Life as a Physician Assistant Student...

Emails

2010-09-05T19:34:00.002-05:00

Ok, I am in the process of trying to link my email accounts together as well as my blog so it is easier for me to remember passwords etc. Blogger changed my settings and I was locked out of it for a while...but I'm slowly getting it together again!

In the interim I received a lot of emails, mostly from students and I'm working through them. If you emailed me, I will get back to you. The majority of you are expressing your doubts and fears about making it through PA school. YES, I HAD THE SAME FEARS...we all do. But harness that fear and turn it into MOTIVATION. You will have good days and bad days. Days when you question what you are doing and why you are doing it and days when your desire to be a PA are very clear. And guess what? These same feelings will occur even when you graduate and are working as a PA. In fact, I'm sure they happen in every profession. I have learned that its part of the human condition. Again, harness that energy and use it to your advantage. If you are feeling particularly overwhelmed reach out to your classmates or teachers. Its also very helpful to know the people you can count on even before you start PA school. Create an inner circle of people that will support you no matter what and won't get tired of you complaining about all the studying you have to do!

As many PA programs are starting this time of year (mine did)....BEST OF LUCK!!! As I look back now, I have very fond memories...mostly of my classmates who have become lifelong friends. And to be honest, I actually miss the intensity and academia! Work life is very different than student life. Soak it up, make the best of it and shoot for the stars.

OR

2010-06-01T19:19:00.003-05:00

Wednesdays are dedicated to the operating room. Since I work two 24-hour shifts per week, I average about 1-2 Wednesdays a month. There is always a chance I can get pulled into the operating room any other day of the week (and it has happened) but there is no clinic on Wednesdays, just OR time.

Needless to say, I love the OR. Luckily, the chief of orthopedic surgery in my hospital is a very kind and compassionate man. He is easy to be around. He doesn't yell or scream or throw things (yes, I have worked with other surgeons who do all that) so working with this surgeon is refreshing. He enjoys teaching & is very patient. So, I'm looking forward to tomorrow. I'm not sure what cases are on the schedule...but I'll give a full report afterwards!

Be Realistic

2010-06-01T18:30:00.003-05:00

Since my last posting, I have received a lot of emails encouraging me to continue writing as well as asking me for advice. I'm trying to respond to each of your emails individually but it is difficult. It's mostly difficult because my yahoo address is overwhelmed with SPAM and it's hard for to me go back and find the emails if I didn't respond on the spot. So, have patience with me...I will try to get back to you! And I'll be posting a new email address to fix this problem...I guess having the same email address since 1994 is to blame!

I've gotten many personal questions asking for my opinion on whether or not YOU should go to PA school. I will not attempt to answer that question for anyone. It's a highly personal question and my blog is an attempt to let you know the "behind the scenes" world of PA school. I think there is enough information on this site to give you an idea of what it's like. The BEST analogy I've heard about PA school is this: PA school is like taking a drink of water from a fire hydrant!

PA school will require all of your time and attention. You will have more information crammed into your brain than you thought was possible. It's uncomfortable at the time but you get used to it. At this point, almost 3 years AFTER finishing PA school...I MISS IT! I miss the daily grind of information being crammed into my brain. I miss the intensity. I miss the challenge and most of all...I miss my PA school friends. It's a surreal experience and when it's over and you enter back into the real world, you realize how exceptional the experience really was.

The best advice I can give is if you're thinking about becoming a PA...get to know a PA. Shadow a PA. There are way more websites and blogs out there now dedicated to Physician Assistants than when I thought about entering PA school...so do your research. Get your facts. Call your local PA programs and ask them questions. Most importantly, figure out the finances. Do not quit your job on a whim to go to PA school. Think it through thoroughly. School loans are a blessing but you WILL have to pay them back as soon as 6 months post-graduation...so be realistic. Figure out the numbers, get on craigslist or indeed.com and search the PA jobs in your area. Get an idea of the salaries in your area, factor in your loan repayment and once again, BE REALISTIC.

I don't know your reality. Only you do. Make a list of pros and cons. Keep it simple. Keep it real. You'll find the answer.

Be Realistic!

Back to the Blog!

2010-04-14T22:25:00.005-05:00

It's been 2.5 years since I graduated PA school.

WOW...time flies.

I stopped blogging shortly after I graduated and I'm still not quite sure how or why that happened. Other than to say it was a very intense time in my life filled with a myriad of decisions that had to be made and the realities of heading back out into the "real world" were quite overwhelming.

I sure have kept busy though working as a PA. Here is a brief synopsis.

Job #1: HIV/STD Research Clinician-
I worked with a team of physicians and researchers on the development of microbicides to prevent the spread of HIV and other STDs. I mostly worked with female patients and conducted more GYN exams than I had ever hoped for! This was a Mon-Fri, 9a-5p, job and I worked there for 1.5 years. Stay tuned for more...

Job #2: Adolescent Medicine at a Juvenile Detention Center-
This was a part time job that I worked on the weekends. Basically, I worked with a medical assistant and was responsible for the health of kids in jail. I would also conduct physical exams on the kids that were newly incarcerated. In order to get to their cell...they had to be physically examined by me. I worked there part time for 1 year. Stay tuned for more...

Job #3: Addiction Medicine-
I worked in the Psychiatry Department on the detox floor. I treated patients going through opiate and alcohol withdrawal. It was a 10 bed unit and I was the sole medical provider with a team of 3 nurses. This was a full time gig, I worked 3 twelve hour shifts a week. After 3 months at this job, I decided to change my full time status to per diem status... Stay tuned for more...

Job #4: Orthopedic Surgery-
My current full time position. It's been 6 months and counting! I work for a private orthopedic surgical group in a NYC public hospital. I do morning rounds, see patients in clinic, first and second assist in the operating room (OR), complete consults from the ER and other units in the hospital. I also take "call". This, by far, is the most unique PA job that I have come across. I currently work two 24 hour shifts per week. I start my day at 7am and end the next day at 7am. I am "on-call" after 5pm. I have a call-room that consists of a bed, TV, computer, fridge, microwave, ortho library and is bigger than my current apartment! Some days I am awake for close to 24 hours....other days it's the complete opposite. I never know how the day will go or when it will end...if the beeper goes off at 3am...it's my responsibility.

So far, orthopedic surgery is the best fit for me. I really enjoy the physical, hands on approach with the patients as well as the fact that the majority of my patients WILL get better. Having a patient in excruciating pain from osteoarthritis fully recover from a hip replacement is simply miraculous! Scrubbing in and assisting in the operating room is still a humbling experience for me. I often catch myself thinking, "How in the world did I get HERE?!?!"

All in all...choosing a career as a PA was the best decision for me. The transition from being a PA student to now has been a pretty STEEP learning curve. I am just now starting to see what being a PA REALLY means.

Perhaps, that is why I am back to the blog! After 2.5 years working in the real world as a certified physician assistant...I finally have something to say!

Stay tuned for more...I promise!

License

2007-10-22T22:38:00.000-05:00

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!

Maimonides Award

2007-09-23T23:38:00.001-05:00

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.

Physician Assistant-CERTIFIED (PA-C)

2007-09-23T23:09:00.000-05:00

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!

360

2007-09-12T11:40:00.000-05:00

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

3 Days

2007-09-11T11:32:00.001-05:00

I'm taking the boards in 3 days!!

Say a little prayer for T-rex! ;)

2007-09-07T01:35:00.000-05:00

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.

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.

September 14th

2007-07-05T22:28:00.000-05:00

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!

7 Weeks

2007-07-01T22:30:00.000-05:00

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!

10 Weeks?!?!

2007-06-01T21:39:00.000-05:00

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...

Surgery

2007-05-05T22:06:00.000-05:00

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!

Where Have I Been?

2007-04-29T21:50:00.000-05:00

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

Free Condoms

2007-03-18T14:53:00.001-05:00

Only in NYC.

http://72.32.200.206/flash/

OB/GYN

2007-03-18T00:11:00.000-05:00

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.

Bump

2007-03-17T23:55:00.000-05:00

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!

Buzz Kill

2007-02-21T00:35:00.000-05:00

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!

Here We Go...Again!

2007-02-20T17:46:00.000-05:00

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!

52 hours

2007-02-16T03:01:00.000-05:00

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.

"I get it, doc!"

2007-02-14T03:14:00.000-05:00

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.

Miss Piggy

2007-02-13T00:57:00.000-05:00

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!

Saturday Night

2007-02-11T22:59:00.000-05:00

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!

EMED

2007-02-11T22:35:00.000-05:00

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!

Days 2 &3

2007-02-08T01:07:00.000-05:00

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!

ER

2007-02-06T09:54:00.000-05:00

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?

;)

EMED

2007-02-05T23:35:00.000-05:00

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.

Boundaries

2007-01-19T23:53:00.000-05:00

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.

Not For Me

2007-01-16T23:31:00.000-05:00

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.

Home Sweet Home

2007-01-13T01:43:00.000-05:00

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."

A Time For Change

2007-01-12T00:14:00.000-05:00

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

2007-01-12T00:03:00.000-05:00

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.

Murmur

2007-01-11T23:33:00.000-05:00

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.

Long Term Care

2007-01-05T23:04:00.000-05:00

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!

Right Place at the Right Time

2006-12-21T01:01:00.000-05:00

This week has been all about networking. I attended two holiday parties yesterday. The first party was a luncheon thrown by the Pediatrician. The second party was a dinner thrown by the Primary Care office (my second rotation).

