It's officially official! I've been waiting for my license to be confirmed through the New York State Medical Board. Today I FINALLY received confirmation! They say it takes between 4-6 weeks from the day your test results are released. It took me 4 weeks and 2 days.
I've done a lot of soul searching over the last 4 weeks and have been "cleaning house" in preparation for the next adventure. Although I have a per diem job lined up at a local hospital in Internal Medicine, I've been networking throughout the NY metro area.
Over the last few years I've really learned the importance of trusting my gut. I've developed somewhat of a sixth sense over this past year of clinical rotations. It is that "sixth sense" that I'm relying on now to help me choose the next best path to venture down. I've put myself in a position for change and the universe has been responding.
It is exhiliarating yet frightening.
It is...LIFE.
Life outside of the classroom, life outside of the short white coat, life outside of the "I'm just a student" safety net.
LIFE
Time for t-rex to get busy with her life again!
Monday, October 22, 2007
Sunday, September 23, 2007
Maimonides Award
One award was given out during the graduation ceremony.
The Maimonides Award.
It is not an award based on academic performance.
300 students graduated from various fields (Physician Assistant, Physical Therapist, Oriental Medicine, Occupational Therapist, Nursing, Public Health) and one student from each full-time program received the award.
The Maimonides Award is for the..."graduating student whose endeavors have demonstrated the highest of professional ideals..."
To my utmost surprise, I was selected from the Physician Assistant program as the Maimonides Award recipient.
++++++++++++++++++++++++++++++++++++++++++++++++
The Code of Maimonides:
"May the love for my art actuate me at all times; may neither avarice, nor miserliness, nor the thirst for glory or a great reputation engage my mind; for the enemies of Truth and Philanthropy could easily deceive me and make me forgetful of my lofty aim in doing good for my brothers and sisters.
May I never forget that the patient is a fellow creature in pain. May I never consider the patient merely a vessel of disease.
When wiser people teach me, let me be humble to learn; for the mind of man is limited, and the art of healing is vast. May I have the strength, time and opportunity always to verify and correct what I have learned and to increase my understanding. May I always be able to discover today the errors of yesterday, and to obtain a new light tomorrow on what I think I am sure of today.
I have been sanctioned to care for the life and health of mankind. I am about to fulfill my duties; I am ready for my vocation."
++++++++++++++++++++++++++++++++++++++++++++++++
I am still speechless.
The Maimonides Award.
It is not an award based on academic performance.
300 students graduated from various fields (Physician Assistant, Physical Therapist, Oriental Medicine, Occupational Therapist, Nursing, Public Health) and one student from each full-time program received the award.
The Maimonides Award is for the..."graduating student whose endeavors have demonstrated the highest of professional ideals..."
To my utmost surprise, I was selected from the Physician Assistant program as the Maimonides Award recipient.
++++++++++++++++++++++++++++++++++++++++++++++++
The Code of Maimonides:
"May the love for my art actuate me at all times; may neither avarice, nor miserliness, nor the thirst for glory or a great reputation engage my mind; for the enemies of Truth and Philanthropy could easily deceive me and make me forgetful of my lofty aim in doing good for my brothers and sisters.
May I never forget that the patient is a fellow creature in pain. May I never consider the patient merely a vessel of disease.
When wiser people teach me, let me be humble to learn; for the mind of man is limited, and the art of healing is vast. May I have the strength, time and opportunity always to verify and correct what I have learned and to increase my understanding. May I always be able to discover today the errors of yesterday, and to obtain a new light tomorrow on what I think I am sure of today.
I have been sanctioned to care for the life and health of mankind. I am about to fulfill my duties; I am ready for my vocation."
++++++++++++++++++++++++++++++++++++++++++++++++
I am still speechless.
Physician Assistant-CERTIFIED (PA-C)
So much has happened since the last time I've written!
1) I took the NCCPA Board Exam on Friday, 9/14.
2) My family threw me a SURPRISE party on Saturday, 9/15.
3) I graduated and received a special award on Tuesday, 9/18.
4) I turned 31 years old and found out I PASSED THE BOARDS on Thurs, 9/20!
I've been trying to recover from all of the excitement and surprises ever since. I am officially "partied out!" I found myself retreating to my desk and books this weekend, for no other reason but for the comfort they have provided me for the last two years!
I sent out two resumes last week and received phone calls for interviews immediately. I set up one interview for this week, but today I realized that I'm not ready yet. Last week was such a crazy whirlwind that this week I know I NEED to relax. Actually, I NEED to re-learn how to chill out and relax because I'm still in somewhat of an amped up "I have to study" mode. So many wonderful things happened last week and I want to give myself a few days for it all to sink in. There are so many friends and family members I haven't seen in so long...I need to plug in and reconnect before I throw myself back into the "real world".
I also have a lot of people that I need to thank. First and foremost is my family. My mother, father, and both of my sisters believed in me from the very beginning...and were ALWAYS there for me when I needed them. Whether it be a hug, a home cooked meal, a patient to practice on, or simply someone to listen to me VENT...my family was always there. I wasn't always the easiest person to get along with during the most stressful test taking times...but they put up with me, learned how to ignore me, and put me in my place when I really needed to lighten up. There were days when I couldn't stand being around me! So, I'm grateful that my family stuck by me, believed in me and supported me through the very end!
I would NOT be where I am right now without them.
I would not be a PA-C!
1) I took the NCCPA Board Exam on Friday, 9/14.
2) My family threw me a SURPRISE party on Saturday, 9/15.
3) I graduated and received a special award on Tuesday, 9/18.
4) I turned 31 years old and found out I PASSED THE BOARDS on Thurs, 9/20!
I've been trying to recover from all of the excitement and surprises ever since. I am officially "partied out!" I found myself retreating to my desk and books this weekend, for no other reason but for the comfort they have provided me for the last two years!
I sent out two resumes last week and received phone calls for interviews immediately. I set up one interview for this week, but today I realized that I'm not ready yet. Last week was such a crazy whirlwind that this week I know I NEED to relax. Actually, I NEED to re-learn how to chill out and relax because I'm still in somewhat of an amped up "I have to study" mode. So many wonderful things happened last week and I want to give myself a few days for it all to sink in. There are so many friends and family members I haven't seen in so long...I need to plug in and reconnect before I throw myself back into the "real world".
I also have a lot of people that I need to thank. First and foremost is my family. My mother, father, and both of my sisters believed in me from the very beginning...and were ALWAYS there for me when I needed them. Whether it be a hug, a home cooked meal, a patient to practice on, or simply someone to listen to me VENT...my family was always there. I wasn't always the easiest person to get along with during the most stressful test taking times...but they put up with me, learned how to ignore me, and put me in my place when I really needed to lighten up. There were days when I couldn't stand being around me! So, I'm grateful that my family stuck by me, believed in me and supported me through the very end!
I would NOT be where I am right now without them.
I would not be a PA-C!
Wednesday, September 12, 2007
360
There are 360 questions on the PANCE exam. (PA National Certification Exam)
There are 6 sixty minute blocks of sixty questions.
I am allotted a 45 minute break that can be broken up any way I choose. Breaks can only be taken after completion of a 60 minute block.
The exam is computerized.
So...that's 6 hours of questions on a computer! That's a long time. The longest exam I've ever taken in PA school was 3 hours...and that was a paper test. So, this will be a brand new experience.
How does one prepare for an exam that encompasses everything they've learned in the last 2 years??? study study study study study study study study
I basically gave myself 2 weeks to prepare. I probably studied anywhere from 2-4 hours the first week and from 8-12 hours this past week! I've done over 1,000 practice questions and read two review books. My school provided us with the e-PACKRAT exam (assessment exam) and I purchased another online assessment exam from the NCCPA (they make the PANCE). The review books: AAPA purple book, Van Rhee's green book and Appleton & Lang yellow book.
Yes, everyone refers to these books simply by their colors!
Do I feel like I'm ready for this exam?
"NO WAY!"
But, I'm ready to get it over with. If I fail, I can retake the exam in 3 months. Although I am not one to fail...the option is there and that makes me feel better. I've got nothing to lose at this point (except my sanity if I had to keep this up any longer!).
Tomorrow is the day before the exam. I'm going to review Cardiology one last time and review exam questions I already completed to make sure I understand why the answer is right and why the wrong answers are wrong.
The thing with this exam....there are TWO RIGHT ANSWERS! My job is to pick the better of the two right answers. (Doesn't make much sense does it?) And no, there is no partial credit for getting the answer half-right.
Like I've said, there aren't many absolutes in medicine and the way medicine is practiced IS NOT always the way it's written in the book. So, it took a while to get my brain back into book medicine. I have to say that its been comforting going back to the books and re-learning the basics. I've been having a lot of "A-ha" moments. I actually have flashbacks from my rotations and something a doc or PA said will suddenly come to mind and it will finally make sense! It's a liberating feeling.
So, tomorrow will be about managing anxiety. I will probably work out like a mad woman in hopes that I crash into bed at a reasonable hour.
The exam starts at 8:30am.
360 questions in 6 hours.
360
There are 6 sixty minute blocks of sixty questions.
I am allotted a 45 minute break that can be broken up any way I choose. Breaks can only be taken after completion of a 60 minute block.
The exam is computerized.
So...that's 6 hours of questions on a computer! That's a long time. The longest exam I've ever taken in PA school was 3 hours...and that was a paper test. So, this will be a brand new experience.
How does one prepare for an exam that encompasses everything they've learned in the last 2 years??? study study study study study study study study
I basically gave myself 2 weeks to prepare. I probably studied anywhere from 2-4 hours the first week and from 8-12 hours this past week! I've done over 1,000 practice questions and read two review books. My school provided us with the e-PACKRAT exam (assessment exam) and I purchased another online assessment exam from the NCCPA (they make the PANCE). The review books: AAPA purple book, Van Rhee's green book and Appleton & Lang yellow book.
Yes, everyone refers to these books simply by their colors!
Do I feel like I'm ready for this exam?
"NO WAY!"
But, I'm ready to get it over with. If I fail, I can retake the exam in 3 months. Although I am not one to fail...the option is there and that makes me feel better. I've got nothing to lose at this point (except my sanity if I had to keep this up any longer!).
Tomorrow is the day before the exam. I'm going to review Cardiology one last time and review exam questions I already completed to make sure I understand why the answer is right and why the wrong answers are wrong.
The thing with this exam....there are TWO RIGHT ANSWERS! My job is to pick the better of the two right answers. (Doesn't make much sense does it?) And no, there is no partial credit for getting the answer half-right.
Like I've said, there aren't many absolutes in medicine and the way medicine is practiced IS NOT always the way it's written in the book. So, it took a while to get my brain back into book medicine. I have to say that its been comforting going back to the books and re-learning the basics. I've been having a lot of "A-ha" moments. I actually have flashbacks from my rotations and something a doc or PA said will suddenly come to mind and it will finally make sense! It's a liberating feeling.
So, tomorrow will be about managing anxiety. I will probably work out like a mad woman in hopes that I crash into bed at a reasonable hour.
The exam starts at 8:30am.
360 questions in 6 hours.
360
Tuesday, September 11, 2007
Friday, September 07, 2007
It's been over 2 months since my last post. I believe that's the longest I've gone without posting in the last 2 years! I think that's a sure sign that I am soooo OVER being a student! I'm ready to move on...and indeed, I am.
My last rotation proved to be the most challenging. I chose Infectious Disease as my elective, mostly because of my experience working with a non-profit AIDS organization prior to PA school. The hospital that I was assigned to advertised having an HIV/AIDS clinic, Lyme disease clinic, and a Chronic Fatigue Syndrome clinic. I was also assured by my school that this rotation was going to be a good rotation.
Well, it wasn't what I was hoping for. The "clinic" wasn't much of a clinic. The clinic treated 3-4 patients A DAY! And all of the patients were examined by the Fellow and then afterwards the ID Attending. Mind you...I had just finished my second primary care rotation where I was personally examining 40+ patients a day!
Just to clarify, here's the hierarchy in the wacky world of hospital medicine:
Attendings (Top dogs)
Fellows
Residents
Interns
Students (runts of the litter!)
The hierarchy can be broken down even further to Chief, Asst Chief, Senior Fellow, Head Resident, (insert any other ego boosting adjective here)
The Chief Infectious Disease Attending that I worked with is a world-renowned ID specialist. He is, without a doubt, the most educated man I've ever met.
My mom was right: "Some people are too smart for their own good!"
