A typical school day

Up at 6
Maybe get my son ready for day care, maybe my wife does.
Drop off son at day care.
At school by 7:45
Get big cup of coffee
Classes start at 8
Depending on the day one or two classes take me up to lunch.
Go to the computer lab and print out PPs.
Have some lunch at the entirely unhealthy and comparatively expensive cafeteria
Study, either for the class I will be going to at 1 or the class I just came from.
get a diet Pepsi Max - it has some extra peppy ingredients
One more class 1 to 3:30
Study, alone or with others for an hour
complete any assignments, quizzes, etc that need to be done
pick up son from day care
drive home
listen to wife complain about crappy job/co-workers
play with son
study a little
eat dinner with family
play with son
study from 8 to 10 or 11
go to bed at 11
fall asleep at midnight or so

I had seven classes this semester and 6 were really tough. I ended up with 2 B's and 5 A's and no one is more surprised, relieved, and proud than I am. Now I get to relax, exercise, play with my son and read for fun.

Everything is done but the crying

Finals all but history. I studied what I could and tried not to sweat it too much. Thankfully I was neurotic at the beginning of the semester and built up a comfortable enough cushion that 50's on most finals would let me keep a B. I don't think I got less that a B on any of my finals and actually got a 98% on my biochem final. Interestingly, biochem was the class I was most worried about going into the semester but it really clicked, the instructor was good and the test schedule didn't conflict with any other classes or projects. I still have to wait a week for my grades to be finalized but I am happy to this first semester under my belt. I really think the key is to work your tail off during the semester when time management is, well, more manageable, so that when finals roll around and time is ultra-valuable and fleeting, some lapses in studying won't have as great an impact.

How important are grades?

Here is my dilemma. I have 7 finals (6 classes) coming up next week and little time to study. In the remaining classes (we had a couple finals last week) I have one B, a couple of 90.5's and a few really solid A's. I am debating the merits of studying economically in these last few days of class and perhaps letting some of my A's become B's. I feel that I know the subjects well but I realize that I do not have the time to dedicate to studying to guarantee an A on any of these tests. In fact, any one of these tests on their own would merit 3-5 solid days of studying in order to get an A, especially those classes where I hold a tenuous 90%. The conflict lies in that I worked pretty hard to get the grades I've got and I would feel bad about letting any of them slip. However, time and sanity dictate that I cannot put in the time needed to ace these tests and that really all that matters is that I pass. Add to this the fact that my son has responded very well to my spending addition time with him the past two days. I know which way I am leaning but if you, dear reader, have any input I'd love to read it.

My son is hurting me.

He's just 3 but he sure did put a hurtin' on me today. First my wife tells me that he bit and hit a fellow classmate today. No father wants to hear that his young son has developed a nasty violent streak. When I came home he didn't want anything to with me. He wouldn't really even talk to me. When I asked him questions about his day he would just say "No" and hit me. At bed time he had a total meltdown and refused to let me help him brush his teeth, go potty, put on his pull-up or put his jammies on. He screamed and hollered and balled his eyes out. I tried all evening to spend some quality, positive time with him and got nowhere with that or any studying that I could have been doing in the meantime. Now I have lost what little motivation to study I built up over the day. And I really need to study. Nothing like having a few serious distractions (see previous posts) to derail any train of thought.