I miss working with the Pediatrician already. He's encouraging me to enter Pediatrics. I jokingly told him that I'd love to work with female adolescents and he said, "well, I know Dr. so and so over at *** hospital..." I was just trying to prove the point that I really don't enjoy injecting little babies with vaccines! And all the pooping/peeing/vomiting and crying that goes along with peds!

I do have a strong interest in working with adolescents. I always have. I didn't realize it, but there definitely is a speciality in pediatrics that focuses on adolescent health. By the end of the luncheon, the doc was referring to me as a "future adolescent specialist". I intend to keep in touch with him. I took him up on his offer to write a recommendation as well.

At the Primary Care dinner, I was seated next to the Korean interpretor (that also speaks Japanese). I worked with her in the Chinatown office. We had fun trying to communicate in Japanese...I had moments where I actually felt like I was back in Japan. I was surprised to find that I was the only student at the dinner. The doc has let me know that he's interested in talking to me once I graduate. Who knew my time in Japan would serve me so well?!?!

I worked at Bogota tonight. There was a holiday party with 75 attendees. It turned out the party was for the Pediatrics floor of a major hospital in Brooklyn! I couldn't believe it. I wound up meeting with the Pediatrician that set up the party. She was extremely nice and extended an invitation to join her at the hospital one day to check it out. I told her about my interest in adolescents...and she was very encouraging.

I will admit that it is overwhelming to think that one year from now I will be working. Overwhelming in the sense that I have so much more to experience and opportunities are already starting to present themselves. Overwhelming in that I'm going to be making big decisions in 2007.

What area of medicine do I want to pursue?
Will I specialize?
Post-grad fellowship?
Hospital or private office?
Long Island? Brooklyn? Queens? NYC?
Out of New York?
Overseas?

Trust me...I'm really not stressing about this stuff. I just find it remarkable...life changes so fast.

And it's about being in the right place at the right time.

One Year Later

2006-12-19T02:13:00.000-05:00

Life is so different than it was one year ago.

I am no longer shackled to my desk.
I sleep more than 4 hours a night.
I am no longer haunted by biochemistry or pharmacology in my dreams.
I don't sit on my butt for hours on end. In fact, I rarely ever sit down.
I don't see the same exact faces day in/day out, every single day anymore.
I don't overindulge in coffee anymore.
I don't worry as much as I did last year.

In fact, my greatest strength was not learned in the classroom. It was learned throughout my life and strongly ingrained during my travels overseas. It is my ability to trust my instincts...to go with my gut feeling. As well as my ability to relate to people. Again, this was a skill I honed while traveling. Growing up, I was the shy kid that didn't care to interact and talk to a lot of people. Nowadays, I can't stop talking to people.

After every rotation, the preceptor fills out an evaluation form. So far, all three evaluators have commented on my ability to relate to people. Again, it's not something you learn in school. It's something you learn from life experience. And over the last few months, I've realized that all of my ups and downs in life have been preparing me for this role.

People trust me when they talk to me in my white coat. Parents trust me to take care of their kids. It's a huge responsibility and I've been loving every minute of it.

One year later, I can say that all of the sacrifices I made last year were worth it.

One year later...I'm happy.

Bogota

2006-12-10T02:33:00.000-05:00

I've been hostessing on Saturday nights at Bogota for the last couple of months.

I have to say that it's more stressful dealing with hungry people than it is to deal with sick people!

Especially at one of the hottest restaurants in Brooklyn!

www.bogotabistro.com

As Good As It Gets

2006-12-09T13:24:00.000-05:00

I've got three more days at the pediatrics office, two days of exams and presentations and then a 2-week vacation. My next rotation is Long Term Care...which is going to be the extreme opposite of Pediatrics.

I didn't think I'd enjoy working with screaming, whining, irritable, snotty-nosed, temper tantrum throwing little monsters. But, I do.

I especially love working with adolescents. I always have. I spent five years as a camp counselor, then two years teaching JHS kids in Japan, two more years teaching about HIV/AIDS to elementary thru college level kids. I seriously considered a career as a school psychologist but the more I learned of the profession the more I realized it wasn't for me. I wanted to be able to interact with troubled kids on a grander scale.

In the last 4 weeks I've dealt with kids suffering with ADD/ADHD, major depressive disorder, bipolar disorder, anxiety disorder, and a kid with a very rare feeding disorder. A couple of girls with anorexia and one who is morbidly obese. I've seen kids with sickle cell disease, celiac disease, mono, strep throat, pink eye, asthma, pneumonia, RSV, URI, scabies, flea bites, warts, sever's disease, broken toes/fingers, ulcerative colitis, irritable bowel syndrome, croup, whooping cough (yes, it's still around and you need the vaccine!), and the most recent phenomena is E. coli in a teenage boy after eating at Taco Bell.

These are the most common pathologies I've encountered over the last 4 weeks. I typically see between 10-20 patients a day. It's a nice, comfortable pace. The doc spends at least 15 minutes with each patient. He doesn't rush. He doesn't cut corners to save time. He is very thorough and treats all of his patients as if they were his own.

So, I've tried to adopt the same disposition. Some patients are harder than others to deal with. But it's usually the parents that create the most frustration. I'm working in an area that is predominantly upper-middle class and some parents bring their live-in nannies with them to the office! It's nice working with a population that has the means to properly care for their children, but I realize that the majority of the children in this world aren't so fortunate. Nevertheless, it's been a wonderful learning experience.

The Doc I'm working with is wonderful and I'm going to miss him. He's now telling patients that he's going to be depressed when my classmate and I leave. And, I believe him. The three of us have great chemistry together and my classmate and I recognize how lucky we are to be working with a doc that loves to teach us. And we tell him so. He's been practicing medicine for 30 years and treats both us as his peers. He recognizes our weaknesses and points us in the right direction. He expects a lot from us and makes us think. Yet does this in a very supportive way. He didn't like the way he was treated as a resident and wishes medicine was nicer to students.

This is the experience I was hoping for...this is as good as it gets.

A Recipe for Disaster

2006-11-17T23:25:00.000-05:00

I have to be honest. I wasn't looking forward to my Pediatrics rotation. The thought of dealing with cranky kids all day....everyday...for 5 weeks didn't appeal to my senses. In fact, the crying and screaming I encountered during routine school physicals during the Primary Care rotation was downright frightening! I remember thinking to myself, "Who in their right minds would want to treat children all day long?"

There's been a lot of negative feedback from my fellow students about Peds. A lot of my classmates found it to be a boring rotation. They observed more than they performed. Many of them felt bored and unchallenged.

Now, I can't stand the sound of crying, whining kids! My classmate has had to remind me on numerous occassions that kids are SUPPOSED to cry. He's reminded me that they're SUPPOSED to be brats! They forget to tell you that during the didactic year!

Now, I don't enjoy making babies cry. But, it's my job to inject them with vaccines and they scream bloody murder. I also don't enjoy making kids gag. But, it's my job to make sure I get an adequate throat culture (and it's adequate when they gag!).

It's also part of my job to remain patient and calm when a toddler sneezes in my face, refuses to cooperate, or vomits on the toilet seat when I have to use it!

It seriously is a recipe for disaster!

Well, as it turns out...I am in love with Pediatrics at the moment! And it's mostly because I'm working with a Pediatrician that LOVES being a doctor. He loves being a Pediatrician. He has been practicing for 25 years and he treats each child as if they were his own. Kids adore him and parents respect him. I think he is incredible.

If I had to compare him to a celebrity...he's a mixture of Larry David and Woody Allen. He's brilliant, witty, and has mastered the art of communication. Within seconds of meeting him I felt this was going to be a good experience. It's been almost three weeks and I'm extremely grateful for having been placed in his office.

It also makes up for the fact that I moved out of Brooklyn!

C'est la vie

2006-11-07T01:10:00.000-05:00

I've got six more days left in Brooklyn and then I'll be moving back home to Long Island.

SIGH

I'm really going to miss the life that I've created here in the last 10 weeks. I have a great roommate and live in a beautiful apartment. Did I ever mention that I have a door to the backyard in my room and that I wake up to birds singing every morning! Yes, in Brooklyn!

I know what you're thinking. T-rex, if you're so happy living in Brooklyn, why are you going to move home?

Well, here's my answer. My roommate's fiance is moving from the Dominican Republic to Brooklyn a few days after I move out. So, that's one of the reasons. I've thought about finding another apartment, but my next couple of rotations are back on Long Island and finding an apartment is not something that I want to rush. My last 10 weeks here have been a total blessing. Everything went smoothly. There was a lot of room for error, disappointment, and chaos...but it was smooth sailing all the way through. And for that, I am grateful.

My Primary Care rotation ends on Wednesday. On Thursday I have drive back to campus to give a case presentation on a patient I treated during this rotation. I also have an oral quiz on 10 different drugs. During every rotation I have to choose 10 different drugs (3 of them must be psych drugs) and write down their mechanism of action, class, indication, dosage, entry route, precautions, contraindications, interactions, and adverse reactions! After I present my case to a preceptor and 5 of my classmates, I am qujzzed on all of the cards. I have to spit out all of the information that I have written on my card. It ain't easy!

Then on Friday morning I have my end of rotation exam.

Then I have to pack up my belongings and move out of Brooklyn Sunday. I start my Pediatric rotation Monday morning.

C'est la vie.

PC

2006-10-31T18:28:00.000-05:00

In one week I'll be finished with my Primary Care rotation. I can't believe that I'm about to finish my second rotation already. I've been working in a small private practice run by two doctors and two PAs. I've realized there is a huge difference between working in a hospital versus working in a private office. I've been more relaxed and have gotten more sleep during this rotation! It has been less stressful overall mainly because I've been working very closely with only one PA. At the hospital during my Internal Medicine rotation I worked with a different PA almost every day and that increased the stress level exponentially.