Everyday for 4 weeks I would participate in rounds that would last anywhere between 3-5 hours. If you've watched the TV show SCRUBS you have an idea of what I'm talking about. I would walk around the hospital with one attending, one fellow, and two residents. That's FOUR doctors and one PA student (no med students at that point).
We had a list of patients that needed an ID consultation. The residents and Fellow would examine those patients in the morning and in the afternoon the Attending would meet with everyone and travel throughout the hospital, going room to room, to re-examine and then co-sign every note that the Fellow and Resident wrote.
This took forever.
I was ready to lose my mind by the end of the first day. I wanted to see patients but I could tell that that my "posse" was hesitant. Turns out the ID department doesn't normally have PA students rotating through their department. The last time a PA student rotated through the department was THREE YEARS AGO and none of the current Fellows or Residents had ever worked with a PA (let alone a student) in an Infectious Disease specialty setting.
LUCKY ME!
Well, I managed to convince the Fellow to give me a patient the next day. I basically had to interview, examine, review the patient's chart, document new labs and an assessment and plan. Then during rounds, I had to present the patient to the group, highlighting the pertinent positives and negatives and answer questions about my patient's history.
Basically, all of the fears I had before starting rotations manifested during my LAST rotation! I was constantly being put on the spot and constantly felt like I didn't belong. And things only got WORSE!
During my last two weeks, 4 brand new medical students arrived as well as 2 new residents, one new Fellow and the World Renowned ID Chief Attending replaced the previous attending! Yup...my little crew of 4 suddenly expanded to 8...plus one PA student (me)!
The last two weeks of my last rotation were the toughest. The Chief Attending constantly pimped all of us throughout rounds. Rounds were now at least 5 hours long. He would pack us all into the elevator (even if we were only going up one floor) and drill us with questions. He was relentless.
My confidence was pretty high going in to the rotation. I had received positive evaluations from every preceptor I worked with throughout the year and received several "Call me when you graduate" job offers...all very encouraging signs.
And then I showed up to this rotation. It was manageable when I was the only student the first four weeks with the original attending. But, when the 4 med students showed up, the new Chief Attending did his best to tear each one of us down. He hammered all of us with questions and my questions weren't any different than the questions he asked the med students. He expected me to know what the med students knew. He laughed at me the same way he laughed at the med students when they didn't know an answer.
It was beyond humbling. It was downright discouraging. I dreaded each day but showed up anyway. I was constantly talking to myself...constantly encouraging myself...constantly telling myself, "you're not as stupid as you feel!"
Luckily, I befriended the med students. They all came from the same medical school which made it even harder for me to break through to them, but I did. And I soon began to realize that they felt the same EXACT way that I felt. They felt just as stupid as I did when I said, "I don't know." In fact, I began to realize that the med students didn't always have an answer for the questions that I didn't know. In fact, I knew some things that some of them didn't know. And everyone felt like a complete idiot when they were put on the spot.
The Chief Attending gave each one of us a new topic to look up every night and report on the next day before rounds. Each day rounds started at a different time and the Chief picked that time! He would ALWAYS show up 30-60 minutes AFTER the time he chose. So, the group of us would sit and wait for him in the hospital cafe. Once he arrived, he sat down with us, drank a cup of coffee and ate a chocolate chip cookie while drilling us with questions about our topics.
The funny thing is that the Chief collaborated on many of the textbooks he wanted us to utilize as well as wrote scores of articles on the topics he assigned us. Basically, he knew everything about everything already. The first few days of this was very frustrating...but after a few days the med students and I would often crack up laughing when he was out of sight. After a while, I didn't care about what other people thought if I didn't know the answer.
My last rotation proved to be the most challenging. I chose Infectious Disease as my elective, mostly because of my experience working with a non-profit AIDS organization prior to PA school. The hospital that I was assigned to advertised having an HIV/AIDS clinic, Lyme disease clinic, and a Chronic Fatigue Syndrome clinic. I was also assured by my school that this rotation was going to be a good rotation.
Well, it wasn't what I was hoping for. The "clinic" wasn't much of a clinic. The clinic treated 3-4 patients A DAY! And all of the patients were examined by the Fellow and then afterwards the ID Attending. Mind you...I had just finished my second primary care rotation where I was personally examining 40+ patients a day!
Just to clarify, here's the hierarchy in the wacky world of hospital medicine:
Attendings (Top dogs)
Fellows
Residents
Interns
Students (runts of the litter!)
The hierarchy can be broken down even further to Chief, Asst Chief, Senior Fellow, Head Resident, (insert any other ego boosting adjective here)
The Chief Infectious Disease Attending that I worked with is a world-renowned ID specialist. He is, without a doubt, the most educated man I've ever met.
My mom was right: "Some people are too smart for their own good!"
Everyday for 4 weeks I would participate in rounds that would last anywhere between 3-5 hours. If you've watched the TV show SCRUBS you have an idea of what I'm talking about. I would walk around the hospital with one attending, one fellow, and two residents. That's FOUR doctors and one PA student (no med students at that point).
We had a list of patients that needed an ID consultation. The residents and Fellow would examine those patients in the morning and in the afternoon the Attending would meet with everyone and travel throughout the hospital, going room to room, to re-examine and then co-sign every note that the Fellow and Resident wrote.
This took forever.
I was ready to lose my mind by the end of the first day. I wanted to see patients but I could tell that that my "posse" was hesitant. Turns out the ID department doesn't normally have PA students rotating through their department. The last time a PA student rotated through the department was THREE YEARS AGO and none of the current Fellows or Residents had ever worked with a PA (let alone a student) in an Infectious Disease specialty setting.
LUCKY ME!
Well, I managed to convince the Fellow to give me a patient the next day. I basically had to interview, examine, review the patient's chart, document new labs and an assessment and plan. Then during rounds, I had to present the patient to the group, highlighting the pertinent positives and negatives and answer questions about my patient's history.
Basically, all of the fears I had before starting rotations manifested during my LAST rotation! I was constantly being put on the spot and constantly felt like I didn't belong. And things only got WORSE!
During my last two weeks, 4 brand new medical students arrived as well as 2 new residents, one new Fellow and the World Renowned ID Chief Attending replaced the previous attending! Yup...my little crew of 4 suddenly expanded to 8...plus one PA student (me)!
The last two weeks of my last rotation were the toughest. The Chief Attending constantly pimped all of us throughout rounds. Rounds were now at least 5 hours long. He would pack us all into the elevator (even if we were only going up one floor) and drill us with questions. He was relentless.
My confidence was pretty high going in to the rotation. I had received positive evaluations from every preceptor I worked with throughout the year and received several "Call me when you graduate" job offers...all very encouraging signs.
And then I showed up to this rotation. It was manageable when I was the only student the first four weeks with the original attending. But, when the 4 med students showed up, the new Chief Attending did his best to tear each one of us down. He hammered all of us with questions and my questions weren't any different than the questions he asked the med students. He expected me to know what the med students knew. He laughed at me the same way he laughed at the med students when they didn't know an answer.
It was beyond humbling. It was downright discouraging. I dreaded each day but showed up anyway. I was constantly talking to myself...constantly encouraging myself...constantly telling myself, "you're not as stupid as you feel!"
Luckily, I befriended the med students. They all came from the same medical school which made it even harder for me to break through to them, but I did. And I soon began to realize that they felt the same EXACT way that I felt. They felt just as stupid as I did when I said, "I don't know." In fact, I began to realize that the med students didn't always have an answer for the questions that I didn't know. In fact, I knew some things that some of them didn't know. And everyone felt like a complete idiot when they were put on the spot.
The Chief Attending gave each one of us a new topic to look up every night and report on the next day before rounds. Each day rounds started at a different time and the Chief picked that time! He would ALWAYS show up 30-60 minutes AFTER the time he chose. So, the group of us would sit and wait for him in the hospital cafe. Once he arrived, he sat down with us, drank a cup of coffee and ate a chocolate chip cookie while drilling us with questions about our topics.
The funny thing is that the Chief collaborated on many of the textbooks he wanted us to utilize as well as wrote scores of articles on the topics he assigned us. Basically, he knew everything about everything already. The first few days of this was very frustrating...but after a few days the med students and I would often crack up laughing when he was out of sight. After a while, I didn't care about what other people thought if I didn't know the answer.
There were other students from my school doing rotations at that hospital. Turns out that the hospital is in the process of expanding their PA department. They currently have 4 PAs on each floor and now they are going to have 5 PAs on each floor. A fellow student of mine told me to submit my resume.
I didn't have a resume yet.
So, I put together a resume (took a long time) and submitted it. I got a phone call the next day. I interviewed the day after that. I was told I had a position DURING the interview! It's a per diem gig on the Internal Medicine/Telemetry floor. Basically, I will be taking care of sick patients with cardiac problems.
So, the suffering was worth it. I really like the hospital. It is the friendliest hospital I've rotated through all year. When the house staff is nice to you as a student, you know it will only get better!
I accepted the position right away since it is a per diem gig. The Chief PA told me I could basically work as much or as little as I wanted. Most of the shifts will be OVERNIGHT. If you've been reading along...you know how much I do NOT like overnight shifts. But, its the fastest way of becoming a full time employee and I think getting paid will make it a bit more manageable.
The most encouraging aspect is that there ARE jobs out there. I haven't sent out any other resumes. I didn't want the distraction while I prepare for the boards. After I take the boards on Friday...it'll be job hunting time.
Wow.
Oh yeah, that world-renowned Chief ID specialist? He pulled me aside on my last day and told me to keep in touch and that if I ever needed a recommendation to let him know.
Then he handed me a chocolate chip cookie and thanked me for my hard work.
Thursday, July 05, 2007
September 14th
I just registered for the PANCE!!!
That's the Physician Assistant National Certification Exam.
The cost: $425.00
The date: September 14, 2007
I chose September 14th for a couple of reasons. My birthday is Sept 20th and I want to be done with this experience before I turn 31! Graduation is Sept 18th and I want to enjoy that day. Finally, #4 is my favorite number...so I picked the 14th (the 4th is just way too soon!)!!!
It all seems surreal at this moment. I kind of wish I could just take the damn exam tomorrow and finally move on with my life. But...I'm not allowed to do that!
The last few months have been very trying. I've worked more hours than I've ever worked before...and the fact that I'm working for free is a true testament for my love of medicine. I do enjoy myself, but at this point...I'm ready to GET PAID!
I'm also ready for a much needed VACATION!!
6 more weeks, my friends.
6 more weeks!
That's the Physician Assistant National Certification Exam.
The cost: $425.00
The date: September 14, 2007
I chose September 14th for a couple of reasons. My birthday is Sept 20th and I want to be done with this experience before I turn 31! Graduation is Sept 18th and I want to enjoy that day. Finally, #4 is my favorite number...so I picked the 14th (the 4th is just way too soon!)!!!
It all seems surreal at this moment. I kind of wish I could just take the damn exam tomorrow and finally move on with my life. But...I'm not allowed to do that!
The last few months have been very trying. I've worked more hours than I've ever worked before...and the fact that I'm working for free is a true testament for my love of medicine. I do enjoy myself, but at this point...I'm ready to GET PAID!
I'm also ready for a much needed VACATION!!
6 more weeks, my friends.
6 more weeks!
Sunday, July 01, 2007
7 Weeks
I have two more days left of this rotation...rotation #8. I am off 4th of July and take exams Thursday and Friday. I start my FINAL rotation next Monday. It is my "selective elective" rotation.
I chose Infectious Disease.
I've been at a Primary Care office for the last 5 weeks. This was my second experience in primary care and the office is only 15 minutes away from home. I am very comfortable in the primary care setting. My last primary care rotation was back in October...I've learned SOOO MUCH since then. I like primary care because I like getting to know my patients and getting to focus on preventative medicine.
I'm enjoying this rotation mostly because I trust the Doctor that I'm working with. I like the way he practices medicine. I'd like him to be my doctor and I'd trust my family members in his care. THAT IS WHEN YOU KNOW YOU'VE FOUND A GOOD DOC!
Unfortunately, he is not hiring at the moment. He told me, "I'd hire you in a second, kid."
I've had job "offers" throughout the last year. I've had docs tell me to contact them once I graduate. But, none of the jobs have really interested me.
The #1 question I'm being asked is..."WHAT'S NEXT?"
I am very simple. I want to work in a supportive environment with Docs and PAs that I trust, respect, and admire. The only area of medicine I definitely am NOT interested in is OB/GYN. I've done enough pap smears to last me a lifetime. God bless those that are chosen for that field. That is not my calling!
