Becoming a Physician Assistant

It has been a while

2012-01-26T18:39:00.000-08:00

I feel that I am maturing as a PA. I recognize and pain over my shortcomings. I try hard to correct them and bemoan my failures. Right now i am working very hard to be fake. Let me explain. My personality and approach is to tell it like it is. If you ask me what I think I will tell you what I think. I will give you an honest and straightforward reply. Some of my patients like this. But many do not. I find that my SP, while she may feel the same about any given patient as I do and often does, she sugar coats everything. She is very, very friendly with every patient, even those that were caught in lies, are faking injuries or are simply not very good people. While I am never rude, I rarely ask the malingering, lying, and rude patients how their holidays were and I certainly won't chat with them about their personal life if it doesn't pertain to their treatment. She will go out her way to be nice to a patient that she feels is, in her own words, a "piece of shit.". I know what you are thinking. How dare he call another human being a piece of shit?! Just who does he think he is after all? I get it. It is not right to think this way. But from time to time we do and for pretty good reasons. Back to my point. Why waste the energy to go out of one's way to be extra nice to someone who, by most accounts is simply gaming the system and doesn't deserve it? It just makes the day easier if you do, that's why. A spoon full of honey helps the medicine go down damn it. These patients make less of a fuss and waste less of your time with BS if ther *think* you like them and believe them to call them on their shit only makes them work harder to convince you to bring up glaring inconsistencies in their storry only forces them to act out a grander tale. Being honest hurts these people and causes them to spill their pain onto all they deal with. So now I realize this. I realize that being this way is not in my genetic makeup. I realize that the days are getting difficult. I realize I need to find a way to make them go by a little smoother. I realize I need to try harder.

Lies, lies,lies

2011-12-14T16:27:00.001-08:00

I had a patient today, who admittedly has some serious but old spinal problems, tell me he is almost out of his pain meds that were prescribed by another provider a week ago. " I maybe have 2 days of meds left" he tells me. This fella had seen me for his initial visit and subsequent visit but then his claim was denied. So he had to go to the ER for his pain meds. I had to dig but he fessed up to going to the ED on several occasions while his worker's comp claim was adjudicated to get pain meds for his train wreck of a neck. So, since he told about all the visits I had dug up and investigated so I gave him an Rx for #60 oxycodone and put him on a narc contract. He new what it was before I even mentioned it. He signs it and went off to fill the Rx. I get a call from the pharmacist telling me that this fine gentleman just had an Rx filled 2 days ago for #120 oxycodone. I told the pharmacist to rip up my Rx and to tell the patient I asked to do so. The patient just called as I type this telling me he went back and counted all of his pills and he 68 left and that the pharmacist is wrong and that he got the Rx filled 4 days ago. These are the kind of patients that make me question what I am doing. I am sure it isn't as bad as I feel it is, but it seems so many of patients don't want to get better. It seems so many of them lie. Shit, I wish I didn't care but I do.

Love my co-workers

2011-12-07T10:27:00.001-08:00

The doc I work with just moved a new injury to my schedule from her's so she could purchase holiday decorations for her office.

2011-09-30T21:10:00.000-07:00

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

2011-09-27T13:30:00.001-07:00

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!

2011-09-01T21:17:00.000-07:00

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!

I got one!

2011-07-25T14:36:00.001-07:00

I had a patient who came in last week with a very sore, very firm calf after running to respond to an emergency earlier in the day. No injury really, just pain after resting a bit that was worsening to 10/10 and a lot of swelling. Other than the swelling he looked fine really and was handling 10/10 pain like a champ. Well. I sent him to the ED because I had concerns for compartment syndrome. Turns out he had a major case of compartment syndrome and had an emergency fasciotomy the same day! He has second surgery to remove 2 fist sized blood clots the next day. He came in today for follow-up with his mom and wife and they were all so grateful for my help. Well needless to say the works of thanks lift up my soul today and the fact that I caught a gravely serious condition gave me a boost of confidence.

A challenge around every corner

2011-07-05T09:16:00.001-07:00

I have worked for a lot of companies and had many bosses. A few were stellar, most mediocre, and a couple were just plain bad. Without going into detail things are less than cozy between my boss and I. Mostly along the lines of - I am the doctor and you are not - kind of crap. I like my job and my patients are, for the most part, great to work with. It would be nice to get some training, but as it stands, I have had none since I started seeing patients. No feedback on care or charts or anything.

I know, this comes off as me complaining again. Life is rough at times, I know this as well as anyone, believe me. Maybe I don't write enough about about the highs. Well, here goes. My wife and I are working on things and it seems to be going better. My son is awesome and at five is reading, riding his bike w/o training wheels and swimming, albeit at very much a beginner's pace. He is a Star Wars fanatic and asks me constantly about the nuances of all the story lines and the scope of power of a Jedi versus the Hulk, for example. He has a great imagination and loves to draw - much like me at that age. I will follow his lead and return to art earnestly now that my schedule is under control.

Happy 4th!

Arrrrgh!

2011-05-11T09:22:00.000-07:00

My computer is still out of service. Maybe I'll just buy a new one. Thank goodness for the iPhone!

I just had an interesting talk w my SP. I had anpatoent the other day with a pretty obvious MCL tear, probably grade 2. Before he came to me he had been to the ED and had spoken to his supervisor and both told him he NEEDED an MRI and probably surgery. Through my training I know that regardless of what an MRI might show, the treatment for a torn MCL or a sprained MCL is the same. The almost never need surgery and almost always heal on their own. I explained this him as well as the need to reduce the effusion in his knee before an MRI should be obtained. I thought I had his buy in on the treatment plan. Well he called later that day to cancel his PT and follow up here for a second opinion elsewhere. I was informed By my SP that his employer wanted an MRI stat and that in most cases if the employer is willing to take the hit on their workers comp insurance they can have whatever studies they want, even if all medical guidelines indicate otherwise. So now I have been told by my SP to ignore my training and provide whatever studies this employer wants even if it isn't warranted. I feel like a burger king employee again - you can have it your way.

And the beat goes on...

2011-03-09T08:52:00.000-08:00

Still posting from my iPhone as my computer sits awaiting an attempt at repair. Still seeing a ton of ortho and neuro. Had a pt with a focal infarction only effecting his occulomotor nerve for his left eye as the result of CO poisoning. Reattached a partially amputated finger in office. Long stretches of the mundane punctuated by some cool shit. I seem be working late every night while my SP does not. If I don't have a question for her I may not even talk to her on a given day. I seem to be doing well though my 90 day review. I even bonused recently...a whole $10! Overall I am happy with the job. I realize there will be difficult or annoying people anywhere and that no place is truly perfect. I like being able to pay my bills and have some money left over. I like being mostly on my own at work.

