6 weeks in

I finally got my license and most everything is squared away; I am still waiting on my DEA license but that is not too big a deal. I am seeing 10 to 16 patients a day now. I do a lot of DOT physical - that is physicals for truck drivers. I am managing the care of several patients and seeing some for urgent care issues. I had a patient who whose job it is to pull the stomach and its contents from the cow who has some stomach "juice" splash in her eye. This, she was sure, had caused her to lose vision in one of her eyes. After getting her an opthamology referral and an MRI, I was the one to break the news to her that she most likely has multiple sclerosis. It was tough because I had to use an interpreter but I think I did OK. We have patients from Mexico and Central America, Somalia and Ethiopia, Iran, Sudan and Micronesia - at least those are the ones I can remember seeing.

The drive to work is long but easy - almost relaxing. Most days I am home by 6:30 and am surprisingly tired. My mind has to work more than it ever had to in any other job I've had, that's for sure. It's not really stressful, but I feel a great sense of responsibility and desire not to screw things up. There are a lot pieces to work comp that must be learned and mastered. I must communicate to employers regarding their worker's injuries, restriction and progress. I must convey the need for all the therapies and imaging in my notes, keep the patients, employers and insurance companies happy and do it all pretty quick. My clinic is still allowing my extra time for patients so I haven't felt too pressured for time though.

Most of all, I am happy to have a good job.

Almost 3 weeks In

I have been employed as a PA for nearly 3 weeks now. I still don't have my license though thanks to the bumbling bureaucrats in charge of licenses here. My company has had me shadowing my supervising physician since I started but they are getting antsy and I am getting bored.

The Occ Med practice I work at sees a lot a trauma because one of our big clients is a meat packing plant. They take cattle from the feed lot to packaging. As a result we see a fair amount of lacerations, hand, wrist and shoulder injuries, and more than a few crush injuries including forklift injuries. We see other patients in other occupations like office workers, health care providers and numerous blue collar occupations. We saw a concrete finisher who got too close to a power line with his float pole and was electrocuted. He lost a portion of one foot and needed a skin graft on the other. Another day we saw four forklift crush injuries that were all pretty nasty.

The breakdown of the types of patients I have seen are:
50% orthopedics
20% neurological
15% trauma/urgent care
15% DOT and employer physicals

There are more than a few patients who are faking or playing up their injuries in hopes of getting some big payout from the insurance companies but most just want to go back to their $12/hr job hacking apart a cow or driving their truck.

I am employed

Well I don't start until 10/18 but I have a job. I will be working in occupational medicine in a small clinic that handles people working in meat packing plants and agriculture, among other things. The physician I'll be working with is really quite nice and likes to teach, and has experience in ortho and neuro surgery. I'll be getting paid a lot more than I ever hoped to coming out of school too. I never would have told anyone I wanted to go into occ med a month ago but I am happy to have the opportunity to make a good living and learn medicine. There will be lots of procedures to perform which is cool. It feels more like occ med/urgent care so I think it will be able to carry my interest. The drive will be long (50 min, all rural highway, interstate), but no longer than when i worked in heath insurance (one hour for 19 miles of interstate highway!). I'll keep posting even though the blog is no longer about becoming a PA. Now it'll be about becoming a confident and effective PA.

Ohhh say can you "C" ?....PA-C that is!

This is the biggest feeling of accomplishment I've felt in a long time. I passed the PANCE and am now a certified PA. I did OK on it...sorta average but the main thing is that I passed. I am now having my license application processed so I should be really official in a couple weeks.

The job hunt on the other hand has been rough. I haven't heard back from the last interview I had a couple weeks ago and I am assuming I did not get the job. It was part-time which was the major draw back but the cool thing was that it was part of a family practice residency so I would have had the opportunity to learn a lot more on the job and have a preceptor to go to with questions rather than having to pull my supervising physician out of an exam room or away from charting to ask them a question. Not too many places around here want to hire a new grad, and here I thought getting a job would be one of my lesser worries!