Many people question my interest in Infectious Disease. I have realized that I have a hankering for oddball facts and for the unknown. I have an easier time wrapping my brain around things that don't really make sense than for things that make complete, absolute sense. For example, the heart doesn't change. The anatomy (for the most part) does not change. So much research has been done on the heart, there are so many absolutes about the heart. Yet, everytime I get pimped on cardiology I second guess my answers. But ask me questions about bacteria or viruses and I'm on it. I'm interested.
This does not necessarily mean I want to be an ID specialist. I'm just fascinated by the field and every ID doc I've met has been brilliant. I like hanging around people smarter than me. I like being around people that challenge me.
My last rotation brings me back into the hospital environment. I enjoy the hospital environment more than the office environment. If I work in an office straight out of school, it's going to have to be a GREAT environment. I get claustrophobic pretty easily. I am a girl that likes her space and I enjoy the chaotic environment of a hospital. I like the diversity and the opportunity to meet new people on a daily basis.
But working in a hospital is a lot more stressful for the same reasons!
7 more weeks. 6 more school exams. 1 board exam review course.
Then I take the boards...rather, then I PASS THE BOARDS!
And life begins anew...once again!
I chose Infectious Disease.
I've been at a Primary Care office for the last 5 weeks. This was my second experience in primary care and the office is only 15 minutes away from home. I am very comfortable in the primary care setting. My last primary care rotation was back in October...I've learned SOOO MUCH since then. I like primary care because I like getting to know my patients and getting to focus on preventative medicine.
I'm enjoying this rotation mostly because I trust the Doctor that I'm working with. I like the way he practices medicine. I'd like him to be my doctor and I'd trust my family members in his care. THAT IS WHEN YOU KNOW YOU'VE FOUND A GOOD DOC!
Unfortunately, he is not hiring at the moment. He told me, "I'd hire you in a second, kid."
I've had job "offers" throughout the last year. I've had docs tell me to contact them once I graduate. But, none of the jobs have really interested me.
The #1 question I'm being asked is..."WHAT'S NEXT?"
I am very simple. I want to work in a supportive environment with Docs and PAs that I trust, respect, and admire. The only area of medicine I definitely am NOT interested in is OB/GYN. I've done enough pap smears to last me a lifetime. God bless those that are chosen for that field. That is not my calling!
Many people question my interest in Infectious Disease. I have realized that I have a hankering for oddball facts and for the unknown. I have an easier time wrapping my brain around things that don't really make sense than for things that make complete, absolute sense. For example, the heart doesn't change. The anatomy (for the most part) does not change. So much research has been done on the heart, there are so many absolutes about the heart. Yet, everytime I get pimped on cardiology I second guess my answers. But ask me questions about bacteria or viruses and I'm on it. I'm interested.
This does not necessarily mean I want to be an ID specialist. I'm just fascinated by the field and every ID doc I've met has been brilliant. I like hanging around people smarter than me. I like being around people that challenge me.
My last rotation brings me back into the hospital environment. I enjoy the hospital environment more than the office environment. If I work in an office straight out of school, it's going to have to be a GREAT environment. I get claustrophobic pretty easily. I am a girl that likes her space and I enjoy the chaotic environment of a hospital. I like the diversity and the opportunity to meet new people on a daily basis.
But working in a hospital is a lot more stressful for the same reasons!
7 more weeks. 6 more school exams. 1 board exam review course.
Then I take the boards...rather, then I PASS THE BOARDS!
And life begins anew...once again!
Friday, June 01, 2007
10 Weeks?!?!
The finish line "should" be in sight. I know I compared this entire PA student experience to running a marathon at one point last year. Well, there are only 10 weeks left before I finish rotations and for some reason, I just cannot perceive crossing that finish line. Once I cross that finish line, I'm back in the "real world" again. I'll have my life back. I'll be able to live and work when and where I want to. That has been the goal, but now that it's upon me...it is quite overwhelming!
Which brings me back to running the 2001 NYC Marathon.
I started the marathon running with a friend. I had trained with this friend for several months before the marathon. We ran the same pace and expected to finish the marathon together. Well, somewhere around mile 18 I realized that this friend was holding me back. I found myself running backwards for half a mile trying to encourage my friend to pick up the pace.
Running backwards during the NYC Marathon? Who does that?
Well, it was comfortable running with a friend. It felt safe to run next to someone else. I had never gone that distance before and didn't think I could do it alone.
Once I realized the insanity involved in what I was doing, I took off. For the next mile, I fretted as to whether or not I would be able to go the distance by myself, on my own. By mile 20, I started to envision the finish line. I started to envision myself crossing the finish line with my fists pumping in the air, exhaulting with joy. And that's exactly how it happened.
For some reason, that memory keeps popping into my head lately. Since rotations began in September, I've been able to live SOMEWHAT of a more "normal" life. I've been more social than I've been since I started this process THREE YEARS ago.
Since September I've met so many incredible people. My life changes quite drastically every 5 weeks. Every 5 weeks I essentially change jobs. They say that changing jobs is one of the most stressful things that we humans do. I can definitely attest to that now!
Every 5 weeks I've had to morph into whatever situation I was thrown into. Every hospital and doctor's office has it's own set of rules and "culture". I found myself in situations that were laughable and other situations that were downright frightening. I've experienced really good medicine and extremely poor medicine. I've worked with inspiring mentors as well as un-inspiring mentors.
The hospital where I did my surgery rotation was the absolute worst hospital I've ever been in. This hospital should be closed. It took a couple of weeks for me to become comfortable enough in my surroundings to even enter the operating room. I didn't trust some of the doctors/surgeons there. I never understood how hospitals could be considered bad...until I went to that hospital. Of course, that was the hospital where I worked the longest hours. The record was 82 hours in one week. That consisted of two 26 hour shifts of being on call...which equated into me only sleeping 3-4 hours in a dirty, dusty room on a lumpy, uncomfortable mattress.
I was amazed at how poorly human beings were treating other human beings. On those days, I'd often wonder about the treatment that animals get in a zoo. And how quickly one becomes desensitized to environments that we naturally should NOT become desensitized to. It was the most difficult 5 weeks of this entire experience.
I will quote the words of a Hematology specialist who was called in as a consultant to help a patient who was experiencing massive episodic bouts of necrosis. It started on his toes...so his toes were chopped off. Then it spread up his leg...so his leg was chopped off. Then it appeared on his fingers...so his fingers were taken off. Then it appeared on his penis. This man was in the hospital for one month before his penis was affected. And, for some unknown reason, a hematology consult was not called until it got to that point.
I was present for the Hematology consult. The doctor walked into the room and threw the chart against the wall. He yelled, "This f**ing hospital is worse than a third world country!"
That man's penis was scheduled for amputation the day after I left.
Needless to say, it was not easy. I did meet some inspiring and talented doctors there. They were there trying to help...trying to turn around the hospital. And that gave me the boost I needed to show up every morning at 6am.
Getting back to the point....I've met a lot of people since September. Some of them have added to my life and others have taken away. I'm at the point now that it's time for me to break away from the pack. I need to start envisioning the finish line. I need to take all of the good that I've experienced over the last 10 months and leave the bad behind. I need to embrace those that have continously supported me through the highs and lows.
But mostly, I need to find the confidence to break free and run towards the finish line. I have to look back and remind myself of how far I've come. The girl that quit her job and moved back home with her parents to take chemistry classes over the summer...not knowing if she had what it took to get through chemistry. And three quick years later...that same girl is on the brink of achieving her dream. Her dream of practicing medicine.
I'm at the 18th mile. Crossing this finish line scares the hell out of me. I've only got 4 exams left to pass before I graduate. Then I have to pass the national board exam. Then I will be a licensed Physician Assistant.
Everyone around me has already started asking, "What's next, T-rex?"
At this point, I do not know.
All I know is that I'm going to take a break once I have that diploma in my hand. I'm going to go where I need to go to rest up and rejuvenate. I do not know where that is right now. Whether or not that will be by myself or not. Whether or not that place is local or overseas.
Every marathon runner needs a break before she begins training again.
The next race has yet to be determined...
Which brings me back to running the 2001 NYC Marathon.
I started the marathon running with a friend. I had trained with this friend for several months before the marathon. We ran the same pace and expected to finish the marathon together. Well, somewhere around mile 18 I realized that this friend was holding me back. I found myself running backwards for half a mile trying to encourage my friend to pick up the pace.
Running backwards during the NYC Marathon? Who does that?
Well, it was comfortable running with a friend. It felt safe to run next to someone else. I had never gone that distance before and didn't think I could do it alone.
Once I realized the insanity involved in what I was doing, I took off. For the next mile, I fretted as to whether or not I would be able to go the distance by myself, on my own. By mile 20, I started to envision the finish line. I started to envision myself crossing the finish line with my fists pumping in the air, exhaulting with joy. And that's exactly how it happened.
For some reason, that memory keeps popping into my head lately. Since rotations began in September, I've been able to live SOMEWHAT of a more "normal" life. I've been more social than I've been since I started this process THREE YEARS ago.
Since September I've met so many incredible people. My life changes quite drastically every 5 weeks. Every 5 weeks I essentially change jobs. They say that changing jobs is one of the most stressful things that we humans do. I can definitely attest to that now!
Every 5 weeks I've had to morph into whatever situation I was thrown into. Every hospital and doctor's office has it's own set of rules and "culture". I found myself in situations that were laughable and other situations that were downright frightening. I've experienced really good medicine and extremely poor medicine. I've worked with inspiring mentors as well as un-inspiring mentors.
The hospital where I did my surgery rotation was the absolute worst hospital I've ever been in. This hospital should be closed. It took a couple of weeks for me to become comfortable enough in my surroundings to even enter the operating room. I didn't trust some of the doctors/surgeons there. I never understood how hospitals could be considered bad...until I went to that hospital. Of course, that was the hospital where I worked the longest hours. The record was 82 hours in one week. That consisted of two 26 hour shifts of being on call...which equated into me only sleeping 3-4 hours in a dirty, dusty room on a lumpy, uncomfortable mattress.
I was amazed at how poorly human beings were treating other human beings. On those days, I'd often wonder about the treatment that animals get in a zoo. And how quickly one becomes desensitized to environments that we naturally should NOT become desensitized to. It was the most difficult 5 weeks of this entire experience.
I will quote the words of a Hematology specialist who was called in as a consultant to help a patient who was experiencing massive episodic bouts of necrosis. It started on his toes...so his toes were chopped off. Then it spread up his leg...so his leg was chopped off. Then it appeared on his fingers...so his fingers were taken off. Then it appeared on his penis. This man was in the hospital for one month before his penis was affected. And, for some unknown reason, a hematology consult was not called until it got to that point.
I was present for the Hematology consult. The doctor walked into the room and threw the chart against the wall. He yelled, "This f**ing hospital is worse than a third world country!"
That man's penis was scheduled for amputation the day after I left.
Needless to say, it was not easy. I did meet some inspiring and talented doctors there. They were there trying to help...trying to turn around the hospital. And that gave me the boost I needed to show up every morning at 6am.
Getting back to the point....I've met a lot of people since September. Some of them have added to my life and others have taken away. I'm at the point now that it's time for me to break away from the pack. I need to start envisioning the finish line. I need to take all of the good that I've experienced over the last 10 months and leave the bad behind. I need to embrace those that have continously supported me through the highs and lows.
But mostly, I need to find the confidence to break free and run towards the finish line. I have to look back and remind myself of how far I've come. The girl that quit her job and moved back home with her parents to take chemistry classes over the summer...not knowing if she had what it took to get through chemistry. And three quick years later...that same girl is on the brink of achieving her dream. Her dream of practicing medicine.
I'm at the 18th mile. Crossing this finish line scares the hell out of me. I've only got 4 exams left to pass before I graduate. Then I have to pass the national board exam. Then I will be a licensed Physician Assistant.
Everyone around me has already started asking, "What's next, T-rex?"
At this point, I do not know.
All I know is that I'm going to take a break once I have that diploma in my hand. I'm going to go where I need to go to rest up and rejuvenate. I do not know where that is right now. Whether or not that will be by myself or not. Whether or not that place is local or overseas.
Every marathon runner needs a break before she begins training again.
The next race has yet to be determined...
Saturday, May 05, 2007
Surgery
I think the reason why I haven't written much is because I experience so many different things every single day that I just cannot find the words to articulate these experiences. It's also hard to express the excitement and befuddlement (is that a word?) at the FACT that I will be graduating soon.
Really soon.
