Volume 1 Issue 1
Some would argue that the humanities may be as integral to medical training as physiology and anatomy. Such areas as history, ethics, sociology, literature, philosophy, psychology, and the visual arts have not traditionally been a part of most medical school curricula. However, it has become increasingly apparent that the integration of such material leads to the training of physicians who are more observant, analytic, reflective, and empathetic. The Mount Sinai School of Medicine at New York University recently published data in Academic Medicine (August, 2010) revealing equivalent academic performance in medical school amongst a cadre of students who were accepted to their medical school with a humanities or social science degree and without the traditional premedical course requirements. This challenges years of dogma the Education “ideal candidate” for acceptance into medical school, but Liaison Committee onregarding Medical visits the regional campus is perhaps something we have always known at heart. A good physician may be well grounded in the core fund of knowledge necessary to diagnose and treat, but great physicians are the ones who understand that such diagnosis and treatment is the result of painstaking work by physicians who have come before them, that diagnosis sometimes is impossible without creativity and imagination, that stories are elicited out of patients by establishing humane connections, that treatment is useless unless one understands the psychosocial context of the patient being treated, and that placing a hand on a human being, prescribing a drug, or cutting skin is not done without consideration of the ethics of such an action. This inaugural edition compiles the work of faculty and students who put aside their work of the day for a moment in order to reflect on just this. The pieces vary from advice to other students, humor, personal reactions in providing care, and reflections on individual growth and ethical responsibilities as one reaches milestones in medical training. At this time of Thanksgiving, I am grateful for the efforts of all the contributors as well as Brian Garnet and Paul Rothenberg who took on the gauntlet of organizing and presenting the pieces that follow. Rave reviews can be emailed to me, and any harsh critical comments sent directly to them. I am hopeful that all will enjoy and consider submitting a piece for future editions.
Our Patients... Daniel Lichtstein, M.D.
UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE
Introduction... Gauri Agarwal, M.D.
They come, and they keep on coming.
Was she depressed? Afraid? Did anyone ask?
They leave, at least most of them leave.
Fluids and pain meds, another short stay.
We see them for just a moment in time.
No time to explain, no time to connect.
They don’t usually remember our names, or we theirs.
We should have done more. Another diabetic not taking her meds.
Medicines too expensive to buy. Appointments made and rarely kept.
“Non-compliant,” we said, but we didn’t ask why.
A short time home, and then back again.
Insulin, supplies, and seven more drugs.
Sicker than before. What have we learned?
With five kids to feed, what would she do? We could have tried to do more.
The man with pneumonia had no shoes. Did anyone notice or ask why?
Each of our patients has a story to tell.
Oxygen and antibiotics, “home” in two days.
For each there is much more than the illness itself.
But “home” was a blanket in an alley. We could have done more.
A few more questions, just a little more time. We could have done more.
The young Haitian woman with sickle crisis rarely spoke.
We should have done more.
Obliterants is a journal distributed to the faculty, affiliated faculty, medical students, and staff of the University of Miami Miller School of Medicine Regional Campus.
Advice for the USMLE Step 1 Advice for the USMLE Step 1 The following is a guide with practical advice for USMLE Step 1 preparation based on the experiences of the class of 2012. We greatly appreciate the input of the following M3 students whose advice we have consolidated: Danielle Cameron, Nick Clarke, Fayez Raza, John Rollo and Adam Wulkan. Overview of the USMLE Step 1 USMLE Step 1 is the first in three examinations that medical students must pass in order to become a licensed physician. The exam is an eight-hour exam consisting of seven one-hour blocks of questions and one hour of break time that can be distributed throughout the test between sections. There are 46 questions per block and 322 total questions. Each question is individually scaled against all other takers of that question, and no two people have the same test. The test is becoming more clinical with long vignettes, and that should work to our advantage since our exams are also written in this style. Creating a study schedule The range of time devoted to studying ranged from 8 to 13 weeks. There are schedules available online such as “Tau’s Method.” For people who are looking for more structure, Kaplan does offer a course to prepare for the exam. Most students took one day off a week to decompress and studied around 8 hours a day. John Rollo recommended taking a mini vacation of 2-3 days off in the middle of studying to avoid getting burnt out. A lot of the M3 students recommended preparing a bit over winter break by creating a schedule, buying review books and a question bank, and making sure you’re ready to hit the ground running once it’s time to start.