Here's a run down of post-graduation expenses incurred over the last month through this month:

Review course: $700
Airfare: $200
Hotel: $730
Food: $100

PANCE test: $475

State licensing fee: $300

DEA license: $551

My credit card balances are climbing and my credit score is sinking. My school loans must have just hit my credit report cause my score took a 30 point hit.

I keep telling myself I am not in this for the money, but the debt really stinks.

Anyway, here's to me being a PA-C! Cheers!

PANCE

I am biding my time waiting for my PANCE results. I didn't feel horrible about the test when I was taking it but now that I have time to stew I am starting to worry a bit. Geez would it ever suck to fail the PANCE and have to wait another 90 days to re-take it!

Jobs for new grads are few and far between here and I am resorting to applying for any opening just to get my foot in the door. I am sure the fact that I haven't got my license yet isn't helping. I am a bit pissed that all these loan re-payment jobs here want you to be fluent in spanish. Fu**! I am missing out on employment opportunities and loan re-payment opportunities because there are so many spanish speakers here that they indirectly determine what kind of jobs I can get.

Anyway, I'll be a lot happier when I pass the PANCE and get licensed and start making some money. I know my wife will happier when I can pay for things again.

NEXT!

I have officially graduated! I actually graduated 2 weeks ago but I have been busy with family and and studying. Interestingly, graduating felt very anti-climactic. Maybe it's because I have so many other things to accomplish in order to practice? It was a bit sad for me to realize that I will never see some of my classmates again. We spent so much time together and shared so many unique and trying times that I feel there will always be a bond between us.

Last week I went to a review course for my certification exam. We were in "class' 13 hours a day and had a 2 hour test each evening. It was exhausting but I think it will be worth it in the long run. Tomorrow I have a 2nd interview with a family practice group - more about that later. I take the PANCE next week. I think I should pass based on my tests at the review session but I am studying a bit more between now and then just to shore up weak spots. Wish me luck and put some good vibes out there for me the morning of the 9th.

Balance?

Many readers have asked how I balanced my school work with my family life. The cut and dry answer is poorly. I went into this afraid I might fail. As a result I put 80% of free time the first year into studying, maybe more. As a result I didn't fail. I did piss off my wife considerably and my son vented the way a toddler knows how. My clinical year was really just like having a job, but without the pay or respect. I worked 6 to 15 hrs a day depending on the rotation and particulars of the day. I still had to work on my masters program but that took maybe 6 hrs a week. Things went a lot better but not having an income and thus no money to be able to buy groceries when needed or pay for car registration and having to ask my wife to do all that really continued to wear on her. I think there was slight resentment that I was able to go to school and not have to work. I feel that my wife thought PA school was fun, maybe like undergrad was for her. Other than the occasional moment here and there it was not fun. It was hard-ass work that I will be paying for for many years to come.

Balance? I did my best. Many times it wasn't good enough for the other parties involved but I HAD TO make sure that I did as well as I possibly could while I had the chance. I will graduate with a 3.8 in my PA studies and a 3.9 in my masters, which is from another school. I am still married - today is my 8th anniversary and I hope for many more. My son still loves me and likes to be with me. I'll see if any of that changes if can't get a job real soon!

Hospitalist Rotation

I am seeing a bunch of stuff I have never come across on this rotation. A sickle cell crisis, various county jail prisoners, various substance addictions, lots of chronic kidney disease, lots of uncontrolled diabetes,a gut who swallowed a bunch of pencils, lots of dialysis patients and all their complications, HIV, people from far away lands, TB and then your garden variety CHF and COPD.

I graduate in less than a month and am looking to avail to find a job. It is hard because a lot of employers want experience. Add to that the fact that I am not yet certified means no one is returning my calls/emails. Maybe once I get certified things will turn around. I am so tired of the hassle not having money has created between me and my wife. Rather, me not having any money. She makes well into 6 figures however. And never the two shall meet!

Less than a month to go!!?.....

