and has definitely kicked up a notch w/ that whole single test at the end of this year that determines if I pass the first two years or not. Definitely not a glamorous life. Wake up go to class or hospital, eat, gym, study, eat, study, sleep, repeat until weekend or crisis.

On weekends I have started working Saturday nights as medical assistance at a big dance club. Which is pretty interesting, nothing major so far, cuts, blisters, drunk, too many drugs, etc. Just like a night in the ED w/out the geriatrics. Pretty much clean things up and then tell them to go to hospital or not. Have had to call ambulance for possible hypoglycemic (faker female looking for attention) episode and an OD on GHB (sedative drug, used to be used for date rape, real popular for voluntarily taking by the gay crowd. Besides that haven't really been doing much else. The US in Iraq and good old GWB is killing my exchange rate so my tuition has basically gone up. That's why working seemed like a good idea and the pay is good and I work 9 hours on Saturday night 9pm till 6:30am most weeks.

We have a break coming up at the beginning of July and I am looking forward to, you know it, studying.

Tuesday, July 04, 2006

The screen goes fuzzy

So it's 11pm and I have been studying since about 2pm, with breaks of course. Simpson's at 6pm and 7:30pm eating while watching. So when I got to this:

"Familiarise yourself with the structure of skin of the general body surface, which has a relatively thin epidermis with shallow papillations, eccrine sweat glands, hair follicles and associated sebaceous glands. Dermal papillations and rete ridges are shallow as there is low abrasion here. Compare with plantar skin, where the epidermis is thick, especially the stratum corneum, and where there are deep papillations and rete ridges due to high abrasion. Note there are no hair follicles and only eccrine glands are present here."

the whole screen went kind of fuzzy and I figured I would write rather than read.

So we are on our second week of a 2 week break and I think I need a vacation. The last block was musculoskeletal, which meant we were thrown to the wolves (orthopods) for our clinical skills learning. The chasm between the anatomy they figured we should know and we were madly trying to learn seemed immense. Fortunately, they were kind, which meant they acted surprised when we could name the tendons of the knee, or muscles of the forearm. In the end though I feel comfortable with a basic joint examination.

The chasm I refer to is the fact that most of us have never had an anatomy course and the block was here to teach us the muscles, bones, nerves, and blood supply of the upper limb, lower limb, and the back, oh yeah and we are doing it in 8 weeks. I forgot I meant 6 weeks because the first 2 were dedicated to drug and alcohol. One more thing, we are going to do it with our problem based learning. I will translate that last part for some people to english "It means we are going to talk about these bits and pieces while going over pathology; like rheumatoid arthritis, osteoarthritis, carpal tunnel syndrome (actually really interesting), osteoporosis, and sciatic/back pain."

So that is why for the 2 weeks off I tried to do some review and hopefully solidify the knowledge into my skull. It worked out pretty well, except for random diversions, like the world cup, couldn't miss Australia play Italy (at 1 am here by the way), random B-day parties, a friends' dog relocation project (didn't work and we went back to get her, the dog, yesterday), and finally my need to sleep. Now it is Tuesday and I feel comfortable with the back and the lower limb. Tomorrow I will get to the upper limb (brachial plexus I will be your master.)

To those who have checked this sorry about not writing earlier. I would love to say its because I have been a studying machine and very focused, but its not. It's because I tend to be lazy when it comes to writing. Also, my free time has been used to keep riding my mountain bike, make new friends, and general non school relaxing stuff (yes that does include some late nights out on the town.)