I just finished my first week in Surgery at a hospital in Queens. I have to report to "Sign In" at 6:30am every morning. From 6:30- 7:45am 20 surgeons, residents, interns, and med students meet in a conference room to discuss every patient that has been admitted to the surgery department. From 7:45 to 9:00 we do rounds. The entire team (20 of us) walk to every patient's room and check in on them. From 9-noon we work in a clinic...either surgery, orthopedics, or wound clinic. And from noon to whenever...we can go in and assist in surgeries.
In the surgery clinic, my job is to examine a patient that had surgery within that last few weeks. I examine them and then present the patient to the head attending. In the othopedics clinic, I examine the patient and determine whether or not they are a candidate for surgery. Then I present the patient to the attending. In the wound clinic, I remove bandages and inspect patient's wounds. Most are diabetic ulcers and the smell is unbearable. One of the other students started gagging the hallway. Some of the docs put Vics under their noses for certain cases. I've seen some nasty wounds...
I participated in my first surgery on Friday. I was second assist on an inguinal hernia. Turns out the guy had a direct AND indirect hernia. I really had no idea what was expected of me and I left the surgery completely surprised by the amount of responsibility I had during the surgery.
There were three of us working on the patient. The surgeon, the resident, and me....the student. The surgeon made the first cut and pointed out all of the landmarks. He handed one retractor to the resident and the other retractor to me. I stood to the right of the surgeon. The resident was on the other side of the patient. I held the retractor with my left hand and was surprised when the nurse handed me a pair of scissors. I grabbed them and when the surgeon said, "Cut"....I cut! I would cut the internal stitches that the resident made under the instruction of the surgeon.
After the surgeon repaired the hernia, he closed the deepest layers of the wound and left the resident and myself to close the wound. The resident did the second layer and I closed the superficial layer under his close supervision. I'm glad I had my ER rotation otherwise I wouldn't have known what to do. There was a medical student in the room with us and she had never sutured before.
The curious thing about this rotation is that I am treated EXACTLY the same as the medical students. There are 4 medical students and 2 PA students. The interns and residents really don't know the difference. The majority of the interns and residents are from overseas and are male. Out of the 20 surgical staff...only 4 are female (including me!). I am asked the same questions as the med students. I've had doctors, nurses and patients address me as Doctor. I explain I am a PA student. So then I'm called "student doctor".
Once a week I am required to do 24-hour call. I work a normal day: 6:30am to 5pm...and then I stay in the hospital with a pager and wait to get paged until 8am the next morning! So technically that's 25.5 hours...but who's counting? Either way, I still don't get paid!
I can sleep in between pages. I do have a call room. It's a small room with a desk and a bed. I don't think the room has been cleaned since the 70's...but there is a door and I get to close it and have some "alone" time. I slept about 3 hours during my first call. I could have slept more but since I was in a new environment and was paranoid that I'd sleep through the pager beeping...I woke up frequently. It is the student's responsibility to update a list of patients. We have to update their conditions and treatment plans and make sure they haven't changed rooms. So, at 5am, I have to run around to the different floors and check up on the patients and their status. Then I have to type up the new list and make copies for everyone at the 6:30am meeting.
So, these days, I wake up at 5am...leave my house by 5:15am. I arrive at the hospital at 6:15am and change into scrubs before the 6:30am (sign-in) meeting. The sign-out meeting is usually between 3-4pm and can last up to two hours. I'm usually home by 7pm. I try to get to sleep before 10pm.
I have to say that I do like surgery. As demanding as this rotation is....I like the challenge and the responsibility. I also like the team approach and the dynamics involved. I would like it even more if I were actually getting paid to work all of these crazy hours!
Less than 4 months to go...
Holy Crap!
Really soon.
I just finished my first week in Surgery at a hospital in Queens. I have to report to "Sign In" at 6:30am every morning. From 6:30- 7:45am 20 surgeons, residents, interns, and med students meet in a conference room to discuss every patient that has been admitted to the surgery department. From 7:45 to 9:00 we do rounds. The entire team (20 of us) walk to every patient's room and check in on them. From 9-noon we work in a clinic...either surgery, orthopedics, or wound clinic. And from noon to whenever...we can go in and assist in surgeries.
In the surgery clinic, my job is to examine a patient that had surgery within that last few weeks. I examine them and then present the patient to the head attending. In the othopedics clinic, I examine the patient and determine whether or not they are a candidate for surgery. Then I present the patient to the attending. In the wound clinic, I remove bandages and inspect patient's wounds. Most are diabetic ulcers and the smell is unbearable. One of the other students started gagging the hallway. Some of the docs put Vics under their noses for certain cases. I've seen some nasty wounds...
I participated in my first surgery on Friday. I was second assist on an inguinal hernia. Turns out the guy had a direct AND indirect hernia. I really had no idea what was expected of me and I left the surgery completely surprised by the amount of responsibility I had during the surgery.
There were three of us working on the patient. The surgeon, the resident, and me....the student. The surgeon made the first cut and pointed out all of the landmarks. He handed one retractor to the resident and the other retractor to me. I stood to the right of the surgeon. The resident was on the other side of the patient. I held the retractor with my left hand and was surprised when the nurse handed me a pair of scissors. I grabbed them and when the surgeon said, "Cut"....I cut! I would cut the internal stitches that the resident made under the instruction of the surgeon.
After the surgeon repaired the hernia, he closed the deepest layers of the wound and left the resident and myself to close the wound. The resident did the second layer and I closed the superficial layer under his close supervision. I'm glad I had my ER rotation otherwise I wouldn't have known what to do. There was a medical student in the room with us and she had never sutured before.
The curious thing about this rotation is that I am treated EXACTLY the same as the medical students. There are 4 medical students and 2 PA students. The interns and residents really don't know the difference. The majority of the interns and residents are from overseas and are male. Out of the 20 surgical staff...only 4 are female (including me!). I am asked the same questions as the med students. I've had doctors, nurses and patients address me as Doctor. I explain I am a PA student. So then I'm called "student doctor".
Once a week I am required to do 24-hour call. I work a normal day: 6:30am to 5pm...and then I stay in the hospital with a pager and wait to get paged until 8am the next morning! So technically that's 25.5 hours...but who's counting? Either way, I still don't get paid!
I can sleep in between pages. I do have a call room. It's a small room with a desk and a bed. I don't think the room has been cleaned since the 70's...but there is a door and I get to close it and have some "alone" time. I slept about 3 hours during my first call. I could have slept more but since I was in a new environment and was paranoid that I'd sleep through the pager beeping...I woke up frequently. It is the student's responsibility to update a list of patients. We have to update their conditions and treatment plans and make sure they haven't changed rooms. So, at 5am, I have to run around to the different floors and check up on the patients and their status. Then I have to type up the new list and make copies for everyone at the 6:30am meeting.
So, these days, I wake up at 5am...leave my house by 5:15am. I arrive at the hospital at 6:15am and change into scrubs before the 6:30am (sign-in) meeting. The sign-out meeting is usually between 3-4pm and can last up to two hours. I'm usually home by 7pm. I try to get to sleep before 10pm.
I have to say that I do like surgery. As demanding as this rotation is....I like the challenge and the responsibility. I also like the team approach and the dynamics involved. I would like it even more if I were actually getting paid to work all of these crazy hours!
Less than 4 months to go...
Holy Crap!
Sunday, April 29, 2007
Where Have I Been?
I start my surgery rotation tomorrow morning!
I will try to write more...ob/gyn was not my thing. Although I did delivery 2 placentas! I just was not fond of doing pap smears everyday.
More on that later...
6 rotations down...ONLY 3 to go! August 17th is the last day...I can take the Board Exam anytime after August 24th. I have to work on my resume...people have been asking for it.
It's really happening now...still unbelievable!
t*rex
I will try to write more...ob/gyn was not my thing. Although I did delivery 2 placentas! I just was not fond of doing pap smears everyday.
More on that later...
6 rotations down...ONLY 3 to go! August 17th is the last day...I can take the Board Exam anytime after August 24th. I have to work on my resume...people have been asking for it.
It's really happening now...still unbelievable!
t*rex
Sunday, March 18, 2007
OB/GYN
My OB/GYN rotation started last week in a major NYC hospital in Queens.
I travel 4 hours in traffic each day to perform pelvic exams, pap smears, and listen to fetal heart sounds. I couldn't help but smile when I heard my first fetal heartbeat or when I felt the baby's head during a vaginal exam for the first time.
I may have the chance to go into the Labor and Delivery Room this week.
I've never seen a baby born in real life.
I'll have to remember to bring my Kleenex.
I travel 4 hours in traffic each day to perform pelvic exams, pap smears, and listen to fetal heart sounds. I couldn't help but smile when I heard my first fetal heartbeat or when I felt the baby's head during a vaginal exam for the first time.
I may have the chance to go into the Labor and Delivery Room this week.
I've never seen a baby born in real life.
I'll have to remember to bring my Kleenex.
Saturday, March 17, 2007
Bump
I've learned that I do NOT like working overnights in the ER. I did two back-to-back, 8pm-8am shifts and then slept the following 20 hours...STRAIGHT. That lifestyle is not for me. I was scheduled to work 3 more overnights that same week...for a total of 60 hours. I realized after my second overnight shift that working overnights wasn't in my best interest. So, I spoke with my preceptor and asked to change my hours. We settled on 2pm to 2am. This worked out much better because after 2am...NOBODY wants to teach medicine.
The hospital that I did my ER rotation at was messed up. That's the best way I could put it. By the time I made it to the fifth week of any other rotation, I always felt more comfortable than the day that I began. Not at this place. I felt like I was walking on eggshells everyday. I did meet a few good souls. The nursing staff was very supportive and there were a handful of PAs that were helpful, but there was only ONE doc that really took me under his wing. The same doc that had me aspirate the knee and suture the forehead. This doc saw my potential and encouraged me. He told me to "keep in touch" after I graduate.
The greatest lesson I learned in the ER...I've got a VERY STRONG STOMACH!
The hospital that I did my ER rotation at was messed up. That's the best way I could put it. By the time I made it to the fifth week of any other rotation, I always felt more comfortable than the day that I began. Not at this place. I felt like I was walking on eggshells everyday. I did meet a few good souls. The nursing staff was very supportive and there were a handful of PAs that were helpful, but there was only ONE doc that really took me under his wing. The same doc that had me aspirate the knee and suture the forehead. This doc saw my potential and encouraged me. He told me to "keep in touch" after I graduate.
The greatest lesson I learned in the ER...I've got a VERY STRONG STOMACH!
Wednesday, February 21, 2007
Buzz Kill
I reported for duty at 8pm and couldn't find the PA that I was supposed to work with. He is the head PA of the ER and, more importantly, I have a great rapport with him. He told me last week that we would be working together in the Main ER for two nights. It gave me such a sense of relief because this PA teaches me and knows my capabilities. I wouldn't have to try to prove myself.
Wel, he was nowhere to be found tonight. I found his girlfriend (nurse) and she told me he wasn't working until Friday. My mouth dropped open. So, I asked her who was working in his place and she pointed to a woman (approx. 60 y/o) sitting across the desk from us. She was a nurse practitioner.
So, I went over and introduced myself as the PA student that would be working with her tonight. I could tell she was irritated by the simple fact that she had a student...and then doubly irritated when I told her it was my first day in the Main ER. Her lack of enthusiasm for my presence hit a nerve. I wanted to flee.
I stood in the corner for 20 minutes before she fully acknowledged me. Standing in the corner waiting to be acknowledged is a horrible feeling. Then she told me that I could ask the nurses to teach me how to draw blood and put in IV's. So, I told her that wouldn't be necessary since I already knew how to do that. I could see the disappointment in her eyes, I wasn't going to let her pawn me off to the nurses to do scut work all night. I was there to learn medicine...emergency medicine.
So she handed me the chart of her next patient. I took the history and performed the physical. The patient needed an IV and blood cultures. So, I offered to do it. But, the male nurse ignored my offer and went ahead and did the procedure while telling me how much he hated doing bloodwork. So, I told him I would have done it and that I would do the next patient. He ignored me. So, I had to laugh and walk out of the room.
I left the Main ER and went back to fast track. The doc that was a jerk to me on my first day...who became my new best friend last week...was there. He was happy to see me and I told him I was in the Main ER. He laughed and told me that the staff tonight was miserable. I just looked at him and told him that I felt like I was wasting my time. I told him how I was supposed to work with the other PA and he agreed that it would be better if I did work with him. When I told the doc that I was working from 8pm to 8am, he ruffled through some papers in his desk and pulled out the PA's phone number.