One final down, 8 more to go

The written final for history & physical is in the books. I got a B, which will almost absolutely cement a B for me in the class, barring any disaster in the practical portion of the final coming up. I currently have a B going into the final for clinical medicine and A's in my other classes. I am contemplating whether I should work my butt off to keep my A's or take a more philosophical approach and embrace a few more B's. I was listening to Car Talk on NPR this past weekend and the brothers were giving advice to a young lady who has been experiencing a great deal pressure to achieve A's in all of her classes (I still don't know the connection to cars however). They both told her that B's were perfect as they represented a good grasp of the subject while allowing her to take time from her studies to enjoy life. A's, they told her, were simply not worth the effort because obtaining one in any given class forces her to sacrifice too much in terms of experiencing and enjoying life. I prefer to keep my A's if at all possible, but as we near the end of a very intense and demanding semester, I also feel my ability and desire to focus wane. I am over it. As far as I am concerned, the semester is all but over. The question is, can I wring out two more weeks of intense, sometimes maddening studying to maintain my hard earned A's. Oh, did I mention my wife is leaving town the week of finals (optional overseas business travel) and invited her parents to come over (just 500 miles or so) and take care of my son while I take my finals? They can and will handle most issues smoothly, but should any problem or complication arise, I will have to drop everything to take care of it.

Some Tool(s) stole my tools

I realize it is my fault. I cannot expect that, given the overwhelming temptation that is my cluttered garage, someone could not pass up the opportunity to steal from me. I somehow left the garage door open last night - apparently an open invitation to take whatever the hell you please. Well they did, to the tune of an air compressor, drill, tools and my wife's snowboard. Well at least they were clumsy and knocked over a bunch of stuff, made a racket and ran off scared with more than a grand worth of stuff. They would have taken more if they could have. ASSHOLE(S)! Sorry, not you. I was talking the Tool(s) who stole my tools.

End of first semester nearing

Wow. Well I wish I could say time has really flown by this semester but it hasn't. A few weeks fro the end of the first semester and I feel as though it will never come. It's not like school has been hellish or anything like that. I am just tired of studying and having at least one test every week. There has been no time to catch my breath from the endless onslaught that is PA school. Most of my finals are not cumulative, but my Clinical Medicine class and my anatomy class are. These classes are abundant in small detail. I do not look forward to these finals. The other classes may not be too bad, however my History and Physical class leaves much to be desired. The instructor appears to be lazy, although I can't assign an exact character trait to his apathetic approach to class. I am disappointed that such an important class is teaching us so little. I have to study for finals now. I am not sure how likely it is that I will get around to it today though.

Thanksgiving went fairly well yesterday. My family drove up (My Mom and Dad and nieces - my sister was sick and my brother-in-law was on call) and my wife cooked a fine meal. Both my parents were on pain medicine, as usual, and were slightly goofy. Addiction runs in my family but appears to have left me and my sister alone for now. Hopefully all that crap can be left behind and me and my sis can live our lives without having that monkey on our backs.

Does anyone think Comcast sucks? I just lost another hour of my life explaining to them that we get poor service, if our cable, internet and phone works at all, and that I wanted a credit to our bill. They wouldn't do it but agreed to send out a technician again (10 in 2 years) to try to fix the problem. The real problem is that their techs don't know what the fuck they are doing or don't have the authority to fix the real problem. I am NOT thankful for Comcast.

The first semester is almost over.

Wow. I can't believe I have made it this far with so little hassle. What I mean is that while my classes were tough, I haven't failed a single test. In fact I have 5 A's and 2 B's. I had to hard to get these grades, but I didn't have to sacrifice every spare minute of free time to study. Now that I am in the swing of things I can actually spend a fair amount of time with my son. I'd much rather get B's and be able to play with my son and put him to bed, than get all A's and miss seeing my son grow up. On a similar note, my boy loves his dad again and he actually wants to spend time with me. My wife is still adjusting to taking on the added load of all this entails. She is excited for me, and for us, but has way too much going on to go unaffected by my frequent absence from the home.
Overall, things are tough, time consuming, stressful and a lot of work. But I really do feel that it is 100% worth it. Next semester I have phamacology, pathophys, several clinical classes as well as hands on patient contact. It won't be getting any easier, but I am OK with that.