One of the most difficult aspects of these rotations is being able to adapt to working in different environments as well as with different personalities every 5 weeks. I have worked with some very interesting characters over the last 8 weeks and I've learned from each one of them.

The PA that I'm working with now has given me a lot of opportunities to learn. She told me on my first day that if she trusted me, she'd let me do everything that she does. She said that during my 4th week of the rotation i would be given a prescription pad and would be seeing patients on my own, taking a history, performing a physical and developing an assessment and plan. I remember doubting if I'd be able to reach that point by the 4th week. Well, I was given the prescription pad the first day of my 2nd week and my confidence in my abilities has increased as a result of the added responsibility. During the second week, I was treating mostly colds, sinusitis, flu shots, and general physicals. At this point, I just pick up the next chart and roll with it.

After I come up with my assessment and plan, I present the patient to the PA or doctor and if they agree with my plan, they sign off on the prescriptions. If they don't agree, they explain their reasonings and explore my own thought process about the disease state. Unlike the hospital experience, these healthcare professionals have provided more of a nurturing, supportive environment and that's why I've been less stressed and have gotten more sleep!

BUT...I found working in the hospital to be more exciting. And I have a better chance of bumping into a Mc Dreamy in a major metropolitan hospital than I do in a small, private practice!

;)

A Tree Grows in Brooklyn

2006-10-10T16:51:00.000-05:00

I started my Primary Care rotation yesterday and I've seen more patients in the last 48 hours than I saw during my 5 weeks in Internal Medicine! I've also done more procedures! It's been crazy.

I've been getting emails asking about what I get to do. I basically get to do whatever my preceptor is comfortable with me doing. The preceptor could be a doctor or PA. During my internal medicine rotation I did some blood draws, two ABGs, and a foley catheter on a female. The foley catheter was placed on a woman who was being treated for acute respiratory distress. I had to insert the foley while being surrounded by 8 doctors...they were part of the emergency pulmonary team. My prior experience with foleys was on a PLASTIC model. Needless to say, my hands were shaking but I managed to do it successfuly and then was nicknamed "Foley Queen" for the rest of my rotation. I nearly passed out afterwards when I realized that all 8 docs were watching me.

Within the last 48 hours I've seen 90 patients! I've given countless numbers of flu vaccine injections as well as Vit. b12 injections. I gave trigger point and Hyalgon injections too. I conducted EKGs on four patients and interpreted the EKGs...my initial interpretations were correct...and two of those 4 patients were sent to the Emergency Room! I've listened to all of their hearts and lungs and conducted focus physical exams based on their complaints. I've written in their charts. I've done all of this with the PA at my side. She promises that by the 4th week of this rotation, I'll be doing all of this alone and she'll come in at the end and double check my work...as well as the prescriptions that I choose to write.

This stuff still amazes me.

Today was even more amazing because I was at a clinic in China Town. The majority of patients were Korean the rest were Chinese. We saw 31 patients and NONE of them spoke fluent English! We had an interpreter with us but she only spoke Korean, Japanese, and English...no Chinese. I felt like I was back in Japan! Some of the Korean patients also spoke Japanese so I had fun speaking with them. I am not fluent in Japanese by any means...but I can understand the basics and mannerisms. I had a great time but was exhausted by the end of the day. The clinic treated a record number of patients today...and it was only staffed by the PA and me. The nurse had to go to China for a funeral! It was insane.

When I was living in Japan a lot of people encouraged me to learn Japanese so I could use it in the business world. But, I knew I had zero interest in working in the business world. I've known that my whole life. But, I never thought I'd be speaking Japanese as a healthcare provider!

Crazy.

I love it. And did I mention that I L-O-V-E Brooklyn? I may have to name my firstborn "Brooklyn". And no...this doesn't mean that I've met the man of my dreams. That's not what I'm looking for right now. I've been meeting people from all around the world...different cultures, languages, beliefs, and outlooks on life. I find living here to be fulfilling and inspiring.

I had no idea that would happen.

Since Brooklyn is the most populated borough of NYC...there are plenty of hospitals and doctor's offices!

The seed has been planted.

2006-10-02T21:38:00.000-05:00

I've got a million stories that run through my head on a daily basis that I want to write about. But, for some reason, I can't find the time lately.

Here's a quick update: MY FIRST ROTATION ENDS IN TWO DAYS!!!

I can't believe how fast time as gone by. So, I've been busy preparing and studying for the end of rotation exam on Thursday. I am NOT looking forward to that exam. Since my rotation is Internal Medicine...it covers everything! So, I'm trying to read as much as possible, but there are no specific handouts or specific books that outline everything I need to know. So, I'm taking my readings from several different books, notes, and on-line sites. Basically, I'm all over the place.

Unfortunately, this rotation was not as good as it could have been. I'll go into that more later. Basically, the hospital is understaffed and the PAs are overworked and inexperienced (1-2 years) so that doesn't add up to a good teaching experience. Some days were really frustrating. My classmate and I have been basically teaching ourselves. So, it's been great having him there with me. We laugh during our lunch break everyday...if I were alone, I probably would have been crying!

The most important thing that I've learned is that I love working with patients. My patients have been very sick and I wasn't sure how I would cope with that...but I've been coping just fine. It's strange how you walk into a room and you can smell death...but then you walk out into the hallways and see life. You bounce around all day and walk the line between life and death. It's a very strange position to be in and some of the things I've seen have really made me contemplate end of life issues. These experiences have made me think a lot about my own mortality and that's something I've NEVER thought about before. (or perhaps it's because I turned 30?!?! haha)

The greatest realization....I LOVE BROOKLYN.

I guess if you started reading this blog in the beginning it doesn't come as a surprise. But, I'm actually surprised at how much I really do LOVE it here. I love the apartment I'm living in. I love the park that is down the block. I love the different cultures and religions...the different foods and languages. And most of all, I love that two of my best friends are running a successful restaurant and they've welcomed me as family and have provided me with space to study and delicious food to keep me full. As well as cutie patootie waiters and busboys from all over the world!

I've got six more weeks in Brooklyn and then I move back to the 'burbs.

I'm trying to make the most of it. (hence, the lack of writing in this blog!)

www.bogotabistro.com

Holy Shi*t!

2006-09-25T21:51:00.000-05:00

I attempted to do my first stool sample today. Since the 77 year old woman was overweight and had sufferend a stroke, I wasn't able to turn her on the side for a rear entry. So, I opted to go in from the front door. The woman also suffers from parkinson and dementia. I explained to her what I was going to do and she gave me her "blessing".

Well, I didn't expect to raise her gown and find a pile of poop! I did a good job of stifling my reflex to dry heave. The #1 rule is: Don't ever let the patient hear you say, "Holy sh*t!" or "Oh, my God!" So...I looked over at my classmate and he was also doing a good job of hiding his surprise, then I looked at my patient and explained to her that I found some diarrhea. And she showed the most surprise of the three of us!

On a positive note, I didn't have to dig very far to get a stool sample.

God bless the nurses that came in to clean her up.

Surprise!

2006-09-21T23:39:00.000-05:00

By noon I was saying, "This is the worst birthday ever!"

By midnight I was saying, "This is the best birthday ever!"

I spent the day with the brilliant PA that made me feel like the stupidest PA student in the whole entire world. No matter what my answer...I was wrong. Wrong, wrong, wrong. I'm so grateful that my classmate has been with me because he's always wrong, wrong, wrong too! Even when we're right...this guy finds a way to make us wrong!

By noon, I had a pulsating headache and considered pursuing a career as a hot dog vendor. I was envying the vendor that sat in the sun and fed the hungry, cute, residents all day. I'd probably have a better chance at impressing a single, eligible, "Mc. Dreamy" surgeon with my hot dog making skills, since I can't seem to master the art of venipuncture. Something that seems so simple...really isn't simple on 85 year olds with rapidly disappearing veins.

Anyway, my plan was to stop by Bogota on my way back from the hospital to eat some birthday dinner with George, Omar and the cutie patootie bus boys. I was totally surprised that my friend, Troy, joined the celebration. Troy lives in San Francisco! I knew he was in New Jersey for business and we made plans to celebrate Friday night...but he arrived a few days early to surprise me. Thinking about it now, still makes me smile.

So, the next day when I saw my classmate I told him that the worst birthday turned into the best birthday. He was happy to hear it. Especially since the brilliant PA that likes to make us feel stupid wasn't going to be there that day.

Happiness is...

2006-09-21T22:53:00.000-05:00

Happiness is turning 30 and feeling like you're exactly where you're supposed to be in life...and doing what it is you've been put on this earth to do.

Living in Brooklyn and practicing medicine.

T-rex is happy.

30

2006-09-19T21:17:00.000-05:00

I've been so busy that I almost forgot that I was turning THIRTY tomorrow.

Um, yeah right...I've been counting down the days.

I like the way it sounds though.

I'm thirty.

And nobody believes me....

...so I don't mind saying..."I'm thirty!"

More on turning 30 another time. I have to do a short presentation on Diuretics tomorrow to a PA that has a HUGE EGO and loves to pimp me in front of doctors and med students.

I think I'll wear a big bow on my head tomorrow, so maybe he'll be less of a jerk since it's my birthday.

Dealing with the many personalities of healthcare professionals is a lesson in and of itself.

The patients are the ones keeping me sane!