I recently completed my orthopedics rotation at a very well respected and high profile practice. The doctor that worked with s the team doc for a pro baseball and football team. The problem was that the PA who works there and whom I know was out on vacation for the first week and a half of the rotation. This left me to whims of the surgeon and the fellow he had with him. Unfortunately, the fellow was less than interested in getting me involved and the surgeon was in a perfectionist kind of mood during my rotation. So, the few times I did get in there to hold a leg for an ACL recon or arm for a rotator cuff, I didn't know exactly what to do every minute of the case, leaving the surgeon frustrated. When the PA returned thing improved but the surgeon was still in a pissy kind of mood. So I did my thing and did it as well I could and pushed on. The PA was very apologetic for the disappointing rotation. I learned some stuff along the way, one of them being that surgery of any kind probably isn't for me.

Now I am doing a hospitalist rotation with a group of PAs and NPs in a large county hospital. It has been interesting so far. I've seen HIV, dialysis patients, traumatic brain injury patients, lots of homeless and undocumented residents, and its been fun. I am trying to improve my skills at presenting cases to the attendings. I suck at it, just plain suck.

I graduate in less than a month and am trying to complete my Master's Clinical Residency Project, do well on this last rotation, keep my wife from killing me in my sleep and find a job. I also sprinkle in studying for the PANCE when a spare-spare moment presents itself.

Getting closer

Inpatient medicine was interesting. I was too impressed with docs' desire/ability to teach but they were very knowledgeable and pretty nice. I felt like an idiot coming out of that rotation so I set up my last rotation for IP med at a different hospital.

This rotation, my second to last, is in orthopedics. Last week was boring because my PA preceptor was out on vacation so his surgeon and a fellow had me follow them around. In surgery I did little more than watch and close. Oh and on my first day in the middle of a long surgery I went to sit on a rolling stool and missed. I crashed to the floor on my ass. No one really missed a beat though. They asked me if I was OK and the the surgeon informed that I was no longer sterile. Duh. The surgeon takes care of a major league sports team which is kind of interesting I guess. I am not involved in any of that but the surgeon and his fellow are. I use to consider myself somewhat a jock, as it were, but these guys live it and work it. It is weird to see grown men so interested in a sports team that they don't even play on. Furthermore, the fellow, who has completed residency and is now doing a year in sub-specialty ortho had never removed an ingrown toenail!? These surgeons (now and in previous rotations) do such a wimpy H&P it makes me laugh. They don't even own stethoscopes!

Some folks love surgery, but I think I need more medicine to be happy. Plus standing around in an OR all day telling lame jokes or going over stupid music or history trivia is not my idea of fun. Even if I do get to drive the scopes.

moving forward

Surgery went well. I learned a lot and got pimped more than I cared for. I got t hold a lot of retractors and close up a bunch. I even got to drive the instruments on a few lap choles.

I had an ortho surgeon approach me about a job, but when the interview came I was very disappointed. none of the 6 docs or 5 PAs had read my resume, no one had set aside much if any time to talk to me so I had to wait around the MAs desk waiting for someone to come out of a room so I could talk to them for 3 minutes. When I had lunch the practice owner, he spent the first 10 minutes explaining to me why I shouldn't expect to get paid too much as a new grad and how much of a burden and investment I would be in the first year. By then I had shut down so when it came time to talk to the practice manager I was over it. She asked me if I had any questions and all I could say was "no." She asked me if I wanted to hang around and see some patients with a doc and PA and I lied and told them I had another appointment soon. What a joke.

Now I am doing hospital medicine and I was working evenings and nights, which is why I hadn't written anything here for a while. I was either working or sleeping! By the way, 8p-8a sucks!!!! I was utterly useless most of the time after 2 am and slept from 10a to 4p, further increasing my useless quotient. Furthermore I know absolutely nothing compared to the docs i am working with. The patients are so much more complex and the differentials are seemingly infinite. Or at least pretty obscure in my mind. I am feeling stupid and tired right now. At least my shift is changing now so I should only feel stupid soon.