My beautiful boy turns 5 soon and I am amazed at how great he is. I will mourn the day I am no longer cool in his eyes and have come to appreciate his constant requests to play light sabers or cars. Looking back I cannot remember my dad playing with me. I am working hard to make sure my son won't have the same non-memories when he is older.

PA school was so tough yet it seems like a distant memory now. How is it I can remember getting a string of cellophane-wrapped lollypops from the German couple who lived next door to us in Berlin when I was 2 so clearly, yet trying to recall any particular day in PA brings back only whirls and blurs? I wish I saw my classmates more. We went through it together and only they can relate to that experience and those I have now at work. Sometimes I wish life wasn't so much about moving on.

Computer...is......dead

2011-01-20T10:34:00.000-08:00

My computer died so I have held off posting anything. It has been too long so I am taking a break from work to use my iPhone to post. I am pretty busy at work and am essentially on my own unless I have a question. I have gotten really positive feedback from my supervising physician and patients. I can now get through a full physical exam in ten minutes. I have seen some interesting things and some even more interesting patients. My personal life continues to be a roller coaster with more flats and up hill pushes than enjoyable twists and turns. I was hoping my wife would be happier with me being employed and well paid. It seems she continues to find fault with me, our house, our stuff and our lack things and activities that meet her standards. Will a new house make her happy? Will our son's admission to a good kindergarten make her happy? More vacations? A new job? A cleaner house without clutter? Newer diets? Better exercise plans? Going vegetarian? Losing 40 pounds. Will Having a husband who only wants to do/watch/eat what she likes to help her to be happier? At least I can pay a lot of our bills now!

6 weeks in

2010-12-05T19:43:00.000-08:00

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

2010-11-03T20:11:00.001-07:00

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

2010-10-08T20:24:00.001-07:00

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!

2010-09-18T21:00:00.000-07:00

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

2010-09-13T21:14:00.000-07:00

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!

2010-09-01T22:38:00.000-07:00

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?

2010-08-18T21:34:00.000-07:00

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

2010-08-03T19:46:00.000-07:00

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!!?.....

2010-07-25T20:32:00.000-07:00

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

2010-06-27T19:47:00.000-07:00

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

2010-06-06T21:38:00.000-07:00

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

2010-05-06T14:24:00.000-07:00

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

2010-04-23T16:12:00.000-07:00

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!!!

2010-04-13T20:41:00.000-07:00

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

2010-04-02T21:04:00.000-07:00

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!

2010-03-23T22:10:00.000-07:00

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

2010-03-11T21:34:00.000-08:00

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

2010-03-03T19:31:00.000-08:00

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

2010-02-21T18:14:00.000-08:00

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

2010-02-05T20:27:00.000-08:00

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?

2010-01-19T19:45:00.000-08:00

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

2010-01-19T19:13:00.000-08:00

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

2010-01-06T19:48:00.000-08:00

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.

Holiday Break

2009-12-21T16:08:00.000-08:00

On break now and looking forward to some relaxation time. Well, to the extent possible-you see, I have spent my life in the sun - California, New Mexico, Texas, Hawaii and Colorado is where I've spent most of my life. As a result I have extensive sun damage to the skin on my face. My dermatologist looked me over, and I mean ALL over, and suggested I apply 5% fluorouricil cream to zap the extensive actinic keratosis on my face. Two weeks from the start of therapy and I look hideous. Angry red sore cover 90% of my face. They, hurt, burn, itch and sting. Needless to say I garner many stares when I am out in public and the neighborhood kids ask me what's wrong with my face. I hope that my follow-up visit with the dermatologist tomorrow will be the last day I have use the cream. But if it isn't I'll keep going, keep using it, and show up to my mental health rotation ready to give my patients some bad dreams. It's not like I had an excess of good looks to draw from in the first place so I am looking forward to being back to a 5 or 6 rather than the 1 I am now.

I cried today

2009-12-07T16:20:00.000-08:00

I am not proud of it, but I'm not really embarrassed by it either. I don't want to do it ever again either.

We have a patient in hospice who is in her twenties. She has EXTENSIVE adenocarcinoma, that she ignored while she was caring for her ailing mother. She knew she shouldn't have been bleeding like she was or having the massive discharge that she was experiencing but rather than address it, she ignored the existence of any problem. A year later her mom forced her see a doctor but by that time it was way too late for any kind of treatment. She has a massive wound and an even more massive tumor burden, has been in hospice for over a month now and has been stable and in no acute distress. She participates in activities to the extent someone who is bedridden can. She is usually outwordly cheerful and upbeat, if not denying any problem really exists. Since late last week she has been getting worse (bleeding, tumor growth) and today we informed her that she may not have long to live. It was the first time I saw her openly grieve her own loss and perhaps accept that she would soon die. We left the patient to cry alone, as she requested, and a couple minutes after I left her room I began to cry. Not sobbing or whimpering, just quietly letting tears stream from my eyes. The PA followed and we sat down together to discuss my feelings and how this young lady's imminent death had effected me. It had touched me so much because she is so young and I know that there are so many things she has missed out on and will never get to experience. Too, I felt that I had whitnessed her accepting her death. Literally accepting the fact that she would not only never get better, but that she would soon no longer be on this planet. So we talked and I let a few more tears fly and blew my nose a couple times. The PA gave me some words of comfort and advice and we got up and went to see the next person not long for this world.

Hospice

2009-12-02T19:50:00.000-08:00

My rotation in hospice is very interesting. We aren't running around doing procedures or doing detailed exams or even prescribing that much medications. We do focus on making the "patient" and their family comfortable, well informed and supported from many different angles. It is such a unique perspective to spend so much time with dying people and their grieving families. I am really just learning how to listen to people and to openly and comfortably discuss death and the process of dying.

The team that I work with is great. They truly work as a team and really get along quite well. The doctor treats me with respect and introduces me as his "colleague, PA Phooey." The PA is also great and is fun to work with. They both take time to teach me about listening and ideals of hospice and palliative care. I am really impressed with this group, as are most all the families who come here and can see why everyone has worked in the same place for so long. Not too many places have such a strong group of providers, nurses, social workers and clergy. I can't recall a place where everyone worked so well together.

I am slowly growing comfortable talking to families of dying patients, but have almost broken up a couple times when visiting with families or dying patients who are still able to communicate. The ones who come in already unresponsive are, for me, a little easier to deal with. It's just hard having a conversation with someone you know won't be alive in week. This is a good experience and will certainly help me help my patients deal with death and dying.

Next rotation: Hospice

2009-11-22T17:41:00.000-08:00

This should be interesting and will definitely test my ability to keep it together.