He handed me the number and told me to give him a call. I didn't hesitate. I knew I wouldn't make it through til 8am without losing my mind. I knew it would stress me out too much. I didn't feel comfortable in my surroundings and the people I was supposed to work with. I didn't feel safe in my surroundings. I was disoriented and nobody was going to be looking out for me. I was a nuisance. If it had been a day shift, I would have had more energy for the situation. But, it was my very first overnight and I knew it would do more harm than good. And although I'm willing to do what it takes, working an overnight under those circumstances would cause me more harm than good.
And I'm not into harming myself.
I tried to reach the PA a few times and finally reached him at 11pm. I introduced myself as his favorite PA student and he laughed. I explained the situation and how I felt about it and he apologized for mix up. He thought he told me about the schedule change. He told me I could finish out the night and then come in on Friday to work with him. I told him I'd rather leave at that moment and come back to work with him on Friday and Saturday! I was a bit surprised at my gutsy request. But, he took it in stride and gave me permission to leave.
I went back to the Main ER and told the NP that I was leaving. She looked surprised. I explained the scenario and thanked her for her help.
I had some anxiety once I left the hospital. I wasn't sure if my behavior was appropriate or not. I started to doubt my actions. I started to worry about what the NP thought about me. But, I stifled those self-defeating thoughts by reminding myself that I am a teamplayer and have gotten along with every tech, nurse, PA, and doc that I've worked with over the last 6 months!
It's my own responsibility to look out for myself. And for whatever reasons...I wasn't comfortable in that environment and it was my gut feeling that told me to get out.
So, I left. I came home and read my horoscope:
Personalities may clash when no one is willing to take the lead. Be aggressive without being manipulative. Whatever you do, keep it light. Give other people the freedom they want. Unexpected events may change the course of the day dramatically, so don't get upset if things don't go exactly as planned.
I guess the day was supposed to go down like this!
What a buzz kill!
Wel, he was nowhere to be found tonight. I found his girlfriend (nurse) and she told me he wasn't working until Friday. My mouth dropped open. So, I asked her who was working in his place and she pointed to a woman (approx. 60 y/o) sitting across the desk from us. She was a nurse practitioner.
So, I went over and introduced myself as the PA student that would be working with her tonight. I could tell she was irritated by the simple fact that she had a student...and then doubly irritated when I told her it was my first day in the Main ER. Her lack of enthusiasm for my presence hit a nerve. I wanted to flee.
I stood in the corner for 20 minutes before she fully acknowledged me. Standing in the corner waiting to be acknowledged is a horrible feeling. Then she told me that I could ask the nurses to teach me how to draw blood and put in IV's. So, I told her that wouldn't be necessary since I already knew how to do that. I could see the disappointment in her eyes, I wasn't going to let her pawn me off to the nurses to do scut work all night. I was there to learn medicine...emergency medicine.
So she handed me the chart of her next patient. I took the history and performed the physical. The patient needed an IV and blood cultures. So, I offered to do it. But, the male nurse ignored my offer and went ahead and did the procedure while telling me how much he hated doing bloodwork. So, I told him I would have done it and that I would do the next patient. He ignored me. So, I had to laugh and walk out of the room.
I left the Main ER and went back to fast track. The doc that was a jerk to me on my first day...who became my new best friend last week...was there. He was happy to see me and I told him I was in the Main ER. He laughed and told me that the staff tonight was miserable. I just looked at him and told him that I felt like I was wasting my time. I told him how I was supposed to work with the other PA and he agreed that it would be better if I did work with him. When I told the doc that I was working from 8pm to 8am, he ruffled through some papers in his desk and pulled out the PA's phone number.
He handed me the number and told me to give him a call. I didn't hesitate. I knew I wouldn't make it through til 8am without losing my mind. I knew it would stress me out too much. I didn't feel comfortable in my surroundings and the people I was supposed to work with. I didn't feel safe in my surroundings. I was disoriented and nobody was going to be looking out for me. I was a nuisance. If it had been a day shift, I would have had more energy for the situation. But, it was my very first overnight and I knew it would do more harm than good. And although I'm willing to do what it takes, working an overnight under those circumstances would cause me more harm than good.
And I'm not into harming myself.
I tried to reach the PA a few times and finally reached him at 11pm. I introduced myself as his favorite PA student and he laughed. I explained the situation and how I felt about it and he apologized for mix up. He thought he told me about the schedule change. He told me I could finish out the night and then come in on Friday to work with him. I told him I'd rather leave at that moment and come back to work with him on Friday and Saturday! I was a bit surprised at my gutsy request. But, he took it in stride and gave me permission to leave.
I went back to the Main ER and told the NP that I was leaving. She looked surprised. I explained the scenario and thanked her for her help.
I had some anxiety once I left the hospital. I wasn't sure if my behavior was appropriate or not. I started to doubt my actions. I started to worry about what the NP thought about me. But, I stifled those self-defeating thoughts by reminding myself that I am a teamplayer and have gotten along with every tech, nurse, PA, and doc that I've worked with over the last 6 months!
It's my own responsibility to look out for myself. And for whatever reasons...I wasn't comfortable in that environment and it was my gut feeling that told me to get out.
So, I left. I came home and read my horoscope:
Personalities may clash when no one is willing to take the lead. Be aggressive without being manipulative. Whatever you do, keep it light. Give other people the freedom they want. Unexpected events may change the course of the day dramatically, so don't get upset if things don't go exactly as planned.
I guess the day was supposed to go down like this!
What a buzz kill!
Tuesday, February 20, 2007
Here We Go...Again!
I'm working my first overnight shift...EVER. I'm really not sure what to expect, mostly because I'm working in the Main ER and not fast track tonight.
Nothing like starting your first Main ER experience in the middle of the night.
I couldn't make this stuff up...even if I tried.
8pm to 8am...here I come.
I hope my brain doesn't fall asleep!
Nothing like starting your first Main ER experience in the middle of the night.
I couldn't make this stuff up...even if I tried.
8pm to 8am...here I come.
I hope my brain doesn't fall asleep!
Friday, February 16, 2007
52 hours
I've worked 52 hours in the last 4 days! And of those 52 hours, I can honestly say that 51 of them were spent working. Yup, that's 15 minutes a day...just enough time to shovel a sandwich into my mouth and get back on the floor. I worked two 12 hour days and two 14 hour days.
AND I LOVED EVERY MINUTE OF IT!
What a difference one week makes! Last week was really tough. It's not easy being the newbie and some of the characters I worked with last week treated me pretty poorly. But, I grinned and beared it (although I cursed some of them out under my breathe) and I've gained some "street credibility" this week. I learned how the system works, and it's a terribly disorganized system. Now, the docs, PAs, and nurses smile when they see me coming. I've learned what "not" to do and who to ask when I need help!
Today was the most interesting day of the week. There was a wintery mix of ice and snow yesterday. Today the main ER and the fast track exceeded capacity. There were people waiting in the hallways to be seen.
My shift started at noon. I walked in around 11:45 and it was chaotic. I had a lecture to attend at noon and I had to give a presentation at 1pm. I didn't even take off my coat before a nurse came up to me and told me that one of the docs wanted me to meet him in the main ER. I worked with this doc twice last week and he appreciated my "willingness to learn".
So, I rushed over to the main ER and found him. He told me that he needed to aspirate a knee joint due to a gout attack and wanted to teach me how to do it! I took his request in stride, but inside my head there was a little voice screaming, "YES! He likes me...he really, really, likes me!" I told him about the lecture that was starting in ten minutes and he said he had waited an hour for me to get in and didn't want to wait more than another 30 minutes.
So, I ran over to the lecture center and talked to the chief PA...he excused me from the lecture, but reminded me that I had to present a case at 1pm. So, I ran back over to the main ER and learned how to aspirate the joint. We took out 100cc's worth of gooey, sticky, yellow pus from his knee! It was gross...and pretty difficult to get out with the syringe. The doc let me do everything. He just stood behind my shoulder and coached me.
We finished around 12:45pm and as I was getting ready to leave he told me that he had a patient with a laceration that needed suturing. I really wanted to do it, but I reminded him of my presentation. Again, he told me that he'd wait 30 minutes. So, I ran back down to the lecture center and presented my case. Unfortunately, I had to sit around listen to the other students present their cases (5 in total). It took about 45 minutes. The rest of the students were going to the cafeteria, but I ran back to the ER to see if the doc waited.
And the doc did wait for me.
I was psyched. He told what supplies to get and where the patient was located. So, I got all the stuff and went in to meet the patient. Now, I expected that the laceration was going to be on the patient's leg or arm. I expected it to be in a place where the patient wouldn't really be concerned about a scar...they wouldn't be concerned if I accidentally botched it up.
When I walked into the room, I noticed a 55 year old male sleeping on his bed with a laceration to his FOREHEAD! He was hooked up to all kind of monitors (that kept beeping!). I had to laugh. This was insane. I had thrown a couple of sutures a couple of days ago on a finger. The PA started the suturing and he let me throw in a couple next to his.
I set up the materials at his bedside and went back to see the doc. He looked at me and said, "You're done already?" I looked at him like he was nuts! But, he was serious! He told me that I didn't have to wait for him and that's when I told him that I would be more comfortable if he came in and coached me in the beginning. I knew I would be able to get through it alone, but at this stage, I want all the coaching I can get.
So, he watched me prep the patient, set up the sterile field and throw the first suture. He shared some of his suturing "secrets" with me and left me to do the rest on my own. The patient needed 8 stitches and it took me about 45 minutes. It only would have taken the doc 15 minutes (max) to get it all done!
The patient knew I was a student and was fully aware that the doc was coaching me. The patient was really nice and had a great sense of humor about the experience. I was the one that was concerned by the fact that I was stitching his face...but the patient didn't seem to mind. Usually people want plastic surgeons for their faces!
I chatted with the patient during the procedure and built up a good rapport with him. When I finished suturing, I went to get the doc to show him my work. He asked me how it went and I told him, "I did the best I could." He smiled.
As we walked over to the patient I started to wonder if I should be nervous about the doc's assessment of my work. But, I really felt deep down that I did the absolute best job I could. Considering I had no idea what I was doing last week and the fact that I practiced on pig's feet this weekend...and I threw 2 stiches on a finger under intense supervision two days ago.
Did I think I was ready to sew up a face laceration?
Absolutely not! But, I felt comfortable after he coached me through the first suture and that's why I went ahead with it.
The doc got up real close to the wound. As he was inspecting it, the patient remarked, "She did a great job, doc!" All three of us started laughing...of course the patient had no idea what his head looked like. There were no mirrors anywhere near him!
The doc looked at the wound, looked at me, then looked at the wound again. That's when I started to get nervous! But, then he gave me a wink and said, "Good job...dress the wound and meet me at the nurse's station."
I was still a bit nervous about what he really thought. But when I met him at the nurse's station he smiled, thanked me and said, "I knew you were out of your comfort zone, but I also knew you could handle it."
I smiled and let out a big sigh of relief.
I thanked him for the opportunity and headed back to Fast Track.
I still had 10 hours to go.
AND I LOVED EVERY MINUTE OF IT!
What a difference one week makes! Last week was really tough. It's not easy being the newbie and some of the characters I worked with last week treated me pretty poorly. But, I grinned and beared it (although I cursed some of them out under my breathe) and I've gained some "street credibility" this week. I learned how the system works, and it's a terribly disorganized system. Now, the docs, PAs, and nurses smile when they see me coming. I've learned what "not" to do and who to ask when I need help!
Today was the most interesting day of the week. There was a wintery mix of ice and snow yesterday. Today the main ER and the fast track exceeded capacity. There were people waiting in the hallways to be seen.
My shift started at noon. I walked in around 11:45 and it was chaotic. I had a lecture to attend at noon and I had to give a presentation at 1pm. I didn't even take off my coat before a nurse came up to me and told me that one of the docs wanted me to meet him in the main ER. I worked with this doc twice last week and he appreciated my "willingness to learn".
So, I rushed over to the main ER and found him. He told me that he needed to aspirate a knee joint due to a gout attack and wanted to teach me how to do it! I took his request in stride, but inside my head there was a little voice screaming, "YES! He likes me...he really, really, likes me!" I told him about the lecture that was starting in ten minutes and he said he had waited an hour for me to get in and didn't want to wait more than another 30 minutes.
So, I ran over to the lecture center and talked to the chief PA...he excused me from the lecture, but reminded me that I had to present a case at 1pm. So, I ran back over to the main ER and learned how to aspirate the joint. We took out 100cc's worth of gooey, sticky, yellow pus from his knee! It was gross...and pretty difficult to get out with the syringe. The doc let me do everything. He just stood behind my shoulder and coached me.