I am glad I have my loan

Well, I have my loan for this year. Who the heck knows if there will be any money to loan for next year. Hopefully the economy will come around by then, but I am under no illusion that that is a certainty. My wife just told me that the only stock no to lose value was Campbell's soup. Her comment was that most people will only be able to afford soup soon which is why the value went up. A 778 point hit is just amazing to me. I think wall street caused this problem and it pisses me off that tax payers are expected to bail them out. I also understand that in the absence of a bail-out there will be resolution to the crisis. I just hope that when the bail-out does roll out there is no financial boost to the blue shirt-white collar types. e.g. f-um if they have more than one house or more money in their cars than I do in my house.

School is going fine. My grades are good, although I am no longer ahead in my reading. I'd like to get ahead again, but find that as each big exam comes up, my focus shifts to doing well (passing) and my other subjects get less attention. My son loves me again as I have also eschewed studying for spending time with him. I think my wife admires my work ethic and ability to do well in school, but her own work issues create a great deal of stress for her and, by the rule that brown rolls down, me.

Is there a socially acceptable 'male' analog to the wheeled book bag used by some female students with heavy books. I am looking to attach a milk crate to a skateboard, tethered with a long chain that I can use to cart around the shit-ton load of books I need on any given day.

THUD.

So classes are in full swing and I find myself completely stressed out. My gut is in a knot, my chest is tight and I get headaches. Classes aren't hard but the volume is difficult to manage. I am doing fine in my classes but I have never felt so much pressure to succeed in my life. Every one and their mother knows what I am doing so there is no place to hide in the event this doesn't work out. The fact that neither my wife nor my son has adjusted well to me going to school makes things very difficult. My wife was already stressed out with her job so her threshold for stress is lower than a snake's belly. My son doesn't want much to do with me now and prefers his Mom for everything. He's also about as mean as a toddler can be about about it. My wife on the other hand has not made a single day easy for me either. On top of all this my school is run like a Soviet bureaucracy. My program is OK. Disorganized, but otherwise OK. The school itself is maddeningly idiotic in the way it is run. If this were a true, market driven business, it would likely go the way of our investment banks. Oh, crap. That's a bad analogy considering this is a state school owned by the tax payers. If my school were a true business, it would go bankrupt like any other poorly run business that is not a US car manufacturer or investment bank. CEOs and politicians have at least one thing in common. They work for themselves and their "buddies" rather than their employees and constituents.

School is underway.

I am waiting for the other shoe to drop. They have been easy on us so far and I don't relish the hard times to come. My classmates are a good bunch and are very diverse, in terms of experience. Most are Caucasian and none are African-American, unfortunately.

Holly cow! The date keeps getting nearer and I have not yet lost that nervous/anxious feeling in my gut. When I tell people I am going back to school they ask me if I am excited. I guess I am excited, but I am also scared sh!tless. I put my notice in at work yesterday, removing any last notion that I will be doing anything else but going to school. I am leaving a cush job in medical research that pays more than what most new grads could hope to get. I have severed all ties to security. Sure I have my wife to support me. She has been supportive of this all along. Problem is she has a job that she doesn’t like too much and I think she wishes it was her turn to do something “fun and new” with her life. While going back to school is indeed new, I cannot in any way think of it as fun. I mean, this is 80 hrs a week minimum of sit on your ass and pay attention work that I am paying no small sum to participate in. This isn’t like undergrad where I could sit in lecture and cram the night before the test and get a B-. Nope. In fact anything less than a C is cause to be kicked out of the program and most of my classes ain’t easy. There’s not a lot of comfort knowing that there is no room for failure. But it makes sense given the stakes – I would expect no room for failure when treating a patient either. Still, not much in the way of kittens and cotton candy in terms of my immediate future.

When I put in my 2 weeks notice, no one really raised a stink. They quietly wished me well and that was it. I was relieved in way, but their response didn’t lead me to believe my leaving was a big deal at all. Given my feeling that I was hired way too early and that nobody was really prepared to keep me busy, along with the fact that I had very little work to do, I can see why my departure in an almost non-issue. I am grateful that my employer hired me and gave me the opportunity to learn something new and paid me well during that time. Thanks Generic Medical Research Facility.