Surgery

Surgery rotation is going well. I have been fortunate enough to have been placed with a "nice surgeon." I have a reading assignment every night that I am pimped on the next day. Fortunately, when the med students and residents are around he pimps them rather than me. While I can't answer some of his questions, neither can the MS3s or the R1 or R2s. I have been able to answer more than the MS3s for the most part and know my way around the ER better. Once they are done with their residencies they will know a lot more in their given specialty than I will I imagine.

The surgeon likes to give out nicknames to the students and residents. My nickname is the feminine version of my first name. A resident has been nicknamed Travesty and an Asian female med student was nicknamed Sushi, but not for long. Often times the male student's sexuality is called into question in a joking kind of way - usually mine. It doesn't bother me because I think that kind of stuff is so jr. high school to begin with. The surgeon likes to tell jokes in the OR and they are sometimes of a sexual or mildly vulgar nature, ss are some of the pimp questions. E.g. after a long session on the muscles and nerves of the neck, to a female med student: "What is the economic significance of the platysmus muscle?" Leave a comment if you have a guess.

Another pimp question with no innuendo attached was "how were American Indians able to kill bison with single arrow riding full speed on horseback?" Again, let me know your guesses. Most of the time in the OR I watch or cut sutures or retract but on very rare occasion to I get to first assist on surgeries, which is a lot more interesting. I helped remove a lung lobe secondary to cancer, and assist on a mastectomy as well as help the plastics guy with the first stage of breast reconstruction. We also removed a malleable retractor from a patient after it had been there 19 years - from a surgery elsewhere.

I have been working pretty hard and I am usually beat after 3 or 4 surgeries in the afternoon. It is a good experience overall, and I don't really have a with my preceptor - I am just surprised he can get away with those kinds of jokes and question given what I have witnessed in other similar situations in the business world. He treats me well and teaches a lot so I am grateful for this rotation. I may have a job lined up as an indirect result of this rotation too!

End of ER, Start of surgery

Working in the ER was a great time. Saw a few really sick patients, got to suture a great deal and learned a lot. I also stuck myself with a needle which was pretty intense. I was injecting lidocaine into a wound to be sutured and slipped and and stuck my finger with it. The patient was tested and came back negative for everything which was a big relief. But I was nervous none the less for the day it took to get the results.

Next up is surgery. I hear the surgeon I am working with is a great guy and a good teacher, i.e. not like a lot of other surgeons, so I am looking forward to lots more learning.

I feel a bit isolated on rotations since I don't have much contact with my classmates and my wife really isn't too interested in the "cool details" of my day - I really have no one to share my day with. Basically it is like I never saw the things I saw or did the things I did. I come home, have a superficial conversation with my wife, play with my son if he's not already asleep, go to sleep, wake up and do it all over again. At least it's not as bad as the didactic year was. Money and free time are essentially nil. Meaningful human interaction is minimal outside of clinic. On top of that my parents and sister consistently present opportunities to test my communication skills, patience and ability to love unconditionally. Now I have to start worrying about finding a job. Ahhhh, the joys of life and PA school.

EMERGENCY!!!

Some of the challenges I have faced during my rotation in the ED:

1) Most of the stuff we see there is not an emergency - vomiting x 1 day; diarrhea on and off for 3 days; sinusitis; small lacerations; used up pain meds too soon; ingrown toenail; flu-like illness, etc.

2) People game the system to get pain meds. It gets old quick and I don't have any real compassion for these kinds of addicts. I think they are really crappy people actually. see the youtube video for a humerous yet spot on depiction.

3) Nurses. Some seem to have a problem with students. PA students to be precise. Others don't and that is great.

4) I still don't know sh!t. I am reminded of that constantly.

On the other hand, this has been my most enjoyable rotation - lot's of hands on and the PAs who precept me let me do a lot!

Emergency Med

My rotation in the ED has been a lot of fun so far. I started seeing patients on my own immediately - and the preceptors allow me to do pretty much everything. I've gotten to stitch up a few people which was fun. The ED is interesting because many people use it like a walk in clinic. Most of what we see is not an emergency but I try to have fun with each case. A few are annoying, but I just let those people slide right back down to where they came from.