and do well in classes. Pay attention in PBL because knowing that material will make it easier to study for Step 1. Who to study with? It’s nice to commiserate with people who are also going through the experience. Having a study partner is great if they help keep you focused since you can review difficult concepts together. Remember to interact with people who aren’t studying for Step 1 so you don’t lose perspective. First Aid It was recommended that you take your First Aid to Kinko’s, get it bound in a three ring binder and add notes to it as you review. You can then use this binder as your primary Step 1 guide. day, going to the gym, finding time to relax, seeing people you love and not spending all of your time thinking about the exam. Question Banks Everyone we spoke to also recommended purchasing a question bank. The two most popular options are from Kaplan and USMLE World (the M3s were in strong agreement in recommending USMLE World). They also recommended doing the questions in timed 48 question blocks to get used to the pace of the exam. Build up to a higher number of questions per day as you get closer to the test, complete the entire question bank, and make sure you read the explanations to the questions even if you get them right.
Lastly, Fun! When to start? Start looking through First Aid for the USMLE Step 1 and listening to the Goljan Rapid Review of Pathology lectures for current modules. Focus on your modules Page 2
Everyone stressed the importance of doing something fun every day, going to the gym, finding time to relax, seeing people you love and not spending all of your time thinking about the exam. O B L I T E R AN T S
Brain Doctor by Robyn Sharma “If you can’t spot the sucker in the room, it’s probably you.” I showed up extra early the morning of my first day at Miami Children’s hospital, eager to “scrub in” on a surgery for the first time. My scrub technique was thorough and meticulous, in fact, it was flawless. My attending gave me the green light and I was rip-roaring ready to go. I first started with the betadine prep, paying close attention to my nails and cuticles. Next were three applications of the alcohol spray, focusing on the webbing of my fingers and extending up to just beneath my elbows. With my arms raised triumphantly in the air, I descended upon the operating room and proudly presented myself to the scrub nurse. “Excuse me! We have a 10 minute scrub policy for pediatric surgeries! Have you taken the surgical technique course?” I had, “they must be letting anyone into medical school these days.” Angry, frustrated, defeated, I took the walk of shame back to the scrub station. I decided to take my disappointment out on my poor unsuspecting hands and arms… I scrubbed like no one has ever scrubbed before. My hands started to burn, my arms became raw and I was soon raising my hands not to maintain sterility, but because they hurt when I lowered them. I cautiously approached the OR. As I gently pushed the swinging door open the hallway filled with laughter. The once angry scrub nurse looked towards me and grinned, “Welcome to Neurosurgery.” I was the sucker.
source of comfort for me, especially after we had learned why she was having weakness. The CT scan revealed a brain tumor in her right hemisphere, her parents cried, Sarah remained calm. The surgeons wasted no time in getting her into the OR, within 3 days she was prepped on the OR table, lying in front of me, I tried to mimic the composure of Sarah and the surgeons. Throughout the operation I focused on the neurosurgeon’s hands, as they moved quickly and deliberately, removing the tumor, piece by piece. Seven hours into the surgery, I thought we were in the clear, then the blood began spurting. I couldn’t suction enough to clear the surgical field, her exposed brain was gushing blood and if we didn’t act fast, Sarah would die. My hands were shaking terribly, but the surgeon’s hands grew still, his movements faster, more deliberate, more precise. He quickly gained control of the bleed and within an hour he was closing. Panic is a luxury surgeons don’t have. The thought must have crossed his mind, “was this my fault?” But there was no time for reflection in that operating room, he had to fix the problem immediately or Sarah would be dead. Sarah’s laughter greeted me at her bedside the following morning, washing away the scare of the previous day. Her strength putting my own struggles into context, from somewhere down the hall I hear someone making fun of the tall med student, but I don’t feel like the sucker anymore.