Typical Day

2006-09-13T20:51:00.000-05:00

I wake up at 6:45 and leave the apartment by 7:45am. I get to the hospital by 8:45am. It can take anywhere between 25-50 minutes to drive 5 miles to the hospital! On alternate side parking days, the hospital parking lot is full, so it can take up to 30 minutes to find a parking spot and walk to the hospital. It costs $4.00/day to park in the lot (employee discount) or $45.00 to park on the wrong side of the street!

I meet my classmate outside of the hospital and we drink a cup of coffee and talk about what we learned the day before or what our preceptors told us to read up on. I have a great relationship with my classmate. We were always friendly towards each other in the classroom, but I had no idea that we'd ever get along so well. Although he's only 21 years old, he's very mature and very intelligent. We work well together.

At 9am we report to the Chief PA and he assigns us to our preceptor for the day. Last week I was on the Medicine floor and this week I'm on the Cardiology floor. I had the opportunity to work with the same PA twice last week and I thought she was brilliant. We got along really well and felt very comfortable working with her. I felt like I hit the jackpot with having her as my preceptor.

This week is a different story. The PA on the cardiology floor isn't so friendly. She's just not a friendly or personable person. Surprisingly, she's young...probably around 25 years old. Within a few minutes on Monday, I knew it was going to be a long week. She had the personality of a porcupine.

As a student, you walk a fine line with these preceptors. You are there to learn, yet you don't want to overwhelm your preceptor. You shouldn't ask every single question that pops into your head...you have to pick and choose your questions because they're short on time and you don't want to burden them. And you don't want to aggravate them.

This girl was born aggravated though, so I "killed" her with kindness. I got a kick out of myself and the way I interacted with her. I watched how the nurses and other PAs interacted with her and you could tell that everyone felt the same way. After a few hours of sitting around studying on my own, I asked her again if there was anything I could do. She looked at me and said, "No." And then she went back to working on the computer.

Instead of walking back to the corner of the room where I was studying, I stood there until she looked at me again. I smiled and said, "Well, I certainly don't want to waste any of your time. I can tell you are really busy since you haven't been able to interact with me today. So, I'm going to go back to the medicine floor to work with my other preceptor and follow up on the patients that I worked with last week. So, if you don't mind, I'd like for you to open up the staff room so I can get my things. And, I can call the chief PA if you'd like to get approval."

Needless to say, she walked me to the staff room where I gathered my stuff and told me to have a nice day.

When I returned to the Medicine floor, the PA I worked with last week was happy to see me. My classmate was working with her and she agreed to let me join them. So the three of us have been working together every afternoon from 2-7pm.

It's disappointing that I'm not able to see/do more on the cardiology floor. But most of my patients on the Medicine floor have cardiac problems, so I'm not really missing out. My classmate was miserable last week in Cardiology and now I understand why. It's a shame...but I'm glad that I spoke up and expressed what I wanted to do. Otherwise, I would have been sitting in the corner all day. And I didn't move to Brooklyn to sit in the corner!

Another cool thing is that my classmate and I don't compete with each other. We don't try to outshine each other. I've seen some really negative interactions between med students and it makes me realize how happy I am that I DIDN'T go to med school! My classmate and I are eager to learn yet we take turns with procedures. If he had something cool going on in one room, he'd come and get me and vice versa.

We saw a lot of action today. We observed a woman being intubated in order to keep her alive. We also observed a woman being extubated in order to let her pass away. We observed central lines being placed and were able to remove central lines. We took histories, performed physicals and wrote progress notes. We went down to the Emergency Room to work up an admission. We assisted in a wound debridement...it was bloody and full of pus, I was surprised that I found it cool. Oh yeah, and then there was the stool guiac exam. I let my classmate do it first...I'll get the next one!

A patient that I did a history and physical on in the ER last week was moved to a different floor this week. I've been going there to visit him everyday. He's 84 years old and presented with a diffuse rash that covered his entire body except for his face. Both of his legs were swollen and oozing. He's had the rash for 4 weeks...and the swollen legs for 2 weeks. It's been a couple of days and he still doesn't have a diagnosis. He's a widow and doesn't have any family in the area. Nobody has come to visit him, so I make sure that I see him everyday. My preceptor fears it's a malignancy. Since I am a student and I have time to talk to patients...that is what I do. Today when I left his room he grabbed my hand and thanked me for visiting him.

And that is why I'm doing what I'm doing. That makes all of the sacrifices up to this point worth it. And that's what keeps me motivated. I no longer study to pass a test. I study to help improve a person's life. And I think it's the coolest job in the world.

We finish work at 7pm and by then we're giddy and starving. It takes my classmate 3 hours to get home by train (if I didn't move...that's what I'd be doing too!). And it takes me about 45 minutes to get home. I've eaten the same exact thing every night this week! Black beans with broccoli on quinoa with a salad. I'm too tired to cook anything new. I talk with my roommate for a bit and then I go back into my room and study till midnight.

Then I wake up and do it all over again. I'm happy with this rotation. It ends in three short weeks and then I'm on to the next rotation. It's going by really fast.

So, I'm trying to enjoy every moment.

Pimpin

2006-09-12T21:24:00.001-05:00

My first rotation is going well. I have been doing so many different things, running in different directions and dealing with so many different types of people....I'm exhausted. I'm working four 10-hour days and then I get three days off. The days go by really fast.

I'm going on day #3 though and I'm beat. But, I'm looking forward to going back tomorrow to learn some more. It's an unbelievable learning curve. Today I did rounds with 5 med students and a doctor. I was the only PA student. And the Doc pimped me like he pimped the others. He was a brilliant doctor and I loved the way he dealt with us. He flat out told me not to worry if I get the answer wrong because I'm there to learn and he doesn't expect me to know the answers to all of his questions. So, I knew some of the answers and didn't know some of the others! But the med students choked up on most of the ones I didn't know either.

I left the experience feeling pretty darn good. I've had one year of medical school...and they've had three.

Enough said.

Gotta sleep!

Self-defense

2006-09-06T21:59:00.000-05:00

I wish I had a video camera following me around. I don't have the energy to come up with adequate words to describe what the last two days were like. I feel like this is all make believe. But, it's real. Very very very real.

It's so real that it feels make believe. I wonder how long this self-defense mechanism will last.

I'm seeing really sick patients. The average age of admitted patients in this hospital is 85 years old. Lots of ventilators. Lots of elderly people lying in beds without visitors. Yesterday they were talking and laughing and today they're intubated and unconscious.

Talk about a steep learning curve.

I need to sleep.

Rip Tide

2006-09-04T21:48:00.000-05:00

I'm starting my first rotation in Internal Medicine tomorrow. I guess I should be nervous. But, I've been too busy moving into Brooklyn and getting settled. I took a nice tour of Brooklyn today. It took me 3.5 hours to go 10 miles.

Yes, 3.5 hours to go 10 miles.

There was a West Indian parade/festival today. I knew about it, but I didn't think that it would close down half of Brooklyn! It was unbelievable. I felt like I was in the Caribbean. A police officer actually asked me why I was in that area. I told him I was trying to find the hospital and he said, "You're the first blonde I've seen all day!" I had to laugh. It really was insane.

So, I spent the entire afternoon in the car. I found the hospital, the parking garage, the administration building and the chief PA's office. I'm going to give myself 90 minutes to go 5 miles tomorrow morning! Just in case there's another parade I don't know about!

I was drained after the driving debacle but headed out to the nearby park for a run. I trailed about 10 feet behind another girl and she unknowingly took me for a tour of the park! It was great since she unknowingly brought me back to where we started! I took a couple of looks behind me to make sure I wasn't being followed!

So, I'm pretty tired at the moment and trying not to think about tomorrow. I got about 5 freak out phone calls today from my classmates. I just laughed at them because most of them are within a 20 minute drive of their house! There is one classmate that does have the same rotation as I do. He was told to meet at the same time, so we'll see each other. That does make me feel better. He's only 21. I would be freaking out a lot more if I were 21. But, since I'm about to turn 30 (ahem, in 2 weeks!)...I'm trying to manage my anxiety by thinking about the crazy things I conquered in my early 20's. If I can get off an airplane in Tokyo and manage to live there for 2 years without any Japanese language training...I SHOULD be able to survive in Brooklyn.

Basically, I'm just trying to go with the flow...while avoiding the rip tide!

Wish me luck.

;)

Welcome to Brooklyn

2006-09-02T23:18:00.000-05:00

Wow...I'm writing this from my apartment in Brooklyn! The last few weeks have been crazy...I have tons of stories to write about...but I'm short on time. It took some time to remember how to relax, but once I got there...it took some time to get back in the swing of things!

And, I am definitely back in the swing!

It's Sunday night and I start my Internal Medicine rotation Tuesday morning at 9am. That's all I know about the rotation. The chief PA wasn't that friendly and didn't offer any other information. So, I just said, "See you Tuesday!"

I'm trying to stay calm. I am excited about it, but I really can't believe it's happening. So, I'm just going to go with the flow. I felt the same way when I first moved to Japan. Everything is foreign. Everything is new. And nothing makes sense!

And I did fine. (and that's what I keep reminding myself)

But, it would be good if I could actually find the hospital! It's only 5 miles away from my apartment...but I'm beginning to realize that 5 miles in the NYC metro area is way different than 5 miles in Suffolk County! So, tomorrow I'm venturing out to find the best route. I have options. Car, bus, subway.

I tried to get there today by car, but there was a festival on the street that I needed to go down. So, I tried to go down a different street but got caught up in "one-way" streets so I retreated back home.

So, that's my mission for tomorrow!

On The Horizon

2006-08-14T22:32:00.000-05:00

I start my first rotation 3 weeks from tomorrow. I have a list of things that I need to do before then. I have piles of notes stacked up in my room that need to be filed. It's about 3 feet tall! I have some books that I should read and I have to check out the apartment that I'm going to be living in. Yeah, I haven't seen it yet!