Sunday, March 19, 2006

Hunting for patients

Today I went to the NSW art museum. It was a welcome break from classes. Not to say that classes have been particularly difficult, but it was a nice way to spend the afternoon. The exhibit I went to was artwork from Australian high school kids through a program that allows their work to be shown in a true gallery/museum. It was all very impressive, especially since my artistic skills are minimal. One piece that caught my eye was a cardboard cutout of a physician without a face and a price tag around his neck. The item was labeled “predator”, which bothered me and in the next room was another cutout, this one of a dog with a price tag around his neck titled “genius.” This one I liked.
Writing this now it makes sense although probably not in the way the student was thinking. Especially as first year med students, we do act like predators although with a hint of scavenger. We are told to practice taking histories of patients, so we wander around the hospital, trying to be blend in, asking the nurses if there are any good patients we can talk to. Now good has many meanings, first it would be great if the sickness is interesting, second you want a patient willing to talk, but not too willing otherwise you end up hearing about how their great aunt once removed died from some unknown illness. Although this may be interesting, when reporting back to your tutor, it for some reason doesn’t come across as pertinent. Finally, you hope another student did not beat you to them, since that means the patient has now, not only given a history to the nurse, the initial doctor, possibly a specialist, maybe some other doctor, possibly a resident (technically I know they are doctors too), and a student the patient tends to either not be willing or he leads the interaction because he knows the questions better than I do. Fortunately, there are not that many students at my hospital and hunting, I mean finding patients isn’t too hard.

It is now week 7 of 8 and we are about to finish the Foundation Block. What this has meant is that every week we are given a new case dealing with a major representative illness, heart attack, anorexia, cancer, PKU (a genetic defect in metabolism), and a dental abscess. All of which are meant to briefly expose us to the methodology of analyzing cases and some of the basics surrounding them. In the future our blocks will deal with a specific area such as, musculoskeletal, cardiac, respiratory, etc. where we will have multiple cases dealing with the same organ system for the whole 8 weeks. The problem right now is that my excitement to understand more detail is quickly derailed by the introduction of a new case. Needless to say I will be happy in the next block when we actually focus on the musculoskeletal system.
The foundation block is great though because it does get us acquainted with the system and it allows our involvement in the multitude of social activities going on these first weeks. It seems that almost every night there is something to do, from parties to lectures, all of which seem to have alcohol encouraged, either free or discounted. I kid you not, I went to a lecture/debate on stem cell research and afterwards there was not only food, but beer, wine, and juice offered, for free. Eager to meet new people I have gone to many events, although I have also turned down many nights out to be the geek and study at home. I am working on finding the balance.

Non medical stuff. Sydney does have decent mountain biking!! I have found an engineering student who rides and has a car. So we have been to multiple sites all within 30 min of home and although different from the great NW it exceeds my expectations. Lots of sandstone, (read bumpy) and sand going through the bush. Additionally, I am told there is even better riding, an hour and a half away in the Blue Mountains.

Friday, March 03, 2006

Med school down under the first week

Three weeks have passed since school actually started and I have just been slacking about writing, there are lots of mediocre reasons, but mostly it has been laziness. So the first week of classes was a whirlwind. We had orientations, introductions, and social events. At all of these I was constantly meeting other students, and inevitably the sequence of questions would start, in medical format:
1. Presenting Symptom: So why are you studying medicine?
2. History of Presenting Illness: Why University of Sydney? How long have you wanted to go in to medicine?
3. Past History: What did you study before, where at?
4. Social History: Where you from? Where is that?

The first week was stuffed full with a cursory explanation of all the options we had while going to school and how the classes would run and hundreds of other bits of information that I had forgotten before I left the building. Jargon was thrown around that brought up vague memories of stuff I had read. PBL (a biggie, problem based learning), BCS (also pretty big, basic and clinical science), Pt-Dr. (Patient and Doctor theme), C-Dr. (Community and Doctor theme), PPD (Personal and professional development.) All but PBL are the general themes of what we are going to be taught/learn. PBL is huge here at the University of Sydney and it goes hand in hand with self directed learning, also a big advance in medical learning. Problem Based Learning, is where every week we are given a “patient case” and from there we use it as a means to direct our studying, along with the lectures that go along with the case. Additionally, while this is going on we will be spending one day a week at our allocated hospitals actually seeing patients, at this point I didn’t know what we were going to do with them though, since we really didn’t know much. It was all very exciting to hear that we were partaking in such a revolutionary method of learning.