This ED is a level 4 trauma center which means it can't handle anything too serious. Occasionally stabbings or a car wreck comes in but nothing major so far.

I am working 4 12s a week which leaves me surprisingly little time to do what I need to once I catch up on sleep and complete my fatherly duties. When I get home from a shift I don't even get onthe computer, I just watch TV for 30 minutes and go to sleep. Ahhhh...sleep.

This place is nuts!

Today we had a really annoying lady come in today likely seeking narcotics. She was angry, she cried, she told me how she was just passing through town and needed a refill on her phenergan/codine cough syrup that she just can't live without. She showed me her last bottle that she had filled 14 days ago. It was a 500mL bottle and it was empty. She wanted something for her neck pain too. As it turns out she just got her MRI results before she left California that showed this, that and the other was wrong with her neck. Well, she's also on 4 psych meds, 4-5 pain meds and some other stuff I can't remember. I relay all this to my preceptor who comes in and lays it on the line to her. No narcotics on the first visit. But she can have flexaril and Tessalon Perles for her muscle spasms and cough. She complains about not being to afford them, some problems with her Medicaid in CA, and while grumbling storms out of the office without getting any of her scripts.

Later a guy who I stitched up last week came back to get his stitches out. But he brought his psycho girlfriend who complained about the crappy job I did, the fact that they had to pay another office visit, that I released her bf to light duty at work after 3 days and he went to heavy duty right away, that I should have know better that he couldn't possibly work at all given his occupation as a line cook. Turns out he's also a gopher who "has to" carry and lift heavy foodstuffs or something. Oh and he "has to" wash dishes. After a few hours in the rubber gloves he got keep his hands dry - his hands were likely very macerated anyway. And he stopped using the brace we made for his hand to keep his wound stable, His gf gets entirely bitchy with me from the get-go and starts to berate me and argue with me about who knows what really - mostly how it's my fault her gutless, stupid boyfriend can't take care of his wound properly. Well, after taking out 2 stitches I could see his lac wasn't healing at all. I put some steri-strips down and told him not do anything with his hand if he wanted it to heal. In the meantime, this guy's girlfriend throws a shit fit, the office manager calls the cops and my preceptor throws a very intense, profanity laden shit fit of his own in front of the patient, other patients, and the entire staff. I had to pull him away from the patient (for the second time during my rotation there) as violence would have ensued, and then I finished dressing the patient's hand. The patient's girlfriend ran off and he was stuck answering to the cops.

If this sounds disjointed or confusing, I am ok with that because that is how I still feel having been involved in this crap.

Family Practice, continued

I stayed home today with my son who is sick. My wife had to travel to California for work so it's another boy's day home.

The clinic I am at is very interesting. There are so many chronic pain patients - I can't believe it. 75% must be on vicodin, percocet or MS contin. I feel that the vast majority need these medications but there are a handful that just piss me off. When you've seen these type of patients you'll know what I mean but until then it is difficult to really grasp what these people are like. Manipulative, mean, argumentative, and nasty. I hate dealing with these people. I do mean Hate. And their sense of entitlement regarding coming in late, demanding early refills, refusing to comply with the requirements of continued care and lack of decent interpersonal skills makes being around them a chore.

On a similar note, it seems that the majority of our patients are heavy smokers. The stench of cigarette smoke they carry on them is so overwhelming that I seem to be able to smell it hours after I leave the clinic. The thing is that a lot of them don't want to quit smoking, but they come in frequently for URIs, HTN, asthma and COPD needing O2 and med refills. They complain about all of their health problems and not having money to pay for decent food or health care yet they spend $100-$300 a month on smokes! My parents are heavy smokers and I grew up with the chain smoking mentality. I also realize that smoking may very well be one of the most difficult addictions to break. These people (including my parents) still piss me off with their lack of resolve, self-control and common fucking sense. If you are going to smoke 2 or 3 packs a day, what in the hell good do you think O2 or inhaler is really going to do for you? The spectrum of the human condition and experience is infinitely vast and often impossible to relate to. I "get it", but sometimes I still don't really "get it."