So, I think I'll procrastinate a little bit more and go away for the next few days and deal with that stuff next week. I'm not ready to face reality yet. It's that plain and simple. So I'm going to one of my most favorite spots in the world. Lake Wallenpaupack in the Pocono Mountains. My grandparents built a cabin in the late 60's and after they passed away their children have kept the place running. It's my happy place. I have so many fond memories...swimming in the lake, catching salamanders, getting lost in the woods, playing board games, lounging around without a care in the world. I haven't been there in a few years, so I'm really looking forward to it.

A couple of days in the mountains does wonders for my soul.

Wrap Up

2006-08-13T22:21:00.000-05:00

I had two exams on Thursday. I averaged about 4 hours of sleep every night that week and by Thursday I was shot. The first exam was Pharmacology and an hour later I had to perform a full physical exam on a "patient" (student) in front of a proctor. I was so exhausted by the time I did the physical exam that I forgot to perform some very basic, very important, very obvious physical exam maneuvers.

VITAL SIGNS.

Yup, I totally forgot to take my patient's blood pressure, pulse, and respiration rate. I knew I had forgotten something as I went along with my exam. About halfway through I realized it, so I started laughing and luckily the proctor did too. My brain was my fried and I apologized, luckily I've worked with this proctor before and she knows my capabilities...but it took me a few hours to get over that blunder. The funniest part of this whole story is the fact that I take my personal training client's blood pressure and pulse every few months! I use this as a way to monitor their progress...oops!

That will never happen again!

I left there and stopped off at a bar to meet up with some classmates. We were all a bit shell shocked and unconvinced that we actually finished didactic year. There was a lot of laughter but a couple of hours later when we all went our separate ways...there were tears. There is a definite sense of separation anxiety. These people did become my second family and I'm grateful for having such a good class. I looked forward to seeing them everyday...and that made all the difference in the world. I never thought I'd laugh so much in PA school. And that is what got us through.

Laughter.

I crashed for 3 hours when I got home. I woke up and wasn't sure if it was the next morning! I felt like I had been hit by a bus. It was only 6pm though and my family took me out for a ride on the boat to celebrate. Everything felt surreal, I still felt like I had to get home to study for something.

When I woke up Friday and realized I didn't have to be anywhere...I was able to exhale for the first time in weeks and relax. Well, try to relax. I packed up my stuff and headed for the beach. I stopped off at a drug store and picked up a PEOPLE magazine. That was a first for me...I was just desperate to read something mindless! I soaked up some rays, napped and swam for several hours. Came home and got ready for a party. A party with my classmates!

The party was a lot of fun. It's always fun to meet up outside of the classroom and meet everyone's significant others/friends. By the end of the night, we sat around an open fire and listened to music. And every few minutes someone would remark, "it feels so good to do nothing." We would all smile and then drift back off...

I spent the rest of the weekend over at Fire Island. I partied with my sister and some old friends from High School. I'm proud to say that I was at the bar for "last call!" I partied more this weekend than I have all year! It felt good...I needed it.

I deserved it.

The End...Is Just The Beginning

2006-08-10T19:58:00.000-05:00

I did it. It's done. It's over.

I rocked it.

Yes.

But...now what?

Sleep Deprived

2006-08-08T22:15:00.000-05:00

I can honestly say that this is the HARDEST I've ever had to work...EVER. It's about making the impossible, possible. And I'm 3 exams away from achieving that goal.

Sweet.

6 hours of sleep over the last two nights.

2 exams done, 3 more exams in the next 2 days.

And then I can sleep.

*yawn*

Shocking

2006-08-06T21:55:00.000-05:00

School ends Thursday!!!

Only 5 exams, 2 workshops and a psych presentation...in FOUR DAYS!

The amount of work still shocks me.

It always seems like it's an impossible feat.

Seriously. Shocking.

And then it's all done...and the real learning begins.

PDA

2006-08-03T21:01:00.000-05:00

Picking the right PDA is not an easy task. It takes a lot of time to research the products and then get up enough nerve to plop down several hundred more dollars on a device that everyone says you HAVE TO HAVE. Up until now, it's been books and study guides...now we're going high tech.

So, I did my research and opted for the Palm Treo 700W. Here's the link: http://web.palm.com/products/smartphones/treo700w/ It's got more features than I'll probably ever use, but it's a phone and computer device all wrapped into one. The less I have to carry...the better.

I started to download some software onto the device and I have to say it's pretty cool. It takes pictures, videos, and I can download music onto it. I can also surf the internet with it and write email. It'll probably take me months to figure out how to do all that stuff...but, it's pretty cool!

Heat Wave!

2006-08-03T20:32:00.000-05:00

They say timing is everything and this week, timing was not on my side.

The night before the Emergency Medicine final exam, our house lost electricity. Since this rarely ever happens, I figured that it would be back on within the hour so I decided that I'd go for a run to pass the time.

When I returned home and found that the power was not restored and the sun was quickly setting, I started to panic. During my run, I realized that it was only a small section of the neighborhood that lost power and not the entire county. So that meant that the rest of the class was most likely studying in their air conditioned rooms while I was slowly losing daylight and rushing around to find all my notes.

I retreated to my best friend's house. Yes, my best friend that had a baby 3 months ago. I tried my best to stay focused on studying, but who can resist a beautiful 3 month old baby that looks at you and smiles!?!?! My friend and her husband recently built a brand new house, so her husband set up a table for me in the baby's room to study. It was a really nice gesture but after 2 hours I was back on the couch with my girlfriend and the baby!

The power company told my family that the electricity would be back on by 12:30am. So, I left my girlfriend's house around that time and arrived home to total darkness. It was hot...really hot. No lights, no air conditioning, no fan...nothing.

I lit a few candles but that made it hotter, so I studied with a flashlight before passing out from the heat. It was an awkward, broken up sleep. The power came back on at 4am. I woke up at 8am and felt like I had been hit by a train. I was exhausted. I had 4 hours to cram Emergency Medicine into my head. I tried my best.

But...it was one of "those" exams. One of those exams that makes you feel like you haven't learned a thing since starting the program. One of those exams with innane, obscure questions that have little to do with real world medicine. One of those exams that when you go back to your notes, you realize that the answer is NOT even in your notes. It was just one of "those" exams.

It kicked my butt.

I came home afterwards and the power went out again! And then it came back on again and a few hours later...it went out again! I sat in the dark with an ice pack on my head with my new PDA/phone combo and "studied" using the Epocrates software I downloaded. Luckily, the power came back on by midnight and I was able to get some sleep.

It's been so hot that the NYS governor opened the state beaches for free today. The heat wave is supposed to break tomorrow...down to a more bearable 90 degrees?!!?

Preparing for 5 exams and a psych presentation next week will keep me busy indoors this weekend.

And right now...that ain't a bad thing!

What's Next?

2006-07-31T21:04:00.000-05:00

Final Exams:
Neurology
Psychiatry
Emergency Medicine
Gastroenterology
Nephrology
Surgery
Pharmacology
Physical Diagnosis Lab

Workshops:
Suturing
Casting/Splinting
Clinical Skills
Procedures

Research Papers:
Emergency Medicine: Meningococcal Meningitis
Psychiatry: Bipolar Disorder I & II

Presentation:
Psychiatry: Bipolar Disorder

**all within 7 school days!**

Fun in the Sun?

2006-07-29T13:15:00.000-05:00

It's a picture perfect summer day. 90 degrees, slight breeze, and not a cloud in the sky. I settled in to study for neurology, but can't seem to concentrate.

So, I'm going to the beach to read the 190 pages of powerpoint slides!

Fun in the sun has taken on a whole new meaning...

It's Pouring...

2006-07-28T11:29:00.000-05:00

I got a call today from the personal training academy that certified me several years ago. They asked me if I was interested in presenting a 3-hour lecture on HIV/AIDS and personal training.

I had a brief conversation with the director of the program several years ago about HIV and he expressed interest in having me present at a later date. Well, 5 years later I get the call.

Of course he called at one of the busiest times in my life!

When it rains...it pours.

Wow!

2006-07-27T23:46:00.000-05:00

I'm sitting here revising my EMED paper on Meningococcal Meningitis when I suddenly realized that today was the last official day of classes! Now all I have left are 8 final exams, two suturing/casting workshops and a clinical skills review.

Where did the time go?

Stuff

2006-07-24T21:49:00.000-05:00

I'm 99.9% sure that I'll be moving to Brooklyn come September. I was hoping to have the time to drive to Brooklyn to check out the apartment this week, but my schedule is packed since it's the last week of class. I've known my future potential roommate for a few years and I trust her. That's the key. Besides...it'll only be for 10 weeks. (I won't even write, "what can go wrong in 10 weeks?"...because I know better by now!) So, pretend you didn't read that thought!

4 more days of school!! Then finals begin. I found out that my third rotation will be Pediatrics and fourth rotation will be Long Term Care. I'm liking the progression...although I'm really nervous about Internal Medicine.

Last semester, our Rheumatology instructor told us, "Cross you fingers that you don't get Internal Med as your first rotation!" In reality, it's an excellent rotation to start off with. I was just hoping for a small office with one doctor...not a big hospital with different floors full of patients! And "rounds"...having to do rounds scares the beejeezus out of me. I sometimes have a hard time coming up with answers in front of other people...even if I know the answer, I'll stutter or give the wrong answer. I have to work on that...

In the meanwhile...I have no idea how many exams we're getting socked with in the next couple of weeks. I have to get back to focusing on the "little stuff" for now. Funny, how the big stuff is now the little stuff....with even bigger stuff on the horizon.