I still haven't recovered from my month in the country and very little sleep. I am tired all the time.

The end is near!

2009-11-14T20:23:00.000-08:00

For this rotation at least. My preceptor has relegated to me observing him and listening to heart and lungs sounds for 90% of the 10-12 hours I put in each day. I get the impression he doesn't like me, but then again his interpersonal skills are thin. He just seems very uncomfortable speaking to patients and carrying on small talk with anyone. He staff is irritated with him often because he is NEVER on time for anything. I wait at the office 15 minutes to 2 hours for him to come in or to call to tell me where to meet him. He runs through mid-levels fairly regularly and some of his office staff were openly wondering how long his newly hired, yet very experienced PA would last. Seems his PAs and NPs don't stay for longer than a few years at most. I truly look forward to moving on and putting this rotation behind me. It is as close to a waste of time as medical education could be. It's shame too because he knows so damn much. He's just too busy to share it.

Interesting patients

2009-11-06T23:03:00.000-08:00

The town I am doing my rotation in this month has maybe 10,000 residents. Many are poor, most are older. Almost all have been very pleasant and friendly. The other day however I was asked to see a patient while my preceptor saw a couple of worker's comp patients. I knew I was in for something when the MA gave me a look of pitty as walked past her to greet the patient. Actually the patient came out into the the hall to meet the "PA student working here for the next month." She was agitated and came at me full bore, demanding to know my name, where I was from and what kind of student I was. I shook her hand and brought her back into the exam room to find out what brought her in that day. She was there with her 11 y/o daughter, there because she was again in pain and needed medication. She pulled a curling iron out of her jacket, plugged it in and began to curl her thinning hair in large loops. She explained to me that she was in pain but that my preceptor had cut her off from narcotics because she had just tested positive for cocaine. What she didn't know was that her test also revealed she wasn't taking any prescribed pain meds either. Her phone then went off and she answered it, and described to the person on the end of the line the quantity and size in milligrams of a substance she could provide to the caller. Soon she answered another similar call and replied to a text message too. She then went on to explain that because she could no longer get pain meds from the doc that she had to "hustle" to get her pain taken care of adequately. After 30 minutes of learning that she had a terrible childhood, had lived in the same town I had when I was young, was the same age as me, that her daughter's dad had been murdered and that she hid nothing from her daughter, I began to wonder where my preceptor was. The patient then showed me a text message from a "friend" looking for some help with their pain from her. One minute she was friendly and smiling, the next she was confrontational and aggressive. Her daughter was embarased, quiet, friendly and smart. She tried to read a book while her mom cursed and rambled and spilled her guts to a stranger. After talking to her for 45 minutes I went to look for my preceptor and to seek a break from the intensity this patient exuded. I waited for 20 minutes for my preceptor to finish with his patient and then we went in together to talk to her. While my preceptor, with his back to us for most of the time, reviewed her meds and medical conditions, she had her daughter apply a fentanyl patch to her back and then she dug through a large prescription medication bottle filled with meds of varying sizes and colors of tablets. She pulled out a few tabs and swallowed them without water. She was now very friendly yet apparently reeling in pain, unable to sit or stand still. I spent this time to talk to her daughter about school and her favorite subjects, while my preceptor sifted through her chart and made notes while occasionally asking a question of the patient. I felt bad for this young girl who would be lucky to have her mom around for her highschool graduation. I was mad at this woman for being so selfish and vile and manipulative. I was frustrated with my preceptor for having me spend and hour and a half with a patient that he never wanted to see and had made wait an hour before he sent me in to talk to her. And I was disappointed with myself for letting any of them make me feel they way I had. She left without any new meds, undoubtedly as frustrated as i was, but for different reasons. I wish i had learned something valuable form the experience but I didn't. It only reinforced my feelings that some people are shit and will not hesitate to put people - loved ones and strangers- in positions they shouldn't be in to meet their own selfish needs. It reinforced the notion that innocent kids everywhere have crappy parents and must beat all the odds just to have a decent life. I also learned that my preceptor is passive aggressive and puts off doing what he doesn't want to do by placing a student in a crap situation just to prolong the inevitable. Thank goodness for the many kind and truely friendly patients I hve met during this rotation.

rural family practice

2009-11-03T20:24:00.000-08:00

1) meeting lots of really nice people. really nice.
2) bought my SP a wireless router so I can do school work at the office rather than at mcdonalds.
3) bought a can of raid to kill the multitude of beetles that invade my living quarters.
4) doing a little more now on this rotation. SP a bit more social and friendly.
5) lots of the same here compared to the "city" - chronic pain and worker's comp mostly.
6) small town = lot's of old folks, not too many young folks.
7) miss my son like nobody's business.
8) rides back home with classmate are entertaining, enlightening and awakening.
9) not a damn thing to do or places to eat at 10 pm when I finish for the day
10) can't sleep for heck with the beetles and trains
11) bonus - ALL learning experiences are valuable.

Family Practice

2009-10-29T19:17:00.000-07:00

I am in a rural, under-served area now with a doc who has been here for 26 years. He has his own, sizable practice, admits to the small local hospital, is the county health department's medical director, sees patients in the nursing home and the county jail, plus he covers the ER a couple days a week. I am staying in a trailer in the country where there is no internet and the TV doesn't work. We got a foot of snow last night so we didn't have too many patients come in. Unfortunately he is under the impression that students can't write in the chart so I don't get to do any documentation. Plus he does a LOT of workers comp which he has to see in their entirety so that cuts back more on what I get to do. He is a great doc who is very thorough and he spends 20-30 minutes with each patient. But that means we often aren't done until 10 pm. I wish that since i am putting in all this time I could do more, and in turn learn more. Well, I guess I'll just have take as much away from this experience as I can squeeze out of it.

I am driving back home tomorrow so I can go trick-or-treating with my boy. I sure do miss him already.

ME

2009-10-15T20:30:00.000-07:00

A few of my patients and "co-workers" have asked me about my background and how I got into PA school. I thought that it would be interesting to show one PA student's qualifications before entering school, mostly in order.

BA - biology
Master health administration
6 yrs firefighter/EMT
EMT/CPR instructor at college and hospital
PT tech 2 years
10 years in Sr. position in health insurance
2 yr volunteer medical assitant in under-served pediatric clinic
1 yr volunteer EMT private ambulance company
1 yr cutting edge job at #1 rated research hospital

My undergrad GPA was 2.8 but my last 100 hrs had a GPA of 3.75 which helped alot. I worked 20-40 hrs a week in college, paid for most of it myself, hated every minute of and couldn't wait to be done with it.