Pediatric Neurosurgeons are an interesting breed, how calm and collected must a person be, when they have time to torture the first year medical student before a lifethreatening procedure. But, both the surgeons and a 10 year old girl named Sarah demonstrated the value of laughter, composure and resilience in medicine and in life. Sarah’s parents brought her to the hospital when she began complaining of her left leg “dragging.” She used to run and play kickball, but she began tripping recently. Her parents were concerned, but Sarah never cried. I spent a lot of time with Sarah, her laugh became a Page 3
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Our by Ekaterina OurDance Dance “How are you feeling today?” Our dance starting with a simple question. The song begins with a soft rhythm, a rhythm of when two complete strangers meet for the first time. He looks at me and wonders whether this stranger in a white coat can be trusted. Trusted with precious secrets that perhaps, he will not share even with his closest friends. Before I met him for the first time, before I even knew his name, my days were spent preparing for this special moment. Sleepless nights learning the chemical pathways of his body, long hours memorizing his anatomy, many days discovering how his body works, all to meet him here, today for the first time. I sit down, pull my chair closer and listen. I listen to his story and listen to his pain. He starts cautiously only mentioning a few things. Today, he feels sick and he is afraid. He sings a song of sorrow of fear and of despair. I listen, and then sing back to him, I tell him that I hear his pain. I look at his sick body and examine it from head to toe. I try to find the reason, the source of his malaise. We are no longer strangers, we now together sing. We dance this song of sorrow, of pain and of relieve. We look into each other’s eyes and he lets me see his life. He tells me about his childhood, his family, and his medicines. He mentions drugs and some bad habits, he explains his daily life. I ask him questions about his body and inquire about his bowels. I ask about his private matters and then I ask some more and more and even more. I sing that part, which I had practiced for today; I sing it and ask him to sing with me the chorus of the review of systems, the verse of the history of his present illness, and then we take turns to sing the solo parts where he complains and I explain. When our dance ends, the music ends and the lyrics of our song hide inside the yellow chart. They hide until next time for when he comes back and we can dance again that special dance of trust and of respect, that dance of confidentiality and frankness, the dance of the patient in the paper gown and the doctor in the white coat.
Thoughts on Medicine by Dwayne Heis ♦
Sometimes it’s better to give your patients sugar pills instead of real medications. Unless they’re diabetics.
If bacteria were people, doctors would punch them in the face. Except the good ones. They’re all right. And the rest don’t have faces.
I hate the flu. Every year it changes. It can’t just be who it is.
Cell phones can be very unprofessional. When with a patient, the only person you should be talking to is the patient. Sometimes I call my patients’ cell phones when I’m with them to check how professional they are.
Patients listen to you more when you show them a website that supports what you’re saying.
Some of my best teachers are people. If Laennec came back as a zombie, I wonder if he would use a straw.
The best treatment for fibromyalgia is unicorn horns. Fight fire with fire, I say.
Once I argued with a woman for 20 minutes about the best management for a patient with Crohn’s. I told her that as a medical student, I should know these things. She agreed and proceeded to lower my grade.
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Smile by Jessica Buicko Smile It had to be at least 100 degrees outside. Or at least it felt it surrounded by the stale humid air in the backroom of our makeshift clinic. It was our third day, everyone was tired, and we had seen about forty patients already that morning. About to see my first patient of the afternoon, I called out the next number using my newly acquired but very limited Spanish skills. A young mother apprehensively raised her hand, lifted up her daughter, and quietly followed me back into the room where Kim and I were seeing patients that day. The mother looked visibly tired, and after some questioning, we found out that she had walked from hours away, like most of the patients that we saw in clinic, without so much as shoes on her feet. The mother placed her four year-old daughter on the examining table and took a seat on the nearby stool. She explained to Kim (who at this point was not only seeing patients with me, but also helping translate) and me that her daughter had been very sick recently. She hadn’t been eating at all and had lost weight. As Kim asked a few follow up questions, I attempted to entertain her. She was reserved as first, but after I gave her one of the many “silly band” bracelets on my wrist, she immediately opened up and flashed one of the biggest smiles I have ever seen. I was immediately taken aback after noticing her teeth. I’ve never seen such tooth decay in my life. Most of her teeth were rotted to the core, jagged, and blackened. Her gums were completely swollen. I interrupted Kim to show her, and we began asking the mother questions about dental hygiene and nutrition. We soon learned that the family didn’t have access to clean water, nor the money to buy a toothbrush, yet alone toothpaste.
Often I find myself complaining of inconsequential matters, but after seeing this girl and the hundreds of others we saw in those ten days, I truly realized how fortunate I am. I, along with every other student on our trip, could write countless anecdotes about individuals and events that moved us during our stay. I could talk about the family that cleared out almost their entire house so that we could have a place to eat indoors for our three meals each day. Or I could tell you about the one afternoon when Jess Savas and I taught many of the village children to make bracelets, without either of us being able to speak Spanish.