I’d like to think my institution of higher learning is organized and on the ball. But interactions with its various representatives and current students have given me the notion that not all will be smooth sailing. We’ll see I guess. Plus, it’s not like I can do anything about it or just pick up and go to another school, right? At least I got to stay in state and can live in my own comfy home while going to school.

So, now I have all of my books, stethoscope, diagnostic set, new laptop, etc. Heck I haven’t even started classes and I’ve already dropped 2 grand. I am fortunate that I had the money and was able to get a head start, if in the end only to sooth my anxiety and make me feel like I am somehow getting a jump on things.

I guess I am excited, a little. But I can’t wait to get the first semester under my belt!

Why the Mid-Level Hate, Docs?

As I get closer to attending school I have found myself reading more and more medical blogs. I find many of them to be humorous, well-written and insightful. During my admittedly shallow investigation into these medical blogs I came across a disturbing and somewhat disheartening trend. There is a group of vocal and relatively popular blogs written by physicians and med students that go to some length to question and/or discredit the role of Physician Assistants in modern American healthcare. Their anonymous supporters chime in with an occasional ‘here-here’ and are equally, if not more so, anti midlevel. These doc bloggers point out that since PAs do not have the extensive training that a residency trained physician does, they are incapable of treating most patients, and that anyone who chooses to become a PA is lazy, not smart enough to handle any of the rigors a physician does or is simply wasting their time in such a limited and undignified role. They also argue that patients who see a PA are selling themselves short by forgoing the artistry and command of the obscure that a Physician provides and may likely fall victim to a disease or injury because their lowly PA simply couldn’t wrap their reptilian brains around a medical condition or was being a renegade by practicing outside their scope.

First I want to get the points of agreement with out of the way. PAs do not have the extensive training that physicians do. PA school is two to three years long and usually doesn’t have a residency component. The time spent in school is not nearly as long a residency trained doc. Great! While most med students have no real world experience, let alone any that would serve them in a medical field, most PA students are required to have direct patient care experience in order to gain admission to the highly competitive programs. With this medical experience often comes maturity and knowledge of how the world outside of school operates. PAs learn a great deal about the practical application of medicine during their time on the job. PAs should not operate independently. That’s why they call them Physician Assistants. The PA’s job is to assist the doc where needed, see the lesser acuity patients, free up the doc’s time to do what he/she needs to, get more patients seen and hopefully improve patient satisfaction and practice profitability along the way - under the supervision of a physician. PAs are limited in what they can do. I’ll add that PAs are also limited in what they should do. That is to say, recognizing the inherent limits of a PA, they should consult with/differ to their supervising Physician when a questionable case arises and should only operate within their scope of practice as agreed upon by the PA and their SP. However, a PA’s training allows them to diagnose and treat illness and injury, order and evaluate labs and x-rays, splint and cast fractures, repair lacerations and in most states, prescribe medications. A PA cannot perform open heart surgery (may assist however) or perform certain independent medical research, for example. Sounds good to me…..

