IV practice (and some other stuff)

So we had practice with intra-venous access and venapuncture the other day. I haven't done that stuff in a while but I use to be able to get 16 gauges in on a trauma patient in the unlit median of the interstate. I screwed up every attempt I had the other day. I either let got of traction on the vessel or blew through the vein or whatever. I was so nervous I couldn't believe it. My partner is the nicest young lady who was very patient and able sink all her sticks with no problem. I run through a bunch of excusses but in the end I just didn't do what I should have to get it done. Whatever sort of anxiety I am experiencing is systemic. HR, BP, tremors, insomnia, lack of concentration, nervousness.... I do have a hx of depression and the anxiety thing isn't new, it's just I have never felt it to this extent or for this long.

I know I'll pop out of this funk some time so I am not freaking out. The problem is that I am so acutely and constantly self-aware, to the extent that on occasion I can only concentrate on myself. There isn't a thing I haven't thought about lying in bed at 1 am or on the drive to school. I used to be so laid back and carefree that people would be describe me as having a type Z personality. I liked being that way. It was good. I don't really care for being pissed frequently or losing my temper over stupid shit. But I do it. I tell myself not to. I tell myself it's coming and to just let it go but I have a hard time letting stuff go. I take things personally that I know I shouldn't. I complain all the time on this blog. I know why I feel the way I do. I will feel better without the stress of school. Some free time and leisure activities will help. But, I can make my situation better if make a loved one's situation worse. Not A loved one, THE one and, well, only loved one. I can't do that yet. It's not bad enough yet. I don't know what bad enough will feel like, but I can't yet. The words and the hope work too well, ok just well enough right now. The pain it would bring him is not worth removing the pain I am going through now. She's going through it too.

For what its worth I have fun at school. Not sitting there for hours on end being killed one powerpoint slide at a time. I get along with my classmates. We joke around. We are silly. We do fun things to honor our struggle. We give each other a lot of shit. We bitch and moan. We play sports together. We drink together (not enough it seems right now). We understand each other right now more than our parents do, or our friends, or our S.O.s do, at least on some basic yet vital level. Soon that is going away. When clinicals start that support net will be gone. I hope it will come back now and then though.

Hmmmmm

Below is a post I put up this time last year. It came after I read some physician bloggers comments about how midlevels simply don't stack up to the care required by many patients. I amde some minor adjustments to the post below to make it read better this time around, but the changes are minor. I should have documented the offending blogs but I think white coat and panda bear were two of them - not sure about white coat though and I don't feel like searching their archives now.

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 health care. 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 of physician training 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 that these patients 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 extensive 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 any medication. 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/Med School 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 with absolutely no 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 among the crowd. 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 patient. 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 medical colleagues, but doctors through the decades have led oft-esteemed and privlegded lives killing countless patients, couldn’t you all use a little help? Until there is scientific 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 health insurance industry and try to make due as a PA.

Two sides of burnout

So along with most of my classmates I am officially burned out. I can and will keep going but I am over this didactic year. I have 7 weeks to go and I can hardly wait to go out on clinicals. The downside is that I have little or no energy to read the hundreds of pages that are assigned each week. The 3 hour classes this semester are simply excruciating for the mind, soul and ass. The upside is that I finally got in the study groove and am pretty proficient. I can pass my tests with a modest effort and can get As if I work hard. I am learning along the way which helps but I can't remember all I was taught - to both my horror and bitter acceptance I understand that "getting it and keeping it" will come with practice, use and seeing "it" over and over and over again. I learn best by doing, rather than reading or seeing - so doing this stuff will really help me retain and synthesize better.

Seven weeks is so long and yet really just such a short period of time to get my shit together. Will 7 weeks make a difference in how I will approach a patient? I hope so because even though I really look forward to getting out there on clinicals, I am pretty nervous too. Shhhhhh. Don't tell anyone though, OK?

Pharmacology

Took the first of four Pharm exams today and got a low B. I thought I had a good grasp of the subject (parasympathetic, syspathetic, asthma, allergies, GI) - at least better than my grade would indicate. I overheard a classmate complain about the ONE question they missed. Others were talking about getting straight A's last semester. There are certainly some very competitive people in my class who always want to know if they got the best grade or how they faired compared to everyone else. I don't really talk to those folks too much. Not for any reason, just 'cus.

Today

Today was one of those soul draining, mind bending, ass numbing days. We had two 3-hour lectures- pharmacology and clinical medicine with PBL and lunch in the middle. pharm is great, our instructor is great, the information is great. However our instructor has a very laid-back delivery style that is almost monotonous and is certainly sedating. I cannot drink enough coffee in the morning to keep me alert. I can however induce some pretty amazing tremors and palpitations with an adequate intake of caffeine. Our clin med class consisted of 175 power point slides of various problems one will encounter when dealing with the penis. Horrific photos. Enough is enough already! Tomorrow our clin med class is four hours long but at least we get a new instructor every hour. 8 1/2 weeks to go!

Last semester's grades

Just to point out that given all the crap I've gone through and not being particularly brilliant I was able to get 4 As and 4 Bs last semester. This is really encouragement for those just starting school or perhaps hitting a rough spot yourself. It can be done. Not easily. Not without some carnage. But it can be done.