It was something that they’d never thought about because when you struggle to put food on the table every day, dental hygiene isn’t a priority or even a thought. No wonder she couldn’t eat, her gums were completely raw. We didn’t have a dental clinic so we were limited as to what we could do. Our attending doctor told us the only “good” thing about this situation was that they were still her baby teeth and would eventually fall out. Despite this, Kim and I felt like we couldn’t just stand by and do nothing.
I could also tell you about our living conditions which consisted of an open air barn without electricity, running water, bathrooms, showers, or even solid walls for that matter. We slept on thin metal bunk beds with worn mattresses thinner than our GI textbooks. We draped our beds with mosquito nets, yet slept among cockroaches, bats, spiders, and other insects that still to this day make me squirm. Let’s just say that before this trip, I’d never even been camping before. Talk about a culture shock.
I was so moved by this situation that I literally sprinted back to my bags and grabbed my personal toothbrush and toothpaste and after a quick tutorial gave them to the girl and her mother. The conundrum of the situation was that even with the dental supplies, would our efforts be futile? At the end of the day, she still didn’t have clean water, and we weren’t sure if with both the language and cultural barriers, that we were adequately able to convey the importance of something as simple as brushing one’s teeth.
Or I could tell you about the mini-twelve person plane that we took from Managua to Wani, the site of our clinic. The plane that required us to get weighed before getting on. The same plane in which Adam and I sat less than six inches away from the pilot and that landed in an airport with a gravel “road” in the middle of town that cars (and animals!) sped across daily.
We saw a great deal of patients during our trip, but for many, like the child above, there was not much that we could do. In America, toothbrushes can cost as little as 99 cents. In Nicaragua, they’re a luxury. I was touched by the fact that the girl, who was clearly in such pain, was still able to smile and play along with me. Page 5
These are just a few of the stories that I’ll remember about our trip this summer. All my life I’ve learned about poverty, yet actually seeing it first hand was something that I couldn’t have prepared myself for. What struck me most was how genuinely happy the people were that we saw. They were so gratified that we volunteered to be a part of their life. Their smiles, like the four-year old girl’s, made all the difference.
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Thoughts on Development by Aaron Weiss Day one. I know nothing of human physiology or anatomy. I have never heard of Frank Netter. I don’t know where the liver is. Seriously, I have no idea. I know nothing and can’t possibly resemble a physician. Yet, I sit in on patient interactions and hear their most personal information and wonder, “Who am I to know this? I’m no doctor.” But, I do have a slick white coat, maybe too big. So I sat there and pretended. It lied there barren. It had probably always been barren; possibly deforested. Yet, it sat there, naked and innocuous. I glanced at it from time to time, but never thought twice about it. Perhaps I thought twice once. On my way into school one morning, a gloomy and distasteful morning, I thought of the possibilities, of what this barren land could become. I had high hopes. Weeks have passed. I’ve dissected a body; I’ve learned the Kreb’s cycle. Surreal, in parts! I still don’t resemble a doctor. When talking with patients, I fumble through my words, perusing my mind for the right way to describe something. “Ummmmmmmm.” I forget what I was taught and revert to small talk. I like schmoozing; in Boca, it’s easy. Still, not a physician but incredibly excited about the possibilities. The liver is on the right. Wait, what before was desolate is now fruitful? This could not be. The plot, overgrown with weeds and sterile, has become fertile? I’m excited, though only moderately, and think of the possibilities. Wait, I thought owls lived there? Months. My body doesn’t resemble a body. Dissected lungs, intestines, brain. Yea, brain! Not to mention I found the liver. On the right, right where I expected it. By now, I know a lot! I’m telling ya, my people call me Robbins. Yet, still, I am no physician. Sure, I can be pimped. Successfully. But, I know nothing. I can’t diagnose, I can’t analyze, I can’t think. Well, critically, that is. I can’t type.