So along with all of this orientation, I was busy working on moving in to a new place which I lucked out on. I am living with 3 other first year medical students, a Canadian, another American, and a guy from Taiwan who did his undergrad in the states. The house is brand new and beautiful. Oh yeah it was also completely empty. So my priorities were food and sleep. The refrigerator was the first thing to be delivered to the house. Second was my bed and that made it livable. Now after 3 weeks we have gotten a kitchen table, a washing machine, and a sofa is going to be delivered next week. During all this I have learned a few things: I really don’t like IKEA, price wise it is not all that cheap but quality wise it is cheap crap, a bike is a great way to get around, but is not good for taking home furniture (already pretty much knew that though), some people are just cheap and if so they will never offer to pay for anything extra.

Saturday, February 04, 2006

Everyone needs a Cookie

Every once in a while I get this question in my head. It is normally sparked by something else, a comment made by someone, a scene in a movie, an episode of Scrubs. Today it was as I finished reading Winterdance by Gary Paulson for the 2nd or 3rd time. The story makes me laugh and cry sometimes at the some time. The fact that he decides to run the Iditarod with only cursory experience mushing is incredible and naive and crazy. Yet he does it. The passion he feels overwhelms him. So now you might be asking what a story about freezing cold Alaska has to do with medical student in the heat of Australia. It makes me ask what the hell did I get myself into.

It makes me imagine that my work in the hospital is simply a cursory taste of what I am going to go through. I look at the massive student loans, the moving away from family and friends, and finally the future. Four years in school then at least 3 years of residency which is supposed to be more grueling than school. Oh yeah, but you get paid during residency, I think the going rate is somewhere around $2.50 an hour. Fortunately, and hopefully this continues throughout my life, there is that 1 in 10 patients that really made it worthwhile. They made me feel especially good, even if it was just for helping him to his wheelchair or cleaning pebbles out of her arm after a car accident. Gary had his Cookie I hope I keep seeing mine.

School starts in about a week and I am still looking for a place to live. I have however managed to get my mode of transportation sorted. I have purchased what I affectionately will call Blue lightning or Blue for short. She is a beautiful, but not so much so that she stands out, commuter bike. I will hopefully figure out a way to attach a picture of her to the blog. She has allowed me to dart around town to look at multiple apartments and houses today to find that there is a big range from infested to gorgeous here in Sydney. It’s all about how much I want to spend and since I figure every dollar I spend now I have to pay back two, it is a careful balance. Infested or close to is not even an option.

Tuesday, January 24, 2006

The next big step

Well it’s Tuesday morning the 24th at 6:30am and I have been flying since 10:30 pm Sunday night. The last couple of days have been a whirlwind. Between deciding what to take with me, packing up the stuff I am leaving, selling the stuff I am not keeping, and saying goodbye to all of the people I can’t take with me. It has been heartbreaking. It wasn’t until I realized I would not see some of these people for multiple years that it got harder and harder to say goodbye. Additionally, I gradually became more of a recluse as my list of people I had to say goodbye to decreased. I had already said goodbye and didn’t want to go through it again. It also makes it harder because I am starting a new adventure and many of the people I leave behind will simply be continuing on the path they started years ago.

It is going to be amazing. I am heading to a new country to start a new life through a unique opportunity. Not only do I get to study medicine, but I get to do it in a totally new environment. Yes I know I could have done it somewhere in the East Coast or another American school, but I am pretty sure I wouldn't be as excited as I am with this complete adventure. Things I must do: Get a mailing address, start a bank account, find somewhere to live, phone, internet. Oh yeah and I have to start school on the 13th. Just a minor detail.

School has always been fun for me. I like the stimulation, camaraderie, and chance to excel. These next four years will fly by and I look forward to everyone coming to visit and eventually returning home.

To those I don’t say this enough to. I love you and thank you for all your support I already miss you.

A little addendum here on Tuesday the 24th evening. I arrived with no problems only to find that my two suitcases had decided to see more of the world before they stay with me in OZ. Needless to say they ask for my address, which fortunately I know and a phone number they can contact me at….Oops. I don’t have a phone nor do I know any number they can call. So today I managed to get a cell phone and a bank account all in the stinky clothes I have been wearing for the last 40 hours. Well hopefully my bags will decide to join me tomorrow.