Family Practice

So now I have started a FP rotation in a rural mountain town. Today was stressfull but mostly draining. The PA I am with got into an argument with a patient with no patience. She complained he was taking too long and he told her not to give him any crap today. The argument ended with her refusing to quit smoking or follow his advice and with him frustrated and furious. He walked out of the exam room and left me to smooth things over with her which I was able to do for the most part after 20 minutes. We then had a lady in late her late 60's complain that after a year and a half of practicing anal sex with her boyfriend she wanted to know why her perieneum hurt soo much and if we could fix it. We tried. I was left to counsel a young man with pneumonia who decided to break down crying to me about his grandma and aunt's ilnesses and concerns. After I got those under control and returned with his rx for a chest x-ray and antibiotics he broke down again about the feelings he had for his high school sweetheart who resides in another state and who he hasn't seen in years. He feels they still have a relationship but isn't sure and as a result has put off having sex with a few of his cousins until he knows for sure what is going on with his "girlfriend." This guy in his 30's was sobbing and I was the only one there to talk to him about his nutty-ass problem. Add to this some drug-seekers and "I'm and hour late but you need to see me anyway" types and I left there drained and wanting to have a few stiff drinks. My real wish was that there was a chlorox handi-wipe I could stuff into my skull and wipe my brain clean. Some cheap red wine will have to suffice.

OB/Gyn continued

I have really enjoyed this rotation. I have scrubbed in on a bunch of surgeries, assisted in few, gotten a couple intubations, done a bunch of pelvics and a couple paps and closed a few lap incisions. Tomorrow I scrub in on a pretty serious case of colpoceisis. Usually performed on frail, elderly women with severe prolapse of the pelvic organs and with no use for their vagina, the colpocleisis involves denuding rectangular portions of the cervix, everting and sewing the vaginal lemum closed. The denuded portions are then in contact and heal together, sealing it almost completely.

My doc has spent some time helping me with knots and suturing and given me some advice on confidence (mine and other's in me). Everyone at the practice, in the OR or on the labor and delivery deck has been friendly and helpful. It goes without saying, but I go out of my way to thank everyone for helping me with anything, and I make a huge effort to help with transferring patients or whatever needs to be done. Being helpful and friendly goes a long way in making rotations go smoothly.

The master's program work is an additional grind that I'd rather do without. But since my masters is health administration I don't have a clinically related master's and need this for the future, I think.

The end of this rotation marks the midpoint of my final year. I am 6 months away from graduating. Yikes.

Ob/Gyn Rotation

The first week of my Ob/Gyn rotation is complete. It has been interesting and, dare I say it, fun. I spent day 1 with an NP. No "hands on" exams but I saw a bunch of cervices and observed all the exams and an endometrial ablation. Only one woman didn't want me in the room for her LEEP. She was in fact the only person to decline my presence all week long. Tuesday and Wednesday were half days in surgery and half in clinic. On tuesday the lovely Austrailian anesthesiologist allowed me to intubate the two patients in the OR and the surgical assistant gave me pointers on subcuticular sutures and allowed me to close on my side after the doc scrubbed out. Wednesday didn't bring any intubations but I did get to do some minor assisting in the OR and helped close. Thursday was call day and the doc and I rounded at the hospital, did a hysterectomy, had a vaginal delivery and c-section with twins (major, gushing volumes of amniotic fluid). I also performed bimanual exams on the surgical patients under anesthesia. Today was a clinic day, mostly OB checks, so not nearly as exciting. The Or has its own rules and etiquette. I contaminated myself twice and had to get a sleeve (which is better than having to scrub out!) and I felt like a loser but I am getting the hang of it.

My wife went on a girls-only weekend to celebrate her 40th birthday so it is just me and my son for the weekend. I see junk food, a birthday party and a football game in our immediate future. And if he ever takes a nap I have a ton of work to do for my masters program.

Ads, and What do you want to know?

I've added advertisements to my blog to try to make some spare cash. I realize it isn't in the best taste to do so, but figure if I can make any money to supplement my school loans and my life a little easier then it's worth it. If tou have an opinion one way or the other let me know. And please feel free to click on the ads to help me out if you wish. That wasn't in good taste either but hey, I am a student and am exempt from rules of decorum outside of the clinical setting.