Columns stretching to the sky, taking up vacant space, yet there is not structure. Who can imagine what this will become. Taller than I had expected; better than expected. There were mild supports, but nothing concrete. Except, at the bottom. Obviously, there was concrete there. A wise man once told me never to use the word “obviously” because it’s not always obvious. For this, I apologize. Yet, it climbed the sky; high; and so nearby. And, at times, I was shadowed by it; very mildly oppressed. This barren plot, no longer barren, and no longer accessible. Did I regret never visiting the territory? Perhaps dandelions, hawkbit, and ribwort, I missed? Perhaps pimpernel? No, I have no regrets. I am far too busy for regrets. A year. So fast. Yet, one year, and I resemble a doctor. Yes, resemble. I know, you don’t believe me. But I don’t care, as Page 6
I am far too busy to care. I know Franks; Starling and Netter and kosher. Kosher is my favorite. But Netter does have a slick signature. I hope my signature will be as professional, even if I am not. Anatomy is over, biochemistry is over (for now), and the FBS is over. Come on, be professional. Fundamentals of Basic Science. And I remember most. Well, some. To patients, I resemble a doctor, although I know I am very wanting. Of many things, especially hotdogs. Columns are no longer barren but have support. Walls, formed around the nakedness, hiding the inside. Mainly white walls; like my white coat. Pretty slick. A ceiling too, making the metaphor complete. And I got a UMiami pin; extra slick. In medical school, it’s all about being slick, even if you’re pretending. In contracting, pretending is especially important. I know from experience. To me, it resembles structure. To me, it resembles something sound. To the untrained eye, it resembles a foundation. To a contractor, it is far from done! Far from complete! To a physician, I am far from complete! But patients I can fool. Well, most. Well, some. Today. Tired. Very tired. But still optimistic. Still wanting; for knowledge this time. I am presently pondering acinar organization and the glorious hepatocyte. Boring to some, well most. But interesting to me. To patients, I am a doctor, unless I tell them otherwise. Or unless my patient is a doctor. I always tell patients to feel free to ask me anything……………..Unless it’s about the kidneys. I haven’t gotten there yet. Another wise man once said, “Doctors should be graded at the end of their careers, not the beginning.” I agree. Today. I look, as I am curious. This is human nature, and trust me, I’m in medical school. Paths and palm trees and a lagoon? No, just a pond; although a lagoon is much more daring. Fully functional? No, not yet, but it had me fooled. I am still fooled; my patients are still fooled. It is far from being functional and I am far from being a doctor. We can both pretend, and pretending is fun, but we must become. We are both works in progress. Both have good disguises; I prefer the one with the fake moustache. I wish I had a slick moustache, with handlebars. Yet, we will come to fruition. One probably much sooner than the other. I said be professional. But we will. All this pondering has taken away from the obvious. And for this, I apologize. I have no functional ideation of what this mystery will become. Tomorrow, I will take the trek across the manicured paths, around the landscaped foliage, and to the true foundation (lying upon concrete). I will walk across a land that was once naked and now clothed? No, developed. I am excited to learn. Learn what entity has accompanied me on this wild ride. What entity has developed with me. And, while I will one day become a doctor, it will become something equally great, yet overwhelmingly different. … Aha, the new Green Building for the FAU College of Engineering & Computer Science. I force a sigh.
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Beginner’s Workout by Sebastian Baquero Do you wanted to get "toned" but have yet to achieve real results? Do you want to become stronger or improve your athletic performance? Do you want to try weightlifting but are a bit intimidated by the prospect of it or simply don't know where to start? If you answered yes to any of these questions, then read on for a great beginner's workout routine, which can help to build muscle, burn fat, and increase your overall physical strength. The main idea behind this workout plan is simplicity. A lot people can become overwhelmed very quickly with new workout routines and quit almost as soon as they start. The goal here is avoid this pitfall by providing only six exercises to learn and only having to perform 3 exercises per session, 3 days a week. Be warned though: one should not assume that the simplicity of this plan means that it is not challenging. The reason there are only 6 exercises is because they are the quintessential weight lifting exercises that lay the very foundation for virtually any resistance workout. These exercises are known as "compound lifts", meaning they are weightlifting exercises that work many muscle groups at once. They are very demanding and force the body to use much of its strength output. They are the opposite of "isolation exercises", which attempt to work only one single muscle (think dumbbell curls, which attempt to only work the bicep muscle) and do not necessitate as much muscular demand. So, without further ado, the workout schematic is as follows: For great instructions with animations on how to perform these exercises visit http://exrx.net/Lists/ SearchExercises.html and simply type in the exercises listed above. You will perform Workout A, then Workout B, then Workout A in one week with at least one day of rest in between. So your first two weeks of working out will look like this:
Workout A 5 sets of 5 repetitions of Barbell Deadlift 5 sets of 5 repetitions of Bent Over Dumbbell or Barbell Row 5 sets of 5 repetitions of Military Press or Dumbbell Shoulder Press
Workout B 5 sets of 5 repetitions of Barbell Squat 5 sets of 5 repetitions of Barbell or Dumbbell Bench Press 2 sets of max repetitions of Pull Ups or Chin Ups (assisted pull ups/chin ups on a pulley platform system may be performed if one cannot do a pull up/chin up)
Week 1: A/rest/B/rest/A/rest/rest Week 2: B/rest/A/rest/B/rest/rest On your rest days, you can still do whatever cardiovascular or sport activity you like, though I would advise at least taking one full day off. The ultimate goal you should be pursuing the first couple of weeks is learning proper form and making sure you feel comfortable with the movements, and then adding a little weight (either 2.5lbs. to 5lbs.) every week to the lifts and see if you can make it through all the sets. If you can't, that is not a problem, just keep adding weight more weight to at least one set and then another, until you up the weight in all 5 set. Most beginners see rapid gains, and hopefully you will too! Just remember, when lifting keep in the mind the words of Joseph Ouslander, “start low and go slow”.