I applied to 10 PA schools, got interviews to 5, was waitlisted at Pacific University and Drexel, accepted to my program and decided to skip the interview at Cornell since I had already been accepted where I really wanted to go and the person I talked to at Cornell was a jerk. It was the first and only year I applied to PA school, which I consider very lucky.

So far my GPA in PA school is 3.65 but I stopped stressing about getting A's the second semester. I failed 2 tests in my first year and rarely aced any. I really enjoyed PA school even though it was very difficult and very stressful. Being in clinical rotations now I don't have to study every night and have a lot more fun than in didactic year. My preceptors have given me a great deal of praise. In just my second rotation I am seeing patients on my own (roughly 10/day) with the preceptor stopping in to see how I did and to hand me signed, blank scripts and referrals. My current preceptor told me he thought I was ready to see half his patients on my own. I disagree, but it is a great compliment nonetheless for a doctor who has been in practice for 35 yrs and has a strong patients base who really love him and the way he treats them.

So enough bragging. I simply like to point out now and then that regular people can succeed in PA school and that it is not just for the type A overachievers.

More IM

2009-10-06T19:31:00.000-07:00

Along with the numerous, somewhat annoying "pain" patients and type 2 diabetics I have seen, I have also come across some interesting cases. I saw a guy with hemochromatosis and polycythemia, Another guy in his 30s with Dandy-Walker syndrome, a 50-some yr old today with epiglotitis and a lady in her 50's who developed severe liver disease from poorly controlled DM. The doc I am working with complemented me by telling me and his staff that I am a big help seeing patients for him and that I have I come up with some good suggestions for dx/tx/rx. He has been in practice for 35 years and is very knowledgeable and he takes the time to teach me and his patients - which his patients love. I am calling patients with lab results, seeing patients almost entirely on my own on occasion and writing scripts for everything. I really am having fun when I stop to think about it. And I am proving to my self-admitted skeptic doc that PAs (students) know what they are doing and can take care of a lot.

I have eaten lunch in the doc's lounge once and was sorta surprised that all the docs talk about is golf. OK I wasn't surprised at all and actually find quite humorous.

Internal Medicine rotation...

2009-10-01T19:36:00.000-07:00

So my first week of of my first IM rotation is almost in the books. On Monday my boy took a header at pre-school and knocked in 3 top-front teeth. Later that day we began a 13 hour journey at Children's Hospital because he wouldn't stop throwing up. SO I get home from my first day of IM to greet my beat-up little boy barfing frequently and uncontrollably. Was it from a head injury? Was it the copius volume of blood he had ingested that day? Was it a bug. Well, it took 12 hrs waiting in the room, a couple doses of Zofran, many tests, 15+ episodes of emesis, 5 nurses, 2 ER docs, an hour and a half wait in the waiting room to be triaged and 500mL of IV fluids to feel pretty safe it was just shitty luck and coincidence -and oh yeah, some bug. Today he got the teeth pulled, and I was there by his side for every nasty moment. That kid is tough and resilient. He's back to eating Mac and Cheese despite the severe lac on his gum that the DDS couldn't repair. In fact he is bed now, tlaking and playing, back to his normal self. And I couldn't be happier. IM rotation is going fine. Mostly diabetes and chronic pain. I can write for schedule IIs in my sleep after one week there. The doc is nice and takes time to teach me. He slammed today in front of a patient for recommending Augmentin. He justs hates it and spent 10 minutes expaining to the patient why my suggestion was so bad. Funny, the Peds docs Love it.

One down

2009-09-24T20:26:00.000-07:00

Can I just say I had a blast on my peds rotation. It was a lot of fun, way too short and now it's over. Internal Medicine is next - I have a 10 minute drive ahead of me and some pretty reasonable hours. This stuff is fun. If only I could remember all the stuff I learned last year. I am afraid that I have see something 3 times for it to stick. At least once I actually do something (hands on) I usually don't have a problem doing again. Usually. I have the weekend off for the most part and look forward to starting my next clinical on Monday.

I am tired

2009-09-10T20:48:00.000-07:00

getting up at 5:30 and getting home at 6 with 2 hrs of driving is making me a tad bit tired. I am still having fun on my peds rotation. My docs tell me I am doing fine, especially for my first rotation. My diagnostic skills seem pretty good. I wish I knew more about drugs. I mean I feel like my pharm classes were very good but they covered the basic pharmacology of the various drug classes ad not all the specific brands and dosing considerations. All in time i am sure.

More on my first rotation

2009-09-06T21:00:00.000-07:00

For my peds rotation I rotate through 3 different docs. It is good because I get to see different techniques and approaches and philosophies. So halfway through my third day the doc says "how about we start throwing in on cases/" to I say "sounds good." I saw a hand full that day and at the end of the day the doc was running late for a conference call with two patients left. He actually considered letting me handle them all on my own but thought better of it - as students we are not supposed to do the work of anyone or be used to extend productivity. I was flattered that thought enough of me to take that on but I know I don't know enough to do that just yet. Right now I commute one hour each way and wake up at 5:30 ang get home by 6:30 most days. Friday stunk because I got out at 4:30 and because of traffic didn't get home until two hours later. I have a free apartment provided to me which I may use once in a while. The wife is going out of town wednesday through friday so I will have get the boy to school extra early and pick him up extra late. The doc on Friday complemented me that I work really well with the kids and they respond well to me too. I thought that was cool. It seems that kids and dogs like me the most - perhaps they can tell just how much I have in common with them?

Pediatrics Rotation - my first rotation ever!

2009-09-03T19:43:00.000-07:00

Today is the fourth day on my first rotation. I've been seeing patients by myself for the last two days. Naturally the docs will go in a follow-up after I give them my report. The place is really relaxed and collegial and they really want me to learn. Everyone is super nice and friendly - at least it seems that way to me. I am having fun seeing patients and learning the practical application of the past year of book knowledge. It is fun!

My back is slowly getting better an I am encouraged that stretching improves or alleviates my pain for a while. The more I stretch the better I feel, but I get tight very quickly. Many people have asked why I haven't gotten an MRI yet. My reasoning is as follows: The MRI will find something. That something may or may not be the cause of my pain. Other than PT, which I am doing on my own as much my schedule allows, I am not willing to consider any other treatment options (surgery) that might apply to the dubious finding on an MRI that is guaranteed to show something wrong with a 39 year old former football/hockey/martial arts participant who has had other minor infrequent back problems.