If you have any questions about PA school, clinicals or medical equipment for school please let me know. If you'd like my perspective on an issue I'd be happy to oblige. If there is something you had hoped to get from this blog but haven't let know. Maybe I'll ignore it or get all passive-aggressive on you. Maybe I'll do something about it. Mostly I want to do this in worthwhile way - I really don't feel the need for futility in my life. Thanks.

Psych

Psych is very interesting to me. So little of it is based on science. We don't know for sure why mental illness develops, we don't know why exactly the drugs we use to treat mental illness work, or work in some and not others. The people I am seeing on an outpatient basis are for the most part marginally functional. Most don't have a job and have a stream of ruined relationships trailing behind them. If they have kids, they are often no longer in the picture. Alcohol and drugs abuse are a given at some point in their history. If the law hasn't been involved in their life it likely soon will be. Many with scizoaffective disorder will never be productive members of society. The best hope is that they will be able to function, avoid the law and substance abuse and perhaps hold a job of some sort. Bipolar is pervasive and yet often misdiagnosed. ADHD seems to be in the water here - so many of the adults and children have been diagnosed with it that I wonder if I don't have it. Many of the adults with ADHD, as is common, have a history of self-medicating with cocain and meth. In fact, if an adult w/ suspected adhd has tried either and says that they felt normal when using, that is almost pathognomonic for adhd. I've seen a few medical hold placed on patients - for 72 hours they are under the control of the state.

The inpatient setting is astounding to me. The trend in the US has been to close state hospital and to place the mentally ill in nursing facilities. Now these folks are just tossed in with grandma - they have theri own secure locked portion of the building, much akin to an Alzheimer's ward. The folks here are so ill they have little hope living with their family let alone on their own. schizophrenia is commonest illness in this setting. Since these patients were never compliant with their meds and were often using drugs and committing petty crimes on the street. Some can carry on a conversation, others are psychotic that they can't even look you in the eye. Some find their symptoms troubling while others revel in the hallucinations and delusions that come with their disease. Some are as young as 25 or as old as 75. When dementia sets in these patiens can be moved to less secure setting as they pose a decreased flight risk.

I still haven't actually treated any patients or written an prescriptions on this rotation - I am still a fly on the wall for 99% of this rotation. The docs are all nice. One didn't know what MRSA was when it was brought up in conversation with patient. He's been in practice for 40+ yrs and was able to determine it was an acronym for something however. Another doc defers to me for most medical questions from a patient. The other like to pimp me occasionally but her answers are usually not correct. Finally, the one I with tomorrow is very bland and soft spoken. Dowdy and unengaged would be other terms to describe her. I find it interesting how little the psychiatrists actually want to talk to their patients. At this point they have become dispensers of drugs and little more.

Mental Health Rotation

This week I started my mental health rotation. It has been interesting to see really sick people with some unique stuff going on. It has always interested me as to how the mind can work so in some and so terribly poorly in others. The folks we've been seeing are truely in need of al the care they can get. We have PTSD w/ conversion, schitzo-effective disorder, psychosis w/ delusions and numerous bipolar on top of your run of the mill depression and anxiety. The drawback is that since these folks are so sick there is no chance of me jumping in to monkey around. The other drawback to me is that since I am only working with psychiatrists, I don't get to see any of the couseling aspect of their treatment. We only get symptoms and prescribe/change medications. I guess as a PA I wouldn't be doing any sort of couseling to any extent, but it still interests me more than doling out meds.

The face is back to its normal state. My skin looks better than before I started the fluorouricil treatment in fact. The doc also went in and cut out a lesion I had for a while that was multi-colored and irregulary shaped. It ended up being seborrheic keratosis but I was tired of having people tell me I needed to get it looked at. It is gone now and in its place is an inch-and-a-half long scar that is too fine to really notice. I was hoping to add to my collection of scars but I am afraid this one won't really count.