The real stuff. The really scary stuff. The life or death, this ain't no multiple choice test stuff!

The stuff that's going to pave the way to my future.

What have I gotten myself into now?!?!

;)

Brooklyn Bound?

2006-07-22T17:32:00.000-05:00

It's no secret that I've been spending the majority of my free time in Brooklyn over the last year. I've plugged George and Omar's restaurant, Bogota Latin Bistro (www.bogotabistro.com), numerous times in this blog. I've made many friends from my time hostessing, waitressing, managing, and flirting with the Mexicans! As a result, the opportunity to move to Brooklyn has presented itself. And I'm at a crossroads as to what to do.

The first offer came from the cutie patootie, 21 year old, Mexican cook. Although the thought of living with a cutie patootie that can cook is tempting...it's probably not the best move for me right now.

The second opportunity is to move in with a girl that I've known through George for a few years. She's a psychologist and waitresses part-time at Bogota. It just so happens that her roommate will be moving out at the end of August and her boyfriend is scheduled to move in with her the beginning of November. This leaves open the months of September and October. The same months that I will be doing rotations in Brooklyn and Queens. The timing is perfect and the details can be worked out.

If I don't move to Brooklyn, I will be commuting at least 4 hours a day. And the thought of that commute stresses me out. I'd much rather put my energy into learning and taking care of patients than recovering from frequent bouts of road rage!

I've got a week to figure everything out.

12 Days

2006-07-21T20:52:00.000-05:00

Just finished 12 straight days of class! I have been surrounded by my classmates for the last 12 days...and since I've been house/dogsitting for my aunt & uncle, I've seen my classmates more than my family! Many of our days have been really long...between 8-12 hours. But, there is a sense of nostalgia that is permeating the air now. With only 5 more days of class before the official start of final exams, the end is near. We can see the finish line now.

It is strange to think that I won't be seeing my classmates everyday after August 11th. We will have to report back to school once a month for "call backs". Basically, we go to school to take an exam based on the rotation that we finished. But, the insanity of what we've been through didactic year is coming to a close.

And although I cannot wait to get out of the classroom and get a move on with my life...(read: get one step closer to a paycheck!), I'm embracing the next few weeks. The last 3 weeks of didactic year.

Unbelievable.

BUSY

2006-07-14T13:22:00.000-05:00

This is what stands between me and finishing the didactic component of this program (August 10th):

2 weeks straight of classes because of an ACLS 2 day training this weekend!
2 papers
14 cumulative final exams
1 week of suturing, casting, splinting, charting, etc. (Transition Week)

Needless to say, I'm a little stressed out!

And this is what I have to look forward to:

1st Rotation: September 5th, Internal Medicine (hospital), BROOKLYN
2nd Rotation: October 5th, Primary Care (private practice), QUEENS

I live in Suffolk County, Long Island. I'm more concerned about the torturous commutes than anything else right now. At least 2 hours each way...at least.

I can't wait til vacation starts August 11th!

I need it.

Who Let The Dogs Out?

2006-07-01T19:07:00.000-05:00

I left a BBQ party early to come home to study orthopedics on a Saturday night. When I arrived at home I realized that there was a block party around the corner.

So, right now, I'm listening to a DJ encouraging kids to scream at the top of their lungs with "Who Let The Dogs Out?" playing in the background. It's been the same song for the last 20 minutes...I think they're playing musical chairs.

At this point, all I can do is laugh...and fantasize about walking around the corner and unplugging the power cord.

PA School = Party Pooper!

Party Time

2006-06-29T21:53:00.000-05:00

Wow.

Our exam was changed from July 5th to July 3rd.

And we don't have class until 3pm on July 5th.

Party Time!

Top 5

2006-06-28T22:05:00.000-05:00

What am I going to do after I graduate?

That's the question that has been swirling around my mind lately. Will I specialize? If so, what specialty? Will I move out of NY? If so, where will I go?

I did some research and according to the AAPA (American Academy of Physician Assistants) this is where the money is:

Tope 5 States for New Grads
Nevada
California
Alabama
Massachusettes
Maryland

Top 5 States for Experienced PAs
Arkansas
California
Alaska
Nevada
Connecticut

Top 5 Specialties:
CT/CV Surgery (cardiothoracic/cardiovascular)
Dermatology
Neurosurgery
Emergency Medicine
Surgical Subspecialties

I wouldn't mind moving to California...that would bring me closer to Hollywood. So, I can be an extra on ER or Grey's Anatomy during my downtime as a Cardiothoracic Surgical PA.

Um...I'm working on Plan B. (and C, D, E, & F)!!!

Knuckleheads

2006-06-27T22:39:00.000-05:00

I am not a big fan of the 4th of July. Celebrating the Independence of America is great...but I could do without the knuckleheads that feel the need to blow things up.

But, I was looking forward to this year's holiday. One of my friends from class is throwing a party on the 4th. She started planning this party months ago and everyone from class is invited. We've all been looking forward to this party since we haven't really had the chance for everyone to get together for a "proper" college party. Yup...beer pong, keg stands, turbo cups, and jello shots were all on the agenda.

Well, we got our schedule for July today. There is only ONE exam scheduled for the entire month of July.

Guess when that is???

July 5th at 9am!

We offered to take the exam two days earlier than scheduled, but the admin refused. We got the same old speech..."We told you at the interview that you'd have to make sacrifices, that you'd be missing parties, weddings, funerals, etc. "

blah blah blah blah blah blah blah

Party or no party...I know I won't get much studying done on the 4th anyway! I'll be too distracted by the knuckleheads blowing up the neighborhood.

Geez, I can't wait until next year when I'll be treating these same knuckleheads in the ER.

Embryology

2006-06-21T20:33:00.000-05:00

Embryology is no longer part of the curriculum. I don't know when that changed, but many of our instructors would refer to embryology during second semester and we'd always respond with, "we didn't take embryology!"

After a few weeks, when a new instructor would refer to embryology, the class would laugh. It became somewhat of an inside joke for us.

About a month ago, the director of the program addressed our class and our concerns about our education. One of the students brought up the fact that every instructor was referring to embryology, yet it wasn't part of our curriculum.

Well, a few days later, the director sent us a memo letting us know that if more than half the class wanted to take embryology then he would set it up. Only a handful of people wanted to take the class but before we had the opportunity to vote...we were informed that there would be a mandatory embryology class. The catch is we wouldn't receive any credit for taking the class nor would it appear on our transcripts.

Needless to say, that didn't go over well with the class. It is a 4 hour class, which doesn't sound that bad in comparison to everything that we've been through. But, the class is broken up to 4 days of 1 hour classes. And before every class, we will take a quiz. Although we won't receive a grade OR credit for the class...we have to pass the quizzes.

So, we had our first embryology class last Friday and the instructor is a PhD. Semester 2 was all MDs and PAs....we didn't have any PhD faculty. And there is a huge...HUGE...difference. Basically, the MDs and PAs teach us what we need to know and the PhDs teach us everything we never wanted to know!

This class is out there. This class is totally irrelevant to everything that we've been learning. It feels like we're going in reverse instead of forward. It feels like we're being punished for speaking up. Yup....that's what it is....punishment.

We had our first quiz today. 10 matching questions in 5 minutes. I thought the prof was kidding...but, she wasn't. Matching questions usually aren't that tough...but these sure were! Although there were 10 questions...she gave 15 choices...and you could re-use answers. It was a nightmare...all the while she was counting down the minutes.

There were a lot of unhappy students after the quiz. And the student who initially brought the missing embryology class to the director's attention really should consider getting a bodyguard.

It's not solely her fault...but, sometimes you really, really, REALLY, have to be careful with what you wish for...

...I certainly wouldn't wish this class on anyone!

Senior Talk

2006-06-20T21:58:00.000-05:00

We had the much anticipated "Senior Talk" today. Some of the PA preceptors that we will be doing rotations with visited and gave us an overview of what the next year will be like. We were congratulated for making it to this point in the program and encouraged to continue being successful. At that point, we all smiled and patted ourselves on the back. But...that didn't last very long!

The meeting lasted about an hour and we were hit with a lot of overwhelming information. We received a list of all of the doctors and PAs that will be our preceptors. A lot of the offices/hospitals are located in Brooklyn and NYC. We were also given a procedure log that we need to carry on every rotation. There is a list of 17 required procedures and 7 optional procedures.

Here is the list of procedures (all must be completed 3 times).

Required:

Venipuncture
IV Insertion
Blood Culture
Arterial Blood Gas
Fingerstick
PPD/SC Injection
EKG
Nasogastric Tube Insertion
PAP Smear
Foley Catheter Insertion
Pelvic Exam
Rectal Exam
Dressing Change
Throat Culture
Suturing/Stapling
Splinting/Casting

Optional x 3:

Chest Tube Intubation
Endotracheal Intubation
Central Line Placement
Wound Debridement
Newborn Delivery
Removal of Foreign Body From Eye
Fecal Disimpaction

Of course the goal is to do every single procedure as many times as possible. As well as do any type of procedure that an MD/PA asks of you.

Every rotation lasts 5 weeks. Here are the required rotations:

Internal Medicine
Pediatrics
Emergency Medicine
Family Practice
Surgery
Geriatrics
OB/Gyn

We have to repeat one of the required rotations as well as choose one elective rotation (ie. psychiatry, dermatology, orthopedics, neurosurgery...basically any specialty/subspecialty of our choice).