Back from vacation

2009-08-20T20:53:00.000-07:00

We went up to the cabin my wife's grandmother has in MN. Right on a good size yet very quite lake. TV reception stinks and no cable worth a crap. It was really nice. My boy did some swimming in the lake and he drove the pontoon boat we rented for 2 days. I went fishing, played hell with my new rod, caught 2 tiny fish and gave 'em back. Ate at Zorbaz pizza the last night there. Slept with my boy on the air mattress - he peed the bed each night and took a bath in the lake each day.The drive was a real and literal pain in the ass. It sure didn't help my back much either. Mostly the pain is confined to my right ass and leg, consisting mostly of muscle spasms that clamp down on my sciatic nerve creating a searing pain that forces me to limp around like an old coger. It is getting better, at least that is what I am telling myself.

My first rotation starts the 31st. Ill be doing pediatrics in a town 60 miles away. The housing scheme is run by another school and they have not gotten back to me yet so it looks like I may be commuting each day for at least a while. My neighbor who is a nurse got me a women's helth rotation with an OB/GYN she works with so I hope that pans out. Otherwise I'll have to go to a much 'less desirable' city to do my WH rotation. White coat ceremony is tomorrow - gotta go iron my coat........

Year One is over!

2009-08-07T09:42:00.000-07:00

Yesterday was our last final. It was tough just beacuse it tended to cover all things we didn't go over in class and we had a lot of interruptions by the instructor. That said I think I did well enough to keep my B in the class - had no way of getting an A however. In total this semester I got 4 A's and 4 B's. My goal this semester was to keep stress to minimum and to help make my wife happier when I could. This meant less studying. Overall I am satisfied with my performance.

I feel like I should be really excited and celebrating like crazy that this hellish year is over. Really I am just plain tired and my back is not helping anything right now. My PA wants me to get an MRI but I don't want to because I am not willing to do anything about what they might find (e.g. surgery) and I haven't had any time to go either. I have been stretching, one of my classmates gave me acupuncture treatment and another has been doing some deep tissue and muscle energy work on it. It really is nice to have classmates with such varied and valuable experience. I'll miss not hanging out with them, I really will.

Pediatrics is my first rotation and it starts 8/31. Peds was not one of our stronger classes so I have some level of anxiety about it. I like kids and they like me for some reason so I am just going to approach it all with that kind of attitude and work my butt off to learn as much as I can. We go up to the cabin tomorrow and I look forward to some peace and quite on the lake.

Thanks to all who left comments/questions. I appreciate the support a great deal.

My back is a pain in the ass and vice versa

2009-08-01T20:04:00.000-07:00

So Thursday my back just went crazy on me for no good reason. I didn't play hockey (I am done for a while so I can heal). All I did was play ping-pong with a classmate on Wednesday. I missed class Thurs. and went to see my PA - she was really off her game by-the-way, and an MD who does acupuncture. I took 40-some needles, she did some cupping on my back that left pepperoni-like bruises and she also did moxabustion - burning some balled-up herb on my back. Went to massage today, but still walk with a limp. My ass has taken to a rivalry with my back to see who can cause me the most grief. 1g of naproxen, 3 flexaril and 100mg of tramadol per day and I still hurt. My PA wants an MRI but I am going to have to hold off until after finals and vacation to the cabin. The real pain is 6 cumulative finals in 4 days!

Just a nice day

2009-07-24T19:29:00.000-07:00

I sat through 3 hour of pharm and then we had a cook-out on the patio outside our classroom. It was a beautiful, sunny day and we had music and hamburgers and hot dogs (no beer though) and it was just really nice. 8 more school days left.

Pharm test went well

2009-07-21T20:55:00.000-07:00

I was the first to finish - 20 minutes for 50 questions and I got a 92%. Yeah I was surprised too. This wasn't an easy test and some people barely passed. I just knew the answers to almost everything right away. That was a nice feeling for sure. I got up at 5 this morning and was at school by 6 so I could go over things one more time after studying for a few hours last night. I used the same study method for clinical medicine and got the class high score of 94% on that test. My grades are such now that I'd really have to hose things up to lose a B in any of my classes and A's are in reach for all of my classes except Pharm. I had a grin on my face all day today that several people comented on - I just felt great knowing that in less than 3 weeks this didactis year and its hassels will be history. You know when I first started school I wasn't sure if I could do it and now I am all but done with what is in my mind the hardest part of it. Still nervous but looking forward to starting clinicals in September.

3 weeks left

2009-07-17T18:43:00.000-07:00

I can't believe that the didactic year has almost reached its conclusion. I'm not sure I am ready for clinicals but I'd much rather take a different sort of beating now.

We had a clinical medicine test last week that covered hematology, some oncology and ENT. The test was only 33 questions, like always. Somehow I managed to only miss two questions, which was a nice surprise. Usually if I feel good about a test I don't do as well as when I am nervous and study till 11 and get up at 5 to study more and feel like I don't know a thing going into the test. I have cemented Bs in most of my classes which is kind of nice. There's less pressure to sweat an A or freak out over getting a C or worse. I have to study Pharm till the cows come home because it is so much of what a PA does and there are plenty of chance to harm the patient if you don't know what you are doing.

My son's bedroom is 8 feet from my "office" and he is battling my wife over going to bed. He didn't take a nap or eat anything for dinner so he is an emotional rollercoaster now. No studying till he is sound asleep - I am guessing another hour from now. I probably have to go in and take care of some emergency he'll fabricate to keep from going to sleep. He is so much work but I wouldn't want it any other way. He offered to get his buddies together and catch the guy who stole my chaco flip flops at the gym. How can someone who pays big money to go to a really nice gym steal someone's shoes there? It pisses me off that someone has stolen from me again and that they took my really nice, every day attire chaco flip flops. We're talking $50 (I didn't pay that much) here damn it! Sometimes I really hate people.

I Tweaked my back months ago playing hockey and it just won't get better. It really hates it when I have sit for hours on end, daya after day in a chair that amanesty international wouldn't let a political prisoner use for one day. At least in three weeks that damn chair won't be able to torment me any longer. I am popping cyclobenzaprine and ibuprofen like they were tic tacs and to no avail. I can handle injuries to most parts of my body fine. But when the back is dinged it really screws up EVERYTHING. I like playing hockey so there is little chance of getting better untill the season is over. Besides I probably won't have time to play once clinicals start and I am driving/living all over the state. Gotta get my Herriet Lane handbook for my first rotation - Pediatrics. Should be interesting. I hope my preceptors like to teach and provide guidance. Time for more muscle relaxers and a heating pad. And back to studying pharm.