We finished around 12:45pm and as I was getting ready to leave he told me that he had a patient with a laceration that needed suturing. I really wanted to do it, but I reminded him of my presentation. Again, he told me that he'd wait 30 minutes. So, I ran back down to the lecture center and presented my case. Unfortunately, I had to sit around listen to the other students present their cases (5 in total). It took about 45 minutes. The rest of the students were going to the cafeteria, but I ran back to the ER to see if the doc waited.
And the doc did wait for me.
I was psyched. He told what supplies to get and where the patient was located. So, I got all the stuff and went in to meet the patient. Now, I expected that the laceration was going to be on the patient's leg or arm. I expected it to be in a place where the patient wouldn't really be concerned about a scar...they wouldn't be concerned if I accidentally botched it up.
When I walked into the room, I noticed a 55 year old male sleeping on his bed with a laceration to his FOREHEAD! He was hooked up to all kind of monitors (that kept beeping!). I had to laugh. This was insane. I had thrown a couple of sutures a couple of days ago on a finger. The PA started the suturing and he let me throw in a couple next to his.
I set up the materials at his bedside and went back to see the doc. He looked at me and said, "You're done already?" I looked at him like he was nuts! But, he was serious! He told me that I didn't have to wait for him and that's when I told him that I would be more comfortable if he came in and coached me in the beginning. I knew I would be able to get through it alone, but at this stage, I want all the coaching I can get.
So, he watched me prep the patient, set up the sterile field and throw the first suture. He shared some of his suturing "secrets" with me and left me to do the rest on my own. The patient needed 8 stitches and it took me about 45 minutes. It only would have taken the doc 15 minutes (max) to get it all done!
The patient knew I was a student and was fully aware that the doc was coaching me. The patient was really nice and had a great sense of humor about the experience. I was the one that was concerned by the fact that I was stitching his face...but the patient didn't seem to mind. Usually people want plastic surgeons for their faces!
I chatted with the patient during the procedure and built up a good rapport with him. When I finished suturing, I went to get the doc to show him my work. He asked me how it went and I told him, "I did the best I could." He smiled.
As we walked over to the patient I started to wonder if I should be nervous about the doc's assessment of my work. But, I really felt deep down that I did the absolute best job I could. Considering I had no idea what I was doing last week and the fact that I practiced on pig's feet this weekend...and I threw 2 stiches on a finger under intense supervision two days ago.
Did I think I was ready to sew up a face laceration?
Absolutely not! But, I felt comfortable after he coached me through the first suture and that's why I went ahead with it.
The doc got up real close to the wound. As he was inspecting it, the patient remarked, "She did a great job, doc!" All three of us started laughing...of course the patient had no idea what his head looked like. There were no mirrors anywhere near him!
The doc looked at the wound, looked at me, then looked at the wound again. That's when I started to get nervous! But, then he gave me a wink and said, "Good job...dress the wound and meet me at the nurse's station."
I was still a bit nervous about what he really thought. But when I met him at the nurse's station he smiled, thanked me and said, "I knew you were out of your comfort zone, but I also knew you could handle it."
I smiled and let out a big sigh of relief.
I thanked him for the opportunity and headed back to Fast Track.
I still had 10 hours to go.
Wednesday, February 14, 2007
"I get it, doc!"
I worked with the same Doc and PA as I did on my first day. The same guys that got me so frustrated that I broke out in a blotchy rash over my chest and neck. The same guys that spoke to me like I was intellectually challenged. The same guys that rolled their eyes at me and made faces behind my back.
Yeah, those guys.
One week later and I find myself sitting down and eating dinner with "those" guys. A dinner that the Doc paid for, no less. A dinner that allowed me the opportunity to realize that these guys are human and aren't so bad afterall.
The Doc was the guy that really irritated me last week. And he knew it. He remembered it. And, as I suspected, he seemed to enjoy it.
He reminded me of some of my bloopers on my first day and I started to laugh. I had to remind him that it was my first day...and he genuinely seemed surprise. We both kind of looked at each other like, "Are you kidding me?"
So, he didn't know that my first day meeting him was my actual first day in emergency medicine. He's the Chief Attending at a different hospital and comes in to "moonlight". He then began to reminisce about his days as a resident. Turns out he was cursed at and belittled on a regular basis for 3 years.
I couldn't help but blurt out, "Oh, so that explains the way you treated me last week!"
Luckily, he laughed.
But there was a lesson to be learned. And here it is: "Although it was horrible to be humiliated like that during my residency, I know that there isn't anything that anybody can say to me that will get me upset. Unless someone threatens me with bodily harm, there isn't anything that will make me lose my temper, my focus, or my control. Looking back now, I realize that all of that was part of the training. And that's why I'm an ER doctor. I can handle it."
I made eye contact with him, nodded and said, "I get it, doc."
I get it.
Lesson learned.
Yeah, those guys.
One week later and I find myself sitting down and eating dinner with "those" guys. A dinner that the Doc paid for, no less. A dinner that allowed me the opportunity to realize that these guys are human and aren't so bad afterall.
The Doc was the guy that really irritated me last week. And he knew it. He remembered it. And, as I suspected, he seemed to enjoy it.
He reminded me of some of my bloopers on my first day and I started to laugh. I had to remind him that it was my first day...and he genuinely seemed surprise. We both kind of looked at each other like, "Are you kidding me?"
So, he didn't know that my first day meeting him was my actual first day in emergency medicine. He's the Chief Attending at a different hospital and comes in to "moonlight". He then began to reminisce about his days as a resident. Turns out he was cursed at and belittled on a regular basis for 3 years.
I couldn't help but blurt out, "Oh, so that explains the way you treated me last week!"
Luckily, he laughed.
But there was a lesson to be learned. And here it is: "Although it was horrible to be humiliated like that during my residency, I know that there isn't anything that anybody can say to me that will get me upset. Unless someone threatens me with bodily harm, there isn't anything that will make me lose my temper, my focus, or my control. Looking back now, I realize that all of that was part of the training. And that's why I'm an ER doctor. I can handle it."
I made eye contact with him, nodded and said, "I get it, doc."
I get it.
Lesson learned.
Tuesday, February 13, 2007
Miss Piggy
Today was better...much, much, better.
The 12 hours flew by and I only sat down for "maybe" ten minutes to eat a sandwich. It was busy. There were some interesting cases and I did a lot of procedures.
I'm glad I spent my Saturday night suturing piggy feet because I sutured an arm and a finger today! I did the digital nerve block. Splinted a couple of hands and I also inserted my very first IV...all by myself. Doesn't sound like much...but it's thrilling! I'm a bit more independent today than I was a few days ago and I'm embracing the transformation.
I'm also more comfortable in my surroundings. It's a disorganized and chaotic place and severely understaffed. We worked without a nurse today. But today's staff took it in stride. Nobody stood around pointing fingers, everybody just worked. And the day went by smoothly.
I'm actually looking forward to tomorrow.
Tomorrow I'm working with the same two guys I worked with my first day.
Let the fun begin!
The 12 hours flew by and I only sat down for "maybe" ten minutes to eat a sandwich. It was busy. There were some interesting cases and I did a lot of procedures.
I'm glad I spent my Saturday night suturing piggy feet because I sutured an arm and a finger today! I did the digital nerve block. Splinted a couple of hands and I also inserted my very first IV...all by myself. Doesn't sound like much...but it's thrilling! I'm a bit more independent today than I was a few days ago and I'm embracing the transformation.
I'm also more comfortable in my surroundings. It's a disorganized and chaotic place and severely understaffed. We worked without a nurse today. But today's staff took it in stride. Nobody stood around pointing fingers, everybody just worked. And the day went by smoothly.
I'm actually looking forward to tomorrow.
Tomorrow I'm working with the same two guys I worked with my first day.
Let the fun begin!
Sunday, February 11, 2007
Saturday Night
We spent one day learning how to suture last June. I watched docs and PAs suture last week and I want to get in on the action this week. So, I went to my local grocery store and bought pig's feet.
Yup, pig's feet.
You know your social life has hit an all-time new low when you spend your Saturday night suturing a pig's foot!
But, I feel I'm ready for the next stab wound that comes my way! So, it was worth it!
Yup, pig's feet.
You know your social life has hit an all-time new low when you spend your Saturday night suturing a pig's foot!
But, I feel I'm ready for the next stab wound that comes my way! So, it was worth it!
EMED
Despite my previous entries, I do enjoy Emergency Medicine. I just don't enjoy the hours. It's kind of strange to me. We sit around waiting for something bad to happen to people! Isn't that strange?
I'm working in the Fast Track area for the next 2 weeks and then I go down to the Main ER. I see a lot of things that I saw in primary care. Flu, strep throat, gastroenteritis, pink eye, and there are a ton of motor vehicle accidents (MVA). Again, it's not the main ER so people aren't convulsing on stretchers like on the TV show. It's not that exciting.
There's also a lot of drama at this place. They're understaffed and overworked. Most of the docs, PAs and nurses are cranky. I listen to a lot of whining. That's when I go into the corner and take out a textbook and read. Most of the time I'm tired, so I just look like I'm reading. I like having a schedule. I like having "me" time. I don't have that at this place. There is NO lunch time. Everyone eats their lunch right there in the room.
This is my fifth rotation and I'm ready for more independence. I'm ready for more responsibility. Every five weeks I start over at square one. I've had someone take me under their wing the last 3 rotations. That hasn't happened yet. I'm constantly working with a new doc or PA. I'm constantly in the spotlight. I'm constantly being watched and critiqued. I'm always the new girl. And my colleagues know that in 5 weeks I'm out of there and a new student will replace me.
I imagine its tiring to train students month after month.
Just as it's tiring for a student to train month after month.
6 months, 6 days until the last day of rotations!
I'm working in the Fast Track area for the next 2 weeks and then I go down to the Main ER. I see a lot of things that I saw in primary care. Flu, strep throat, gastroenteritis, pink eye, and there are a ton of motor vehicle accidents (MVA). Again, it's not the main ER so people aren't convulsing on stretchers like on the TV show. It's not that exciting.
There's also a lot of drama at this place. They're understaffed and overworked. Most of the docs, PAs and nurses are cranky. I listen to a lot of whining. That's when I go into the corner and take out a textbook and read. Most of the time I'm tired, so I just look like I'm reading. I like having a schedule. I like having "me" time. I don't have that at this place. There is NO lunch time. Everyone eats their lunch right there in the room.
This is my fifth rotation and I'm ready for more independence. I'm ready for more responsibility. Every five weeks I start over at square one. I've had someone take me under their wing the last 3 rotations. That hasn't happened yet. I'm constantly working with a new doc or PA. I'm constantly in the spotlight. I'm constantly being watched and critiqued. I'm always the new girl. And my colleagues know that in 5 weeks I'm out of there and a new student will replace me.
I imagine its tiring to train students month after month.
Just as it's tiring for a student to train month after month.
6 months, 6 days until the last day of rotations!
Thursday, February 08, 2007
Days 2 &3
My second and third day in the ER were much better than my first. Mostly because I'm working with a different doc and PA. I'm working in the Fast Track area for the first two weeks and then I move on to the Main ER. When I showed up at noon, only the doc was there. I introduced myself and hoped for the best.
He immediately began to pimp me. He threw several different scenarios at me and wanted me to come up with differential diagnoses (ddx) for each scenario. He told me that at my level of education, I should be able to come up with 5 ddx for each scenario. I struggled on the first few and he kept telling me to THINK, THINK, THINK. For some reason, when he said that to me, things started to click.
If anything, I know that I can T-H-I-N-K! In fact, I think too much most of the time. The more he pimped me, the more in tune I became to his thought process. When I didn't know an answer, I told him, "I don't know." The first time I said that I didn't know the answer, he had a look of surprise on his face. I immediately thought to myself that the answer must be easy and that I must be stupid for not knowing it. Why else would the doc have that look of surprise on his face?
Well, he was surprised by my "honesty and ability to admit that I didn't know an answer." I kind of gave him a half-smile, because I honestly don't understand how or why a student would try to outsmart an experienced doc or PA. It just doesn't make sense to me.
Within a few hours, the doc began to ask me questions about my past education and work experience. He seemed impressed by the paths that I chose. When the PA came in a few hours later, the doc said, "we finally have a student that knows how to THINK!"
12 hours later, at midnight, the doc came over and thanked me for my help. He told me that it was "refreshing" working with me and that he looked forward to working with me the next day.