At the end of the 5 weeks, there is an exam. You must pass the exam to move on to the next rotation. We will also be assigned a medical topic and have to present a powerpoint presentation to our classmates and faculty at some point during the year. There is also a required community service project of our choice that we have to complete (30 hours). And faculty will be visiting us at the hospitals/medical offices where we will present interesting patient cases including history and physical, labs, diagnoses, treatment (etc) to them.

When the meeting ended, there were a lot of blank stares and strained faces.

The guy sitting next to me whispered, "I'm scared!"

I let out a nervous giggle and winked...

"Me too...but don't tell anyone!"

On With The Show!

2006-06-18T22:00:00.000-05:00

School has been pretty slow and laid back lately. So, I've been taking advantage of the hot weather that's currently blanketing Long Island with my usual favorite outdoor activities...mostly rollerblading and basking in the sun. Although, thanks to my dermatology class...I've become paranoid about every freckle on my body. If I don't become a hypochondriac by the end of this program it will be a miracle!

This past weekend I travelled up to Ontario, Canada to attend a wedding. This wedding was unlike any wedding that I have ever attended. In fact, this wedding is considered illegal in the United States. But, 130 people from around the U.S. travelled to Canada to witness the marriage of two of my girlfriends from college. Same-sex marriages are legal in Ontario and many people travel there to get married, but according to the locals, a same-sex wedding of this size has never been seen. Local news reporters were even there to capture the event!

The ceremony took place in a hotel overlooking Niagara Falls. The site was breathtaking. Both of the bride's fathers gave heartfelt speeches at the reception, and there wasn't a dry eye in the house afterwards. So, in that sense...it was like any other wedding I've attended...

Love is love is love is love. Love is Love.

Overall, it was a great weekend spent catching up with old friends, partying like rockstars, and forgetting that I'm a PA student (thanks to the cute bartender at the Martini Bar!). I came back to school feeling refreshed, refocused, and excited to get on with the show.

11 weeks until rotations!

Still Here...

2006-06-14T21:30:00.000-05:00

Well, I just realized that it's been a while since I've last written. We're finishing up week #2 of the final semester of didactic year and it's been pretty much uneventful! At this point, not much phases me. Classes have been cancelled and added at the last minute and our schedule for June has been revised five times already (that's a record!). So, it's hard to plan anything outside of school.

There are a few weekends where we have class on Sundays. That is irritating when there is plenty of time to fit it in during the week, but for whatever reason...we have to be there...on Sundays in the Summer. (bummer)

The best decision I made in choosing a school is choosing one close to home. I live about 15 minutes away from campus and my gym is located in between. Some students travel as much as 2 hours (each way) and I would have gone insane by now. Sometimes we'll have up to 6 hour breaks and I can't sit in the library and study all day.

I've been doing a lot of rollerblading lately and I validate that by listening to lectures as I work up a sweat. Or I go to the gym and read my notes while doing cardio. Or in my car at the beach or boat dock. This week it was warm enough to sunbathe and study at the same time! Always a multi-tasker, I will basically find any excuse to avoid sitting at my desk lately.

Another reason why I can't stand studying at my desk is because I've recently lost my email buddies. I had a few friends that I would consistently correspond with over the last several months. Some were email and others were through instant messenger. Some have gotten married, had babies, moved in with significant others, or simply faded. And these disappearing acts happened simultaneously within a few weeks time.

I didn't realize how dependent I had become on having friends to chat with while I was up all night studying. Most of them lived in different time zones so that always kept it interesting. I had friends in Italy and Japan that I would correspond with for hours on end. But within the last couple of months, things have changed. It's always an adjustment when your life steers in a different direction as your friends. That has probably been the most consistent development throughout my 20's.

Here today...gone tomorrow...life is constantly changing.

Life changes...but I still have studying to do! That has not changed. I can't wait for rotations to begin. I'm really looking forward to getting started and gettng a move on with my life. Things feel stale lately...somewhat stagnant. I know I am moving forward, but it feels more like I'm treading water lately. That is why they say the third semester is the hardest, I'm tired of drinking from the fire hydrant. I'm ready to start using this information that has been crammed into my head.

I'm ready to hit the ground running...

Semester # 3!

2006-06-04T22:14:00.000-05:00

Tomorrow is the first day of the 3rd and final semester of the didactic year! I start rotations exactly 3 MONTHS from tomorrow!!! I can't believe how fast time has gone by!

I thoroughly enjoyed our one week vacation. The last week of finals really kicked my butt. It wasn't fun, but I got through it. And from what I hear, we didn't lose anybody...which is awesome.

We have 8 more weeks of classroom work and then I am apparently ready to take on some patients?!? I have the same feelings about starting rotations as I did a year ago before starting the didactic year. Anxious and scared are a given, but I really feel excited to get out and start practicing. I'm looking forward to seeing what opportunities I find and the different paths that present themselves...and the people that I will meet.

We start off this semester with a bang. This week we have three 12 hour days and that seems to be the norm throughout the month.

I'm looking forward to seeing my classmates again. I'm looking forward to learning again. I feel rested. My batteries are recharged.

Bring It On!

It Takes a Village

2006-05-26T22:45:00.000-05:00

It's Friday night and I'm totally exhausted. The week from Hell came and went...and I passed all of my finals! We didn't get our hematology grades back yet, but we were told that if we had failed, we would have been notified.

And I was not notified.

13 exams in one month. 6 of them were this week. Studying (cramming) a semester's worth of information into your brain the night before a cumulative exam, that would stand as your grade for the entire course, was daunting. And this happened 5 nights in a row!

It was a struggle to block out everything else going on in life to sit down and study a different subject day after day. Knowing that once you finished a 100 question exam, it was time to hit the books to tackle the next one. There was no time for distraction. No time for relaxation. No time to smell the roses. No time to simply have a bad day! I felt more like a robot than a human being as the week dragged on. A robot that had a few screws loose and was about to short circuit!!

The pressure over the last few weeks left me feeling really vulnerable and I found myself leaning on my family, friends and other classmates to help me get through it. Although I know that's a natural reaction to high stress and pressure...I don't like feeling that way. But, I'm lucky and grateful to those that stood by my side, listened to me and encouraged me.

It Takes a Village...and in my case...a village that spans the globe!"

Muchos gracias. Domo arigato gozaimasu.

Thank you very much!!!!!

Great Story!

2006-05-25T23:42:00.000-05:00

Now this is a doctor that I wouldn't mind working with! (Although his buddies taking his blood should be wearing gloves!)

http://news.yahoo.com/s/ap/20060527/ap_on_he_me/surgeon_s_blood

Bloody Insane!

2006-05-24T12:59:00.000-05:00

This morning's Hematology exam was a mess. This is the third class that this instructor has taught us and his last three exams have been challenging, but fair. So, we weren't expecting a torturous exam. The first ten questions sent quivers throughout the classroom because you could hear people moaning and groaning.

We all left the classroom feeling the same way and saying the same thing, "I think I failed."

Unfortunately, those words came out of my mouth too.

There's no time to dwell on it though...cumulative dermatology exam 20 hours from now. It's rumored to be a very challenging exam...

...the insanity continues.

Halfway There...

2006-05-23T22:59:00.000-05:00

It's Tuesday and three exams are behind me...three more to go.

Surgery Part 2,
Physical Diagnosis,
Radiology.............................Done!

Tomorrow: Hematology (not fun)
Thursday: Dermatology (interesting)
Friday: Rheumatology (somewhat interesting)

The worst part about finals week is the lack of sleep. It's the lack of sleep that exacerbates the anxiety, fear, tension...that leads to panic, tears....and more tears! Cramming a semester's worth of work into your brain the night before a cumulative final exam that accounts for your entire grade for the semester is INSANE. Absolutely insane.

This week has been the toughest week to get through since the program started. This finals week makes last semester's finals week seem like a cake walk. And I'm sure I'll be saying the same thing when Semester 3 comes to a finish. Word has it that next semester is harder b/c all of the exams are held to the end...and it's the summertime!

Summer + PA School = Lethal Combination

SADD

2006-05-20T18:53:00.000-05:00

I have diagnosed myself with a new disorder.

SADD

This disorder does not currently exist, but I'm sure every PA student in the country will back me up. Perhaps I'll write my senior thesis on this subject.

Springtime Attention Deficit Disorder (SADD).

I had no problem hitting the books in the Fall and Winter. But, ever since the birds started chirping...I have a much harder time concentrating on my studies.

Unfortunately, I think this disorder will carry through the summertime...

My motivation at this point is simple. I want to go to Washington D.C. for Memorial Day Weekend. If I pass all of my finals this week, I am off the following week. If I don't pass my finals, then I have to stick around to take a cumulative make up final. And that would ruin my plans for the weekend.

I basically only have one non-married girlfriend left in this world!! And she lives in D.C. We always have a great time together...and t-rex is definitely in need of some F-U-N!!!

6 more finals to go....

Commitment Phobia

2006-05-18T22:26:00.000-05:00

I can't believe that we finished our last class for semester 2 tonight!

Only 6 more exams (in 5 days) and then it's over! Unbelievable.

What's even more unbelievable is that I start rotations in less than 4 months! We were given a "wish list" a few days ago. We have to do 7 required rotations in family medicine, internal medicine, OB/GYN, pediatrics, long term care, ER, and surgery. Each rotation lasts 5 weeks. But, we also have to repeat one of the required rotations and choose an elective rotation. The elective rotation can be anywhere and doing anything. For example, forensics, plastic surgery, neurosurgery, cardiothoracic surgery, dermatology, psychiatry etc.

I was overwhelmed by all of the options and unsure of what elective I wanted to choose. The kicker was that the "wish list" is due tomorrow! Yeah, we were given 3 days to map out our future. We are able to change it as we go along next year...