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Ethics Just imagine being placed in a situation where you and 47 others, give or take, are all given the opportunity to pursue your life’s dream. In the aforementioned situation one of the circumstances just happens to be that you must interact with and learn from each other five days out of the week and depending on how you like to spend your free time and how you prefer to study, possibly even every day. Then add to this situation the stresses of constant testing along with the recent changes to the familiar places in which you study and quiet areas in the building that you spend more than half of your day. Now take these stressed out, frustrated individuals and give them the opportunity to anonymously critique and give “feedback” on each other. Sounds like the making of a great reality show, in fact I’m sure MTV would love to get their hands on this kind of scenario. Welcome to our life. The PULSE survey was designed to measure the opinions or “pulse” of an organization in order to improve the performance as well as to let us fine-tune our skills of interacting with each other in a work environment to prepare us for similar situations in the future. In reality it caused anxiety, frustration, and for some depression. It became an avenue for someone who may be having a bad day and had a disagreement with a classmate or someone who was misunderstood in an email or even someone who just doesn’t speak up as much when compared to others to now become targets of another’s PULSE.
grey but we should try our best to continue to be professional and know that, especially as Medical students, we must be able to, at times, separate our personal emotions from our work life. With respect to using the survey as an outlet for dealing with specific incidences it brings up another situation that I’m sure we were all questioned with during our medical school interviews, “If you had a conflict with a classmate/professor, how would you deal with this?” Being diligent interviewees, we all knew to try to resolve the issue and speak with the person first before going elsewhere because it may have just been a misunderstanding. Finally, the topic of not taking the survey seriously. We must now come to realize that during our careers there will be things asked of us that we feel unnecessary but our institution mandates we do. In these situations we must come to realize that although we may not find it useful, there is always a reason and we must try to take it seriously especially in a situation where our callous disregard for the surveys usefulness could be mistaken for as an insult or even disrespect.
Some may question whether we were mature enough to be given such a survey but this bridges on the topic of intelligence being confused with maturity. Other people question whether it was given to us prematurely and say that we really haven’t had enough time to figure out who each person truly is yet. Whatever the line of reasoning, the overall consensus is that the PULSE survey was ill-timed. Some of the complaints brought forward were that some people felt that the survey and its anonymity was used as an avenue for classmates who felt that they had been wronged by someone and received no resolution to this situation attempt to do so. Others felt that people were confusing personal feelings or using personal conflicts that occurred outside of the classroom as the basis for their comments. And there were even those who felt that the survey was so unnecessary that they wanted to make the most outrageous comments possible.
Special Thanks ♦
All Faculty members who responded to our survey. Look forward to the results in the next issue.
Barbara Locastro for help with Publisher
All of the contributors!
Health Fair Reminder!!!! ♦
Pompano Beach Health Fair—February 19th
Should we have reacted the way we all did? Were we correct to express these ideas to each other no matter what the basis was? Or were we to keep it strictly professional and to the classroom?
Jack and Jill Health Fair—March 5th
I would assume that the PULSE survey was designed to gauge the dynamic in a workplace in its entirety. But life is never black and white and there will always be areas of
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