When I walked in at noon today, he greeted me with a big smile and seemed genuinely happy to see me. This doc gave me a chance to prove myself whereas the other doc, from my first day, did not.
I've gained some confidence. I've learned some procedures. And I'm ready to prove to the original doc that T-rex has a brain...and knows how to THINK!
Unfortunately, I'm working with a different doc and PA tomorrow.
It's a never ending cycle...no wonder I'm exhausted!
He immediately began to pimp me. He threw several different scenarios at me and wanted me to come up with differential diagnoses (ddx) for each scenario. He told me that at my level of education, I should be able to come up with 5 ddx for each scenario. I struggled on the first few and he kept telling me to THINK, THINK, THINK. For some reason, when he said that to me, things started to click.
If anything, I know that I can T-H-I-N-K! In fact, I think too much most of the time. The more he pimped me, the more in tune I became to his thought process. When I didn't know an answer, I told him, "I don't know." The first time I said that I didn't know the answer, he had a look of surprise on his face. I immediately thought to myself that the answer must be easy and that I must be stupid for not knowing it. Why else would the doc have that look of surprise on his face?
Well, he was surprised by my "honesty and ability to admit that I didn't know an answer." I kind of gave him a half-smile, because I honestly don't understand how or why a student would try to outsmart an experienced doc or PA. It just doesn't make sense to me.
Within a few hours, the doc began to ask me questions about my past education and work experience. He seemed impressed by the paths that I chose. When the PA came in a few hours later, the doc said, "we finally have a student that knows how to THINK!"
12 hours later, at midnight, the doc came over and thanked me for my help. He told me that it was "refreshing" working with me and that he looked forward to working with me the next day.
When I walked in at noon today, he greeted me with a big smile and seemed genuinely happy to see me. This doc gave me a chance to prove myself whereas the other doc, from my first day, did not.
I've gained some confidence. I've learned some procedures. And I'm ready to prove to the original doc that T-rex has a brain...and knows how to THINK!
Unfortunately, I'm working with a different doc and PA tomorrow.
It's a never ending cycle...no wonder I'm exhausted!
Tuesday, February 06, 2007
ER
My hours?
This week: noon to midnight x 4days.
Next week: 8 PM to 8 AM x 4 days.
My first patient yesterday?
17 year old male with two stab wounds. He went to school and got stabbed in the arm and the leg by a random kid.
I wonder why I don't want to go back today?!?!
Perhaps the nursing home wasn't such a bad gig?
;)
This week: noon to midnight x 4days.
Next week: 8 PM to 8 AM x 4 days.
My first patient yesterday?
17 year old male with two stab wounds. He went to school and got stabbed in the arm and the leg by a random kid.
I wonder why I don't want to go back today?!?!
Perhaps the nursing home wasn't such a bad gig?
;)
Monday, February 05, 2007
EMED
My first day in the emergency room lasted 14 hours.
I didn't like the way I was treated by the PA or the Dr.
Both of whom were MALES and underestimated my abilities.
Both of whom tried their best to make me look like a fool.
I know they smirked when my back was turned.
They got off on the power trip.
Now that I know what to expect, tomorrow will be a better day.
T-rex will show up and I'll be the one smirking.
Bring it on, boys.
Game on.
I didn't like the way I was treated by the PA or the Dr.
Both of whom were MALES and underestimated my abilities.
Both of whom tried their best to make me look like a fool.
I know they smirked when my back was turned.
They got off on the power trip.
Now that I know what to expect, tomorrow will be a better day.
T-rex will show up and I'll be the one smirking.
Bring it on, boys.
Game on.
Friday, January 19, 2007
Boundaries
As I pulled into the parking lot of the nursing home I tried to become optimistic about the day. I told myself that today was going to be a good day and nothing will bother me. That it's all part of the job.
Well, as soon as I got into the lobby, I encountered a family that was crying. I hadn't even had a chance to take my coat off and I was hit in the face with the reality of working in a nursing home. My stomach sank.
And so the day began.
I'm lucky in that the PA that I'm working with is brilliant. He's been working as a PA for 12 years and before that he worked in a nursing home as an aide for 7 years. I'm lucky that he has a very sarcastic, witty sense of humor and a compassionate heart. He's amazing when it comes to dealing with the patients and their families. When a patient tells him that they want to die, he takes it in stride and finds a way to make them realize that it's not their time. The patients love him. The old ladies flirt with him and he loves what he does.
He takes the time to teach me as well. We basically move from floor to floor and round on our patients. We do a mini-physical on each patient and then we go back to the nurse's station to write in their charts, check labs, and write orders. He's spent a lot of time teaching me how to interpret labs. It's an absolute blessing to have him do this with me. I've learned so much from him and he helps me "connect the dots". There is so much to learn, so much to know, and he takes the time to make sure that I know it. He appreciates all of my questions and my suggestions. And he encourages me and reminds me that there is a light at the end of the tunnel. He reminds me that one year from now...I'll be getting a paycheck!
I've learned from this rotation that I need to work on my "boundaries". When I worked for the AIDS organization, I went to a lot of boundary workshops. I learned how to create distance between my work and my own life. Although I dealt with a very serious and horrific virus, I was able to leave it at work at the end of the day.
I'm finding the nursing home to be a completely different challenge. When I leave the facility, I do indeed leave it behind me. I do not think about the patients once I leave. But, the day does take an emotional toll on me. I'm surrounded by a population that is sick and dying and the overwhelming majority of them do not want to be in a nursing home. Some of them are very angry and upset that they are unable to live on their own anymore.
Today I saw an old man cry and it tugged at my heartstrings with such force that I almost had to leave the room. As we were examing him he started to talk about how much he wanted to go home. Then he started to talk about his wife and how he felt he was a burden to her and the family and that is why he was in a nursing home alone. Then his lips began to quiver and tears rolled down his cheek. Once again, my stomach was in knots and I felt tears welling up in my own eyes. The PA looked over at me and I couldn't make eye contact with him. If I did, I probably would have lost it. I just focused on looking at the patient. The PA put his arm around him and hugged him until he stopped crying. It was an amazing gesture on the part of the PA. Nowhere in our education are we taught about how to deal with patients in that capacity. It comes naturally for this PA and that is what makes him so good at what he does.
Seeing the old man cry tainted my day. I had a sinking feeling in my gut for the rest of the day and I realized it's probably because there is nothing more that I can do for these patients. They are dying. They have lived long lives and it's their time to leave this earth. And it will happen to everyone. That is what probably bothers me...everyone will die. I can help ease their physical pain but their suffering is a different story. Some accept their fate, but others are angry, bitter, and defiant of their fate. Some have outlived their entire network of family and friends and others have family, but no visitors.
I'm not saying that nursing homes are a bad place. They are very necessary in today's society and they do provide a social network as well as opportunities for arts, recreation and exercise. It's simply not an environment that I'm comfortable working in...not yet, anyway. For now, I want to work with younger patients and focus more on preventative health. I have more to offer in that capacity. Dealing with end of life issues is not my forte.
I'm sure that will come with time.
Well, as soon as I got into the lobby, I encountered a family that was crying. I hadn't even had a chance to take my coat off and I was hit in the face with the reality of working in a nursing home. My stomach sank.
And so the day began.
I'm lucky in that the PA that I'm working with is brilliant. He's been working as a PA for 12 years and before that he worked in a nursing home as an aide for 7 years. I'm lucky that he has a very sarcastic, witty sense of humor and a compassionate heart. He's amazing when it comes to dealing with the patients and their families. When a patient tells him that they want to die, he takes it in stride and finds a way to make them realize that it's not their time. The patients love him. The old ladies flirt with him and he loves what he does.
He takes the time to teach me as well. We basically move from floor to floor and round on our patients. We do a mini-physical on each patient and then we go back to the nurse's station to write in their charts, check labs, and write orders. He's spent a lot of time teaching me how to interpret labs. It's an absolute blessing to have him do this with me. I've learned so much from him and he helps me "connect the dots". There is so much to learn, so much to know, and he takes the time to make sure that I know it. He appreciates all of my questions and my suggestions. And he encourages me and reminds me that there is a light at the end of the tunnel. He reminds me that one year from now...I'll be getting a paycheck!
I've learned from this rotation that I need to work on my "boundaries". When I worked for the AIDS organization, I went to a lot of boundary workshops. I learned how to create distance between my work and my own life. Although I dealt with a very serious and horrific virus, I was able to leave it at work at the end of the day.
I'm finding the nursing home to be a completely different challenge. When I leave the facility, I do indeed leave it behind me. I do not think about the patients once I leave. But, the day does take an emotional toll on me. I'm surrounded by a population that is sick and dying and the overwhelming majority of them do not want to be in a nursing home. Some of them are very angry and upset that they are unable to live on their own anymore.
Today I saw an old man cry and it tugged at my heartstrings with such force that I almost had to leave the room. As we were examing him he started to talk about how much he wanted to go home. Then he started to talk about his wife and how he felt he was a burden to her and the family and that is why he was in a nursing home alone. Then his lips began to quiver and tears rolled down his cheek. Once again, my stomach was in knots and I felt tears welling up in my own eyes. The PA looked over at me and I couldn't make eye contact with him. If I did, I probably would have lost it. I just focused on looking at the patient. The PA put his arm around him and hugged him until he stopped crying. It was an amazing gesture on the part of the PA. Nowhere in our education are we taught about how to deal with patients in that capacity. It comes naturally for this PA and that is what makes him so good at what he does.
Seeing the old man cry tainted my day. I had a sinking feeling in my gut for the rest of the day and I realized it's probably because there is nothing more that I can do for these patients. They are dying. They have lived long lives and it's their time to leave this earth. And it will happen to everyone. That is what probably bothers me...everyone will die. I can help ease their physical pain but their suffering is a different story. Some accept their fate, but others are angry, bitter, and defiant of their fate. Some have outlived their entire network of family and friends and others have family, but no visitors.
I'm not saying that nursing homes are a bad place. They are very necessary in today's society and they do provide a social network as well as opportunities for arts, recreation and exercise. It's simply not an environment that I'm comfortable working in...not yet, anyway. For now, I want to work with younger patients and focus more on preventative health. I have more to offer in that capacity. Dealing with end of life issues is not my forte.
I'm sure that will come with time.
Tuesday, January 16, 2007
Not For Me
I'm not cut out for working in a nursing home. I have found something that I definitely am NOT interested in doing. I had an open mind going into this rotation, but overall...it brings me down.
I don't like watching old ladies cry.
I don't like being asked, "When am I going to die?"
I don't like being told, "I'm ready to die."
I don't like having conversations with families about "comfort care".
I don't like the desperation in the eyes of those with thriving minds, but failing bodies.
I don't like it when they curl up in a ball at the side of the bed and stay there all day.
I don't like the psychological torment that plagues the majority of them.
It's uncomfortable. It's awkward. It's not for me.
It's not death that frightens me.
It's the prolongation of death that does.
Medicine = a double-edged sword.
I don't like watching old ladies cry.
I don't like being asked, "When am I going to die?"
I don't like being told, "I'm ready to die."
I don't like having conversations with families about "comfort care".
I don't like the desperation in the eyes of those with thriving minds, but failing bodies.
I don't like it when they curl up in a ball at the side of the bed and stay there all day.
I don't like the psychological torment that plagues the majority of them.
It's uncomfortable. It's awkward. It's not for me.
It's not death that frightens me.
It's the prolongation of death that does.
Medicine = a double-edged sword.
Saturday, January 13, 2007
Home Sweet Home
The nursing home that I'm at now was built to resemble a resort. It's a very impressive looking complex with sunny yellow siding and manicured lawns. The lobby is bright and cheerful with a huge fishtank, chandelier and a spiral staircase. At first glance, it's a very comforting and elegant setting.
When I pulled into the parking lot this morning there were two ambulances parked outside the lobby. My stomach sank. I knew it was going to be a long day...and it was.
I met the PA in the lobby and we started the day off with our daily ritual. We stopped off at the cafeteria for a cup of tea. Since it was a relatively mild winter day we drank our tea outside on the loading dock. The PA quizzed me with board like questions as we sat in the sun and drank our tea. As we were sitting there a family-sized, powder blue caravan pulled up and a man in a three piece black suit got out and walked into the building. We both thought it was odd for a man dressed in a three piece suit to be entering a building through the loading dock area. But, we shrugged it off.
The man returned a few minutes later...pushing a stretcher with a body bag on it. The body bag was full. My mouth dropped open. I looked at the PA and he was equally confused. The man in the three piece suit opened up the back door of his caravan and slid the stretcher with the body into the van....right next to the other full body bag that was already in there!
