One of the things I do at work is perform dept of transportation physicals. With a healthy patient this goes smoothly and takes 10 minutes. I had one the other day that took 30 minutes. Keep in mind that truck drivers in general have poor health. They spend all day seated with almost no physical activity. When they stop driving for the day they eat whatever is available at the truck stop. These choices are almost never healthy. In their free time many have been known to undertake risky behaviors. They also are never at home and so they do not see a healthcare professional unless it is urgent These are not just stereotypes. When I worked in health insurance all but one of the companies I worked for refused to underwrite policies for over the road truck drivers. Flat out. No consideration, no negotiations.

So back to my 30 min DOT physical. This guy in his 50's comes in having been on Xanax for 20 years. His psychiatrist is weaning him off of if by putting him on another benzodiazepine. Since he stopped taking Xanax his blood pressure has shot up to 170s / 110s. This blood pressure is incompatible with driving commercial vehicles in the US. Furthermore, taking benzos on a daily basis is also - they are too sedating. Now he's been driving for 20+ years while taking Xanax daily. I certainly never saw him before but this apparently never concerned any of the examiners who cleared him medically in the past. So, now it is up to me to tell this guy that I can't pass him. Now he can get these forms filled out by his specialist providers stating that, in their professional opinion he is not at risk and the medications he is taking won't make him take a nap at the wheel. If he does and comes back with a slightly lower blood pressure I can give a three month card. Well he proceeds to complain that I am taking away his livelyhood and then starts calling everyone he knows. But he won't leave my office. He calls his daughter who works in healthcare and she tells him to go somewhere else and not tell them about his medications and conditions. He calls his employer and complains to them. They run through every scenario; when will he get his Rx for his BP filled? How long can he drive on his current card? Who's going to pay his bills? Why won't I accept some 8 word note he brought in from his PCP stating he is under his care? Then he tries to call everyone of his providers to get them to talk to me so I will sign off on his med certain card. Only it's ten to five so he can't get ahold of them. He complains how I am taking away his livelihood by not clearing him and that all he wants to do is drive his truck and make a living. I explain to him that I want to continue to make a living as a PA and that if he were to wreck his truck i could loose my PA license. He turns to me and asks:"what's a PA"?

Becoming a PA doesn't change your life

Today things seem to have caught up with me all at once.  Nothing really significant if taken separately.  But their cumulative effects have me feeling worn out today.  Work just isn't fun.  It's not miserable, as it had been a couple months ago - it just isn't enjoyable.  I find myself filled with dread when I see certain patients on my schedule. I feel drained by my patients at times - almost never energized by them. The computers are slow and my boss isn't great. Since I work with women I have very little socializing to do - I don't care about cute tops or the size of my butt. I spend 2 hours a day commuting which would be more tolerable if I were commuting to something I looked forward to doing. Plus, with my glass half empty right now I see that time as lost - I would rather have an extra hour a day so I could ride my bike or paint or something.  As it turns out I almost no time for myself now. Between commuting and work, 12 waking hours are accounted for 5 days a week.  When I get home my son is there asking which game or toy we should play with before and after dinner.  After playing with my son I put him to bed, which with reading stories and brushing teeth and whatnot, takes me to 8:30. By then my wife is well into another episode "Housewives of XYZ" - she likewise has similar feelings of time poorly spent and needs to unwind in a way that works for her. I really cannot stand to watch these shows so I usually stay upstairs and read email or facebook or play games on my ipad for an hour or two and go to sleep.

On the upside I have a car to get me to a good paying job where have to do nothing more than think most of the time. I have a beautiful son who wants to spend all the time he can with me. I have plenty of food to eat and a decent house to live in. I have an ipad for goodness' sake. In the whole scheme of things, my problems seem pretty trivial and I am sure there are literally tens of millions of people who might like to be in my shoes. However, these are the problems I face and they do bother me. The thing that bothers me the most is feeling like I am in a rut or that I am on autopilot all the time. I continue for ways to break the cycle.  I long for exercise and activity and creativity.  I search for ways to get these things back.  In the meantime I vent to strangers. 

Got me an iPad!

My lovely wife got me an iPad for our anniversary. Pretty cool, huh? For what I do now, I really don't need much else. I just need to figure out. How to get my Microsoft documents on here so I can edit them and email the out. By the way I got her a necklace from me & ro. My son is doing well and looking to wrap up his second week of kindergarten.

Work is going fine. Recently I saw an amputated distal index finger, a bunch of lacerations, a fractured great toe, a completely torn ankle, a couple hot water burns to the eye, a few dental injuries, and some miscellaneous fractures. This is on top of the multiple rotator cuff strains and tears, carpel tunnel, and a ton of low back injuries. Just a reminder...never twist and lift, never reach out and stoop while pulling or lifting heavy weights and use your knees!