5 weeks left

2009-07-02T21:31:00.000-07:00

5 weeks remain in the semester and it feels like it can't come soon enough. The didactic year has been demanding in ways I never imagined. I've written about the toll it has had on my family life and to some extent it has had on my psyche. I've wondered out loud to my classmates if we'll look back on this time with any nostalgia or fondness. None of them seem to think we will. I don't know, but I think it is possible. One of our intructors likend it to childbirth and the amnesia that goes along with it, ensuring that women don't quit having kids after the first one. I will miss my time spent with classmates and the camaraderie we have built through our shared struggles. Most have not experienced the the problems I have, yet I dont see my classmates who would easily or freely admit to struggling in anything.

Some of my single classmates have made this time little more than an extension of their undergraduate studies and therefore have little problem going out several times a week and partying on the weekend. It seems to work fine for them, and at times I am envious at their lack of apparent effort or stress; I couldn't do what they do and get away with it. I do wish that my wife were interested/involved in my studies. She hasn't helped me study for a single test and seems at times confused and dismayed as to why I would want to spend my professional life peering into strangers orifices, not to mention the requisite physical contact of exams.

But it is what it is and I am almost done. I have worked my tail off and have gotten good grades and evaluations. I made some good friends and tested myself under some difficult scenarios. It hasn't been perfect and I have made some mistakes. At times it was all I could do to keep from defenestrating myself, other times I had a ball doing and learning and trying. 5 more weeks of class. It feels like I just started yesterday. It feels like it's been forever.

IV practice (and some other stuff)

2009-06-27T20:59:00.000-07:00

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

2009-06-16T20:26:00.000-07:00

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

2009-06-15T21:00:00.000-07:00

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

2009-06-11T21:48:00.000-07:00

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

2009-06-09T20:18:00.000-07:00

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

2009-06-03T20:41:00.000-07:00

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.

Great vacation. Too short, too expensive. But fun!

2009-05-28T16:13:00.000-07:00

Got back from Sedona yesterday. My wife made arrangements at what turned out to be a really nice place. I'll post some photos soon. On Memorial day I spent the day with Vince Vaughn. What I mean is that he sat at the table next to us for breakfast and lunch and we even spent some time together in the steam room. Like 2 minutes. Anyway, I am not one to follow celebrities and such but I do like Mr. Vaughn's work and feel I can relate to the characters he plays. Very unpretentious. My wife and I went on a long hike, ate some great, expensive food, drank $15 margaritas with prickly pear in them and layed by the pool and got massages. Oh, and I spent a lot of time in the steam room trying to heal my back that I injured playing hockey last week. I have been injured severely on more than one occasion playing hockey, but I keep coming back for more...hit in the throat with a stick, two concussions, re-dislocated shoulder, separated ribs, and numerous contusions. It goes to show you that one doesn't really have to be too bright to get into PA school.

Sedona, here I come

2009-05-23T18:36:00.000-07:00

Going to Sedona tomorrow for a few days of R & R with the misses. ACLS & PALS went fine. I noticed that I heard the preceptors describing a patient a certain way but my thought process would hang on something else unrelated. Sitting back as a "team member" in megacodes I could easily and correctly think through the algorythm , but as a team leader I would have dumb little brain farts. It was interesting to watch my classmates respond to the stress too. I am an observer - by that I mean that take pride in and enjoy observing people and their behaivor and quirks and what not. Observing my classmates in these scenarios was interesting and seem to corelate with previous observations. It was fun to see some of them try to figure out what sort of antibiotic they were going to give to some baby in septic shock during the megacodes.

ACLS and PALS this week.

2009-05-18T21:28:00.000-07:00

So we have ACLS today and tomorrow and PALS Wednesday and Thursday. Today went by quick and tomorrow we practice and test for ACLS. It sure has changed a bit since I last took it in the late 90s. It seems to be going well and I am told it was simplified a great deal since I took it. I had no problems then so I don't anticipate any this time around. It is nice to be learning and practicing some "real" medicine finally.

ACLS & PALS this week

2009-05-18T21:23:00.000-07:00

Whew!

2009-05-12T16:08:00.000-07:00

The second semester is in the books and I couldn't be happier. Looks like I got mostly Bs with a few As. all things considered, it couldn't have turned out better.

My wife did a really nice thing for me this past weekend. She used some of her Marriott points and got me a suite so I could study without any distractions. I think it helped and I really do appreciate her giving me all that time to myself. Thanks a lot.

My classmates are out now celebrating and drinking. I am at home having ice cream with my son and celebrating the fact we both had a good day. Yep, a good day.

4 more tests to go

2009-05-08T20:26:00.000-07:00

Unfortunately 2 of them are going to be brutal (Pharmacology and pediatrics) and all four come before wednesday. At least when Wednesday rolls around I'll be done for a few days before ACLS and PALS start. Then a week off before summer semester begins.

I am lucky to have the classmates I have

2009-05-02T11:06:00.000-07:00

My program is one that requires a significant amount of direct, hands-on patient care. As a result my classmates are older and well, more experienced. I have people in my class to go to with questions about sports medicine and orthopedics, EMS and emergency med, phlebotomy, cardiac care, PT and OT, alternative medicine, mental health, women's health, radiology, cytology and hospice. Since everyone has been around the block a few times there are no head games or overt competition. No holding out on your classmates if you know something they don't. Everyone really does help everyone else out. There a certain cliques as is expected in any situation like this this, but I don't feel overly excluded by any group. Much like in high school, I belong to no one group but hang out with all them.

5 tests this week and 4 next week. I just have to remember how much I really wanted to be in this position this time last year and how fortunate I felt to be accepted. This semester really is as tough as our instructors told us it would be. Fortunately everyone in my class feels about the same way I do and are just trying to push through and learn something along the way.

I also have all but one of my clinical rotations set up for next year and wee are planning a celebration for our white coat ceremony. I can almost see the light at the end of the tunnel!

Food and Medicine

2009-04-16T19:01:00.000-07:00

I have noticed the disturbing trend in medicine of name pathological processes and nasty stuff after food. Just a few examples: Strawberry tongue - Kawasaki's; Chocolate cyst - endometreosis; rice water stool - Cholera. There are a bunch more but that being said, which ones have you heard and do you find these comparisons a little unnerving?

6 more weeks in the semester

2009-04-08T19:53:00.000-07:00

I am continually amazed at how difficult school is and the fact that I continue to progress. I envy my classmates who are single and can study when they please for as long as they please where they please. I envy the fact that they have fewer responsibilities than I do. For some of them school is easier and some are having fun to boot. I've written about how my wife and son have responded to me going to PA school. I wish that I could enjoy the process for what it is. I wish that I didn't feel like complaining as much as I do. I am so glad that I am in PA school and am learning all that I am. I feel that there is so much i don't know, that I don't know enough, that I'll never know enough. I really look forward to the clinical year and applying what I've learned and learning so much more. I look forward to not feeling guilty for sleeping in or playing with my son instead of studying. I look forward to being normal again. I look forward to being a PA.