The man in the three piece suit jumped back into his powder blue caravan and drove away. It took me a couple of minutes to process what I had seen.
Then the PA reminded me..."that's the only way home."
When I pulled into the parking lot this morning there were two ambulances parked outside the lobby. My stomach sank. I knew it was going to be a long day...and it was.
I met the PA in the lobby and we started the day off with our daily ritual. We stopped off at the cafeteria for a cup of tea. Since it was a relatively mild winter day we drank our tea outside on the loading dock. The PA quizzed me with board like questions as we sat in the sun and drank our tea. As we were sitting there a family-sized, powder blue caravan pulled up and a man in a three piece black suit got out and walked into the building. We both thought it was odd for a man dressed in a three piece suit to be entering a building through the loading dock area. But, we shrugged it off.
The man returned a few minutes later...pushing a stretcher with a body bag on it. The body bag was full. My mouth dropped open. I looked at the PA and he was equally confused. The man in the three piece suit opened up the back door of his caravan and slid the stretcher with the body into the van....right next to the other full body bag that was already in there!
The man in the three piece suit jumped back into his powder blue caravan and drove away. It took me a couple of minutes to process what I had seen.
Then the PA reminded me..."that's the only way home."
Friday, January 12, 2007
A Time For Change
2007 is all about change.
I change rotations every 5 weeks.
I finish my last rotation in August.
I graduate in September.
I PASS the boards in October.
I consider my options in November.
I start anew in December.
2007 is all about change.
I change rotations every 5 weeks.
I finish my last rotation in August.
I graduate in September.
I PASS the boards in October.
I consider my options in November.
I start anew in December.
2007 is all about change.
I Miss Brooklyn
I miss the freedom I felt while living there.
I miss the neighborhood I lived in.
I miss the culture.
I miss the grocery store where English was the second language.
I miss the diversity.
I miss the twin-size blow up mattress I slept on for 12 weeks.
I miss the alternate side of the street parking.
I miss the fire hydrants.
I miss the pitter patter from the apartment above mine.
I miss the subway.
I miss the part of me that felt at home everywhere I went.
I miss Brooklyn.
I miss the neighborhood I lived in.
I miss the culture.
I miss the grocery store where English was the second language.
I miss the diversity.
I miss the twin-size blow up mattress I slept on for 12 weeks.
I miss the alternate side of the street parking.
I miss the fire hydrants.
I miss the pitter patter from the apartment above mine.
I miss the subway.
I miss the part of me that felt at home everywhere I went.
I miss Brooklyn.
Thursday, January 11, 2007
Murmur
I was walking down the hallway of the nursing home with the PA when he asked me, "Did you hear the murmur on the last patient that we examined?"
My intelligent response was, "Uh...what murmur?"
He smiled at me and sent me back to her room. "Don't come back until you hear the murmur!"
All of this went down during day ONE of my long term care rotation. I was rusty. I didn't hear any murmurs during Pediatrics. My ears were out of tune.
I went back to her room and the nice little old lady let me listen to her heart. She was very patient with me. She was so patient that she actually fell asleep in her wheelchair while I listened for her murmur.
And then I found it. It took a few minutes but then I remembered the sound...harsh, blowing, 2/6, RRR murmur over the aortic valve. I was mighty proud of myself once I heard it. I bounced down the hallway and proudly reported back to the PA..."I heard the murmur!"
Again, he smiled at me. I could tell I wasn't impressing him that much.
Two days later the same PA sent me to examine a different woman. An 87 year old female with dementia, end stage renal disease and a slew of other maladies. I start every exam by listening to the heart and then the lungs and then proceed to rest of the body. Once my stethoscope hit her chest I immediately heard a murmur. Since I was alone in the room and my patient had dementia I just made a mental note of it and continued with my exam.
Afterwards, I went back to the nursing station to document my findings. I reviewed her chart and searched for documentation of her murmur.
I couldn't find it.
So I consulted with the PA about the patient's murmur.
He said, "You heard a murmur? I never heard one on her. Are you sure the sound was coming from her heart and not her lungs?"
I realized I had a choice. I could stick to my original diagnosis or I could doubt myself and recant my finding. It was possible that the sounds I heard were coming from her lungs. But something deep down told me to stick with the murmur.
"Murmur...FINAL ANSWER!" Then I jokingly stated, "Don't come back until you hear the murmur!"
He smirked at me, picked up his stethoscope and said, "Let's go take a listen."
The PA took a listen, then looked up and smirked at me again, "You're right...that's a murmur...I don't know how I missed that earlier!"
I just looked at him and smiled.
I finally impressed him.
My intelligent response was, "Uh...what murmur?"
He smiled at me and sent me back to her room. "Don't come back until you hear the murmur!"
All of this went down during day ONE of my long term care rotation. I was rusty. I didn't hear any murmurs during Pediatrics. My ears were out of tune.
I went back to her room and the nice little old lady let me listen to her heart. She was very patient with me. She was so patient that she actually fell asleep in her wheelchair while I listened for her murmur.
And then I found it. It took a few minutes but then I remembered the sound...harsh, blowing, 2/6, RRR murmur over the aortic valve. I was mighty proud of myself once I heard it. I bounced down the hallway and proudly reported back to the PA..."I heard the murmur!"
Again, he smiled at me. I could tell I wasn't impressing him that much.
Two days later the same PA sent me to examine a different woman. An 87 year old female with dementia, end stage renal disease and a slew of other maladies. I start every exam by listening to the heart and then the lungs and then proceed to rest of the body. Once my stethoscope hit her chest I immediately heard a murmur. Since I was alone in the room and my patient had dementia I just made a mental note of it and continued with my exam.
Afterwards, I went back to the nursing station to document my findings. I reviewed her chart and searched for documentation of her murmur.
I couldn't find it.
So I consulted with the PA about the patient's murmur.
He said, "You heard a murmur? I never heard one on her. Are you sure the sound was coming from her heart and not her lungs?"
I realized I had a choice. I could stick to my original diagnosis or I could doubt myself and recant my finding. It was possible that the sounds I heard were coming from her lungs. But something deep down told me to stick with the murmur.
"Murmur...FINAL ANSWER!" Then I jokingly stated, "Don't come back until you hear the murmur!"
He smirked at me, picked up his stethoscope and said, "Let's go take a listen."
The PA took a listen, then looked up and smirked at me again, "You're right...that's a murmur...I don't know how I missed that earlier!"
I just looked at him and smiled.
I finally impressed him.
Friday, January 05, 2007
Long Term Care
I started Long Term Care on January 2nd. I don't recommend waitressing at Brooklyn's hottest pan-latin restaurant (ahem, www.bogotabistro.com) two nights before the start of a new rotation. But, it was New Year's Eve and it turned out to be one of the best "Eve's" of all time. There's nothing like ringing in the new year surrounded by friends and "family". Thank you George, Omar and the cutie patooties!
I thoroughly enjoyed my two week break away from medicine. I finally got rid of the sinus infection that scarred my 5 weeks in pediatrics. Every time I felt like I was getting better, another kid would come in and cough on me. And then I'd get what the kid had a few days later. It really was one long month of coughing, sniffles, and headaches for me. But, the laughter and the kinetic energy that only kids can produce overshadowed my declining health!
So I started Long Term Care feeling physically healthy but intellectually sluggish. The first few hours of meeting a preceptor are crucial. In this case, the PA that I would be working with for the next 5 weeks hit me up with cardiology questions within 10 minutes of us meeting. I felt my stomach drop. Ugh...cardiology. UGH UGH UGH
I don't know why I have issues with cardiology, but I do. I have a love/hate relationship with identifying murmurs (S1, S2, harsh, blowing, crescendo, decrescendo, snaps, clicks, rubs, gallops, S3, S4?!?...) all of the medicines involved (diuretics, calcium channel blockers, beta blockers, nitrates, ACE Inhibitors...)and all of the intricate details of an EKG (S-T elevations, depression, t-wave inversion, "Wenky" who?).
The PA showed me no mercy. I was familiar with the questions he was asking me, but after 5 weeks in Pediatrics and a 2-week vacation...(errr...did I mention the champagne and tequila on NYE?) my brain kept coming up empty.
I've mastered the art of saying, "I don't know." When I really don't know something I look em dead in the eye and say, "I don't know." But, there are times when I think I know, but I'm not sure if I know, or I can't explain why I think I know what I know or if I really do know anything at all." During those times, I usually say, "I don't know, but...I DO KNOW THAT...xyz." So, I admit that I don't know exactly what kind of answer the preceptor is looking for, but I try to relay information that I truly do know and understand. I spit that back out and follow up by trying to show the direction of my thought process.
It seems to work.
It shows the preceptor that I am somewhat intelligent and it buys some time for my brain to kick into high gear. Sometimes I come up with answers and impress the heck out of myself. But other times I find myself grasping for an answer that I know I "should" know cold by now.
I carry around a small spiral notebook in my lab coat and I try to summarize the learning points/subjects that the preceptor spoke about during the day. If I don't know a question, I'll go look it up and write down the answer, because 9 times out of 10...I'll be asked the same exact question a few days later.
The first day of long term care was rough. It was my first time in a nursing home and at first glance, it was depressing. I didn't want to be there. I wanted to go back to Pediatrics. I was VERY comfortable in pediatrics. I felt like I knew stuff in Pediatrics and Primary Care. I felt like I had a clue.
Patients in long term care facilities have very complex medical issues. The average patient has between 10-15 different diagnoses and is on 15-20 different medications/supplements. My day involves sifting through piles of labs and reviewing charts. There is very little hands-on action. I mostly sit at a nursing station with the PA and we review labs.
It's absolutely mind-boggling.
I have a lot to learn!
I thoroughly enjoyed my two week break away from medicine. I finally got rid of the sinus infection that scarred my 5 weeks in pediatrics. Every time I felt like I was getting better, another kid would come in and cough on me. And then I'd get what the kid had a few days later. It really was one long month of coughing, sniffles, and headaches for me. But, the laughter and the kinetic energy that only kids can produce overshadowed my declining health!
So I started Long Term Care feeling physically healthy but intellectually sluggish. The first few hours of meeting a preceptor are crucial. In this case, the PA that I would be working with for the next 5 weeks hit me up with cardiology questions within 10 minutes of us meeting. I felt my stomach drop. Ugh...cardiology. UGH UGH UGH
I don't know why I have issues with cardiology, but I do. I have a love/hate relationship with identifying murmurs (S1, S2, harsh, blowing, crescendo, decrescendo, snaps, clicks, rubs, gallops, S3, S4?!?...) all of the medicines involved (diuretics, calcium channel blockers, beta blockers, nitrates, ACE Inhibitors...)and all of the intricate details of an EKG (S-T elevations, depression, t-wave inversion, "Wenky" who?).
The PA showed me no mercy. I was familiar with the questions he was asking me, but after 5 weeks in Pediatrics and a 2-week vacation...(errr...did I mention the champagne and tequila on NYE?) my brain kept coming up empty.
I've mastered the art of saying, "I don't know." When I really don't know something I look em dead in the eye and say, "I don't know." But, there are times when I think I know, but I'm not sure if I know, or I can't explain why I think I know what I know or if I really do know anything at all." During those times, I usually say, "I don't know, but...I DO KNOW THAT...xyz." So, I admit that I don't know exactly what kind of answer the preceptor is looking for, but I try to relay information that I truly do know and understand. I spit that back out and follow up by trying to show the direction of my thought process.
It seems to work.
It shows the preceptor that I am somewhat intelligent and it buys some time for my brain to kick into high gear. Sometimes I come up with answers and impress the heck out of myself. But other times I find myself grasping for an answer that I know I "should" know cold by now.
I carry around a small spiral notebook in my lab coat and I try to summarize the learning points/subjects that the preceptor spoke about during the day. If I don't know a question, I'll go look it up and write down the answer, because 9 times out of 10...I'll be asked the same exact question a few days later.
The first day of long term care was rough. It was my first time in a nursing home and at first glance, it was depressing. I didn't want to be there. I wanted to go back to Pediatrics. I was VERY comfortable in pediatrics. I felt like I knew stuff in Pediatrics and Primary Care. I felt like I had a clue.
Patients in long term care facilities have very complex medical issues. The average patient has between 10-15 different diagnoses and is on 15-20 different medications/supplements. My day involves sifting through piles of labs and reviewing charts. There is very little hands-on action. I mostly sit at a nursing station with the PA and we review labs.
It's absolutely mind-boggling.
I have a lot to learn!
Subscribe to:
Posts (Atom)