Now, here is where I feel these doc/MS bloggers are off their nut. Some have insinuated that PAs are simply not smart enough to be a doc and are PAs because they couldn’t get into med school. What crap – all crap and absolutely no empirical proof. With all the education these folks possess, how can they still make completely unfounded and uneducated statements? It is a sad attempt to undervalue the training and intelligence PAs possess. Some doc bloggers have hinted that those in the profession are inferior or lazy for accepting the simple role of assistant when becoming an elite medical leader is possibly within their grasp. As if being a doctor is the ONLY way one can and should be able to treat the sick and injured and that anyone who attempts to do so by other means are hacks and poseurs, regardless of their education, training and commitment. This kind of attitude reinforces the not uncommon notion that doctors can be arrogant, pious and controlling tools. I imagine that since their views are so strong that these doc/MS bloggers tend to stand out. Finally, and most aggravatingly, these bloggers posit several medical scenarios that may not have a clear diagnosis or outcome and then use the rhetorical question, “what if you had this disease/injury? Would your PA discover it in time or would you die having forgone your only true salvation - being seen by a MD/DO?” They bring up fictitious scenarios where some cowboy PA operates outside of scope and harms a patient. As if only PAs were capable of such arrogance. Well, we can find numerous documented instances where doctors operated in such a way and injured or killed their patients. These pseudo scare tactics are almost silly, save their attempt to undermine the PA profession in a most classless way. These bloggers will also argue obtusely that a medical practioner with anything less than 6-8 years of medical education and residency is not only useless, but is dangerous to boot. No offense to my esteemed medical colleagues, but doctors through the centuries have led privileged and well paying careers killing countless patients, couldn’t you all use a little help? Until there is empirical proof that PAs are more dangerous or incompetent in their scope of practice than doctors, please shut your highly educated and well trained yap.

http://www.healthbeatblog.org/2008/06/the-silence-sur.html

Here’s why I wanted to become a PA and not a doctor. At this point in my life I have neither the time, energy nor resources to tackle med school. It is difficult - not impossible, but it takes more time than I care to give. Nor I do desire to be burdened with the additional debt and lack of free time that becoming a physician requires. I’ll have a loan of $60k plus when I am done - that is already too much in my opinion. I also have a young son I’d like to see grow up. Being a PA will allow me see patients, learn and grow as a clinician, have a comfortable income and see my family often.

So, I’ll gladly take my BA, MHA, 15 years of experience as an EMT and 10 years in the insurance industry and try to make due.

I should be working

I have a job right now that should be interesting and challenging. I work in a sub-field of medical research that is technology intensive and led by smart, if not socially capable PhD s. I continue to ask for new assignments but am given only minor ones that require little thought or effort. Since my role depends entirely on the work of others in my department, I am unable to make my own work, per se. Everyone here knows how little work I have to do and no one seems to give it any thought whatsoever. I'll be leaving here in a couple of months, so that takes the sting out of being a high-priced chair filler, but I wish I was more involved.

Classes start in a couple of months!

OK. So, a little about myself. I am married and father of a two year old. I live in the four corners part of the country and will be attending PA school in a few months. I am leaving the dark side (working in health insurance) to become a physician assistant. More on this later....

I've volunteered in one health care setting or another for most of the last 15 years. I've always enjoyed the interactions with patients as well the various challenges medicine provides. Now I have the opportunity to become a PA - something I've wanted to do for many years now. However, I am excited and frightened. Quitting a very well paying job to experience the mental beat-down that awaits me is tough spot to be in. But, I can do anything for two years, especially if at the end a massive reward awaits.

So now I've got what has turned into a temporary job, now that I have been accepted to PA school. I got the job after a year off of work, staying home with my kid being Mr. Mom and before I was accepted to school. This was my first year applying to school so I didn't even think I stood a chance of getting in given the competitive nature of the application process. I applied to 10 schools and got interviews at five. Of the five I was waitlisted at two, declined at one, accepted to one and I declined the last interview. While that school was an Ivy League school, the cost associated with attending and the fact that I had been accepted to a much closer and cheaper school lead me to not attend the interview. Uprooting my family, selling our home (in this crappy market) and drastically changing our lifestyle were just too big of factors to take lightly. I now have my books and diagnostic equipment for the first semester and am brushing up on biochem and physiology.

Unlike most people who go into medicine- MD, DO, PA- I am not particularly driven or intense. I am a type B personality who thinks getting 89% on a test is just great and wants to have as much of a life as possible during my education. I hate (as much as I can hate people I don't know) gunners and students who whine about getting a B in organic chemistry. I am in for a world of hurt if school turns out to be anything like my pre-med days.