I failed my first exam

2009-03-31T14:42:00.000-07:00

Luckily I am still passing, but geez does that sting! Got the lowest grade in the class which is a first for me in my PA studies. I will take this as a sign that I need to get my ass in gear and study better and more often.

I got the new iPod touch and is it sweet. I discovered skyscape I am amazed at all they give you for free.

5 tests this week

2009-03-24T19:24:00.000-07:00

3 tests are in the books, one huge test tomorrow and another on Friday. I should be studying now but I need a break. I am REALLY looking forward to spring break.

Just to clarify my previous post: I was miffed that an instructor of mine tested us on a poor quality photo that we had never seen before and were asked, as we have been many times before, what is the medical problem that this person has. So, in any given lecture we will be given 100-200 PowerPoint slides with 1/3 of them containing photos of various disease processes. Then for the test, a new, poor quality photo is cast upon the whiteboard, all washed out and glaring. There would be no way to study for such things and unless you have an exceptionally good eye and ESP, it is difficult to figure out what is going on with this "patient."

I am also really grateful for some awesome instructors who really know their stuff, want to teach and care about us as people and students. They put forth the same kind of effort that demanded from us students daily and I appreciate that. I have taught before and know how difficult a job it is. I don't think I'll ever do it again because I feel to be a good teacher you need to know your shit forward and back, put a fair amount of time into your presentation and have an engaging delivery of the material. I am lucky to get 2 of those criteria on any day and I don't think it's fair to short change students with anything less.

There are tough teachers and then there are unreasonable teachers

2009-03-18T06:00:00.000-07:00

Guess which type we dealt with yesterday? One of our core classes is taught by a rather hyper, unorganized and socially awkward person. She uses 10-12 different fonts in her hand-outs, tests us on poor quality photos of vague skin conditions and material and procedures that are the personal preference of various guest lecturers. e.g. "According the Dr. x, from his lecture in early February, the examination of y should be in the following order." It doesn't matter if our instructor never covered the right way to do it or that several multiple choice options are right. So I am pretty sure I failed the first test of my PA student "career." The only reasonable thing about our instructor is that he allows us to throw out one test. I didn't think I'd have to use this option, but I have changed my mind now. If only I didn't spend 2 hours late last night laying in bed thinking about it. Moving on....

I survived

2009-03-16T18:31:00.000-07:00

My 'standardized patient' experience was better than I thought it would be. It was still a little odd but overall a good thing to get done. At least now I know for sure how perform these exams along with all nuances and such. The teaching associates were very patient and spent a great deal of time teaching us the ins and outs (no pun intended, I think) of these very invasive and uncomfortable exams. They didn't seem to be terribly odd people and one of them mentioned they get paid "very, very well" so that clears it up a bit. Still, I'd think there would be many other jobs I'd rather have.

I've got two exams tomorrow and four next week; then spring break. Will the fun never end?

Thanks

2009-03-11T20:28:00.000-07:00

Thanks for the words of support. I plan on continuing the blog, if only because it is a good means of letting off some steam. And boy, do I have some steam built up lately.

On a lighter note, I face my first encounter with standardized patients next week. This includes the full female breast/pelvic exam and male rectal/GU exam. These standardized patients are people who receive special trainnig regarding the speificds of the exam and they then teach the students and guide them through the exam. I often put myself in other's shoes in order to gain a portion of their perspective, but I can't fathom why any "normal" or "average" person would want to do this? I understand they contribute a great deal to medical education and are an invaluable resource, but from a person-to-person interaction standpoint this seems extremely strange to me. I've heard that prostitutes are commonly used - they would seem to be the best fit for something like this - but I also know that there are just as many people, if not a lot more that are not prostitutes or the like. I'd like to know what motivates these people and what they really think about they are doing. Ideas?

Pile it on

2009-03-10T19:09:00.000-07:00

My dad, who has a 70 pack year history just had to undergo emergent CABG. They bypassed 3 coronary arteries that were 90% occluded. He has come out of it as well as expected, but he is still really gorked. It's tough seeing your hard-ass, drill Sargent, bar brawling dad near comatose and helpless as a baby. It is tough having so much extra crap to think about.

Pratice on my classmates?!

2009-03-03T17:43:00.000-08:00

So for our history and physical class we have to practice almost all physical exam techniques on each other. That of course means that one must also be the patient. It is a little weird for me to see my classmates at various, albeit not necessarily inappropriate, levels of undress and to palpate their abdomens and percuss their backs etc. We have standardized patients for the DRE and pelvic exams, but we are expected to practice frequently on each other for all the other examinations. Not something you think of - I am not even sure it is common across programs - but as much as I'd prefer not to be shirtless for an hour in front of my classmates, I understand its necessity.

It's a distinguished look

2009-02-27T18:52:00.000-08:00

I keep getting asked by the student employees of my wonderful learning institution if I work there or what class I teach. More on these and other school employees later. It must be the few gray hairs on my head that have them confused. I'll take the employee discount at the coffee shop though.

Not what I needed at this point

2009-02-21T20:52:00.000-08:00

There are still tears in my eyes as I type this, but since I don't have any real close friends this is my only outlet. So, my wife and I have an argument tonight and she informs me, after vigorous and heated pleading from me to get her to talk, that she hasn't been happy with since we got married (seven effing years!). She's been mad at me on a near daily basis for a lot for the generic husband things and because I haven't been too romantic really since school started, even further back. I left water in the bath tub a couple days ago and she was furious that our 3 year old son would drown because of my negligence and stupidity. I accidentally shut the door too loudly and she chewed me out for being insensitive to our son's sleep needs. A previous post of mine re: "listening" was about her. She actually read it and commented on it I think. Anyway she says she's sick of looking at me and feels like she does everything while I do nothing. This is true since my studies take up almost all of my time so I can't argue with that. It's funny (not in a ha ha kind of way) that she was the one who encouraged me to go after this dream of mine - now it's ending in a nightmare.

Our relationship hasn't been the best for a while now. She hates her job and wants a new life. She wishes that I wanted to go running and skiing every day and go on last minute trips every month and we could be this mythical uber-couple that she imagines infest a nearby, ultra-yuppie, outdoorsy, fit and wealthy community. She hates our house and wants to move; hates the city we live in; wants to live in the mountains or the beach where everyone is what we are not. Now she wants a different family. The grass is always greener ain't it Sugar? Now it's all pretty much over - at least from the look in her eyes. She'd deny it but she had a slight smirk on her face as I asked her, tears streaming down my face, if this was how it would end. She is notorious for the faces she makes - they show how she really feels. Her face was otherwise emotionless, except for a hint of irritation at having to discuss this with me. I thought we could push through these two years and then the stress would be so much less we and my son would be in school so things would be easier on us all. Not so much.

Considering how little I can count on my family for anything, loosing the only person I ever really loved hurts. It hurts knowing the pain my son will have to go through - it really rips my heart apart. He is innocent and will truly come out the loser in all of this. That really kills me. But I can't be with someone who is so consistently and utterly sick of me. To her it doesn't matter that I am a good dad - well I can't even say at this point that she thinks I good at anything honestly. My only sense is that she would rather simply have me out of her life. So as soon as I can swing it we will get this THING ironed out and done.

Financially, I have nothing and am really living off of my wife and loans. Unfortunately those loans will have to get a lot bigger soon sine I have more than a year of school left. I wish rents were cheaper around here. I wish I had some money saved. I wish I new someone I could move in with. Her parents sure will be happy. My son sure will be sad.

I imagine I'll be ending this blog anyway since no one really sees it. It's kind of like writing in a diary actually except I don't feel as wussy as I would writing in a diary. Back to studying!

Don't get me wrong

2009-02-11T20:28:00.000-08:00

I am fortunate and 'happy' to be in PA school. Any PA school for that matter. I am making it and soon enough I'll be in clinical rotations. This schoool thing will be a distant memory before I know it. I wouldn't rather be anywhere else.

Still, isn't it human nature to see things that can be better and want them to change for the better? Am I being a jerk to complain about this kind of stuff (oh, and there is lots more!) given the fact I have been given an opportunity that many people would give there left gonad for? I guess the way I see it, as students we are held to very high standard - much different from regular undergrad students, we pay no small sum of money in tuition, fees, books, books, books, etc and we are stongly discouraged from working. We are told we must sacrifice and give to succeed. Why can't the people who demand so much from us step up to the plate and bring some sacrifice and professionalism to the game too? I understanding paying your dues and all that crap, but passing the pain down the chain, just because you can or because that's the way you came up will simply never cut it with me.

So, my regular readers out there: what do you think? Where do you stand? where are you in the this crazy process? Am I full of it?

There is always one a semester

2009-02-09T19:04:00.000-08:00

Crappy instructors that is. In a core class, not that any are unimportant, but a major clinical discipline. This instructor talks 120 mile an hour. She crams, by her own admission, 5 hours of material into 2.5 hrs. She refuses to take questions during her "lecture." She glances over material or doesn't even cover material that she feels is important - important enough to test us on. She refuses to clarify her unclear and poorly worded test questions. The entire class is disappointed in how the class is shaking out so early in the term. I am usually the person who will talk to the instructor and let them know how things are going or aren't going - but I've been the sqeaky wheel for too long. Unfortunately no on else will suck it up and talk to to an instructor if things aren't going well. This is going to be the class we all complain about during lunch but that no one does anything to change.

2nd semester classes are under way

2009-01-24T20:02:00.000-08:00

Our instructors told us that this semester would be the most difficult of all. They told us this was typical of most PA programs though I am not sure what their reasoning is. Perhaps their experience with other programs allows them this foresight. Needless to say, I am beginning to think they are telling the truth. Pharmacology will certainly not be a breeze. Our instructor told us that we will get about 30 hours more of pharm than the med students she teaches. I don't know how I feel about that other than to say I better know my shit when this is over. I am not terribly psyched about our Pathology instructor. He seems a little ill prepared - so we'll have to take up the slack as students. OB/Gyn will certainly be interesting - my only practical experience with the subject is recreational and the birth of my son.. Peds should be fun. I have some expereince working with them, I like them and they like me. I think they can sense my inner goofball so they tend to gravitate toward me. During the summer the neighborhood kids come by the garage to see what I am working on or fixing, or just to tlak to me. The kids at my son's school always come up to me and ask me to play or show me what they are doing. This is interesting to me because adults tell me I am imtimidating or aloof at times. Perhaps I let my guard down around kids. The other classes will be challenging as well since we will be expected to integrate all we have learned and are learning - to start thinking clinically and to see the whole patient rather than simply the problem they present to us.

Spring semester awaits!

2009-01-12T19:00:00.000-08:00

Classes start in one week and I am ready to get crackin'. This semester I have pathology, pharmacology, OB/GYN, Peds, History and Physical, Psych, and Clinical Medicne. This round of classes promises to be very intense but at least they are more applicable to being a PA than last semester's classes. I also look forward to starting my clinical experience this term as well.
My break didn't go as I would have liked, but it was good to be able to spend so much time with my Boy.

Why is LISTENING so difficult?

2009-01-03T09:58:00.000-08:00

Being human necessitates communication with others (absent disorder or pathology). What I continue to struggle with is others' lack of understanding that true communication is something that involves give and take, multi-directional exchange of thoughts, feelings and ideas, and a tacit understanding that the other party will evaluate your input by putting forward some effort of thought. In my daily life I, like most of you, attempt to have meaningful conversations with those around me. I take the time to listen to what the other person is saying (most all of the time) and attempt to to put togehter a thoughtful response given their input. I expext the same from others who are "listening" during a conversation with me. I expect them to remeber what I just told them, or if the other party is particularly close to me I expect they will have a memory and understanding of most of our prior conversations. I cannot describe the intense feelings I experience when I speak to someone, be it family, classmate or friend, who cannot or will not make the effort to mentally process a conversation we have shared and make meaningful efforts to have a quality interaction. My point is that so many people do not listen -they hear so that they can respond. They do not process but rather prepare to expell. So many of us are not in the least bit interested in what the other person has to say, let alone give it any real thought. No, we are simply interested in our own interests. This could be extended to people who may actually listen but choose to ignore out of hand the information presented to them. I could go on and on but you get the idea. Stay tuned for my next bitch session when I complain about people who choose not to think.

A typical school day

2008-12-13T20:14:00.000-08:00

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

2008-12-11T19:19:00.000-08:00

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?

2008-12-05T18:21:00.000-08:00

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.

2008-12-02T19:28:00.000-08:00

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

2008-12-01T20:47:00.000-08:00

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

2008-11-29T20:09:00.000-08:00

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

2008-11-28T13:35:00.000-08:00

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.

2008-11-06T19:45:00.000-08:00

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

2008-09-29T19:01:00.000-07:00

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.

2008-09-20T20:23:00.000-07:00

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.

2008-08-26T19:13:00.000-07:00

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.

2008-07-29T12:52:00.000-07:00

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?

2008-06-30T13:03:00.000-07:00

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

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

2008-06-18T12:21:00.000-07:00

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!

2008-06-18T08:39:00.000-07:00

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.