So, for now I chose to repeat either primary care or emergency medicine. And I chose infectious disease, psychiatry, and dermatology as my three elective choices. We'll see how that turns out...I know I will be changing my mind often. I am somewhat of a commitment phobe!

But, that's the beauty of this profession...unlike MDs...I can change specialities throughout my career. I just want to make sure I get a very well rounded rotation experience!

Million Dollar Baby

2006-05-11T21:08:00.000-05:00

Going to the gym is my way of dealing with stress. 30 minutes on the arc trainer and life is good again! If I have extra time to lift weights...birds start singing and rainbows appear! As busy as the program keeps me, I still try to get there at least 3 times a week.

Last summer I took boxing lessons with some of the other personal trainers at the gym. I saw the boxing trainer trainer tonight and he started asking me about the program. I guess I sounded like a sissy, because he smirked at me and reached for his gloves.

He handed me the gloves and told me to start throwing punches. It felt good to be "back in the ring" again. We sparred together but he never actually hits me (hard, anyway). As we were sparring he kept yelling at me to keep my guard up. And he said something that really struck home..."Step into the Punch!"

"You know you're going to get hit and if you shy away from the punch, then you're going to knocked out! You have to step into the punch and take it. Then fight your way through it! Keep you guard up and step into the punch!"

So, I'm done being a sissy with this school stuff.

My guard is back up, and it's time to start stepping into these punches!

T-rex

Welcome to Hell!

2006-05-09T23:14:00.000-05:00

So the feeling I had a few weeks ago that I was just going to cruise through the rest of the semester has been obliterated! There is a lot of stuff going on within the program and as a result, they've added on two more exams. Basically, the admin "forgot" to give us the surgery mid-term! So, now they added on that exam as well as another pharmacology exam. Apparently, the admin "forgot" to put antibiotics on the exam we took the other day. So, they're throwing together another exam for that.

Of course my class wasn't going to take this without a fight. So, the director of the program addressed the class and apologized for the miscommunication and carelessness of the staff. He also opened up the floor to hear all of our criticisms and concerns about how things are going. There are a handful of instructors that do not take their job as seriously or as professionally as we (as a class) would like. So, once that was revealed, I was surprised that the director actually took it to heart and promised that he would look into it. He is the type of guy that you DON'T want to get in a confrontation with!

He came back and addressed the class again the next day and told us that he is addressing all of our concerns. He even typed up a 3 page memo detailing the changes that he's making in the program. He also asked us to type up an anonymous letter with any other concerns we have about our education and the instructors. I was impressed...very, very, very impressed.

He went on to tell us that we are an exceptional class. He said that some of our concerns are the same as previous classes and that some of our complaints are common at all PA programs, especially at this stage in the game. But, he said that our class approached the issue professionally and that he is pleased with how well our class gets along and at how well we are all doing. Apparently, the senior class does not get along and they have a lot of problems. Our main class is next to the director's office and he says that he never heard so much laughter coming from a PA class before. There were other experienced instructors in the room that agreed with him.

So, that was very encouraging. But, then he went on to talk about the summer semester and our rotations in September. He went on to tell us that we are in HELL and will not be getting out of it anytime soon. He sympathized with our situation by acknowleding the stress we are under and the fact that unless you've been through this process you don't/can't truly understand it. The truth of the matter is that it's only going to get more intense, especially when rotations begin.

I tried to walk away from the meeting focused on the good stuff that was highlighted. But, it is getting tougher in the sense that we all feel like we don't know a damn thing. And they tell us that is exactly how we're supposed to feel. But, that is NOT a good feeling! As much as I enjoy learning about medicine, there is a constant, nagging, feeling of vulnerability and insecurity. And the realization that all of this training (torture) is for a J-O-B!

I know things will get better again once we get through the next 2 weeks, but we're all freaking out. We're all questioning the process. We're all wondering how and why we got ourselves into this in the first place! So, we moan and groan and tears of frustration are pretty common. The thought of keeping up this intensity for the next year and a half is daunting. Knowing that it will get worse come September is downright frightening! But, as a class, we pick each other up and that is really what keeps us going. That is what keeps me going. I also bank on the satisfaction that will come when I start treating patients. It's a short program, but a long road to travel.

And right now we're traveling over some bumpy ground.

A Glimpse of the Finish Line

2006-05-09T22:57:00.000-05:00

Semester 2 Completed Classes!
Cardiology
Pediatrics
Pharmacology
Pathology
Pulmonology
Ophthalmology

Final Exams on Deck:
OB/GYN
Lab Medicine
Radiology
Surgery (2 finals)
Hematology
Rheumatology
Dermatology
Physical Diagnosis

The Simple Life

2006-05-08T22:30:00.000-05:00

I was talking to a friend the other day about how I feel like the weight of the world is back on my shoulders. He questioned why I felt that way and I didn't really have an answer. Besides the 10 final exams that are waiting for me, life is good. But, there is a heaviness that comes with this program, with this responsibility...with practicing medicine. And some days that heaviness simply wears you down.

But then my friend broke it down for me, in very simple terms. "You will study, you will pass these exams, and then you'll start the 3rd semester. You will study, you will pass exams, and then you'll start your rotations. You'll study, you'll pass your exams, and learn during your rotations. And then you will graduate, and study, and pass the board exam. And then you will work as a PA."

I couldn't argue with him, because he was right. But, it does not feel that simple. There is so much to learn about medicine and it's impossible for one person to know it all. And therein lies the responsibility...the heaviness.

On the flip side, if it were that simple...I wouldn't be interested anyway!!

Semester 2 Countdown

2006-05-02T23:14:00.000-05:00

I really cannot believe that Semester 2 is coming to a close. Three finals are done...only 10 more to go!!

This week was a rough one though. I spent the majority of the week recovering from a stomach virus. That was not fun and it made last week's jet lag seem like a piece of cake! When you're not feeling great, it's hard to focus on anything...especially studying.

Today was our Pediatrics final exam. I did really well on the first two exams but I had a feeling that this exam was going to be a doozy. And, although my gut was out of whack this week...I was right. One of the best things about my class is that we all seem to react to the exams in the same way. And it feels really good when you walk out of the classroom and see your classmates in the hallway with expressions on their faces that match exactly how you're feeling.

After several minutes of moaning, groaning, and bickering about answers, we wind up laughing at each other and at ourselves for the different reasons why we chose an answer. My personal favorite is, "when in doubt...pick all of the above!" We've learned by now, that life goes on after ridiculous exams...especially on Fridays when Happy Hour begins at noon!

I have learned some very useful skills over the last few weeks. I've learned how to insert foley catheters, nasogastric tubes, and draw blood. Learning how to draw blood has been my least favorite experience. I do not have a problem dealing with the sight of blood...as long as it's someone else's blood! I do not like to have my blood drawn. I do not like needles going into my own arm. And I do not like having students practice drawing blood on my arm!

I was lucky though since my partner was an experienced phlebotomist!

Trust me, that was not a lucky coincidence! ;)

Scrubs

2006-05-02T22:05:00.000-05:00

If you took the cast of Scrubs and filmed them during the didactic year of medical school, you'd get a really good sense of what it's like to be in my class! Tonight was yet another episode full of laughter!

We had two hours of Physical Diagnosis lecture tonight and the MD featured the entire two hours on the RECTUM. Normally this MD gives us powerpoint handouts, but tonight he told us that he just wanted us to sit back and learn by observation. Yup, that meant that we looked at slides of different rectal disorders for 2 hours!!! It was downright disgusting!!!!

The doc lecturing us has a great sense of humor so that encouraged the other comedians in the class to bring it up a notch. I laughed so hard that tears were streaming down my face.

It's nights like this that carry us through...

2006-04-30T18:23:00.000-05:00

Last week was a long week but I got through it and the jet lag is gone. But, I'm still getting to bed before midnight and I'm kind of liking the extra sleep! I wound up doing really well on the cardiology and ophthalmology final exams. Which is ironic since I didn't study as much as I usually would for them. So, perhaps I don't need to study as much as I think I do?!?! (wouldn't that be nice?)

We got our May schedule and the semester ends on the 26th. We have 12 final exams to get through in 26 days! At this point in the game, I'm not even phased. We do have 5 exams back to back in 5 days though, so that will be rough no matter what. But, all things considered I feel like I'm on auto pilot now and cruising through. I'm not saying it's gotten any easier, but I know what to expect at this point.

I really enjoy being around my classmates, we're a quirky bunch, and that makes all the difference in the world. When things get ridiculously stressful, someone will break the ice and make us laugh. Spit balls and passing notes has become a favorite pasttime. Before I started the program, I never would have thought that spit balls would be part of the equation! But, when you're bombarded with 9 hours of lecture, day after day, your brain turns to mush and wacky things start happening. And I wouldn't have it any other way...until, of course, I get nailed in the head with a spit ball!

So, I get a week off in between semesters, then it's full throttle until August 10th. Then we actually get a 3 week vacation before clinical rotations start September 5th. And although the thought of rotations is scary...I'm ready to move out of the classroom and into the field. They say the first year is learning how to pass exams in order to pass the PANCE (PA National Certification Exam). And the second year is when the real learning begins. All of the MD and PA instructors keep reiterating that medicine is not learned from a book...it's learned in practice. And, quite frankly, I'm ready to start practicing!

But, before I get to that hurdle I have get through the next 12 exams!!!

Un Dia Sin Inmigrantes

2006-04-30T13:11:00.000-05:00

Wow. I apparently missed a lot of news while I was away.

I'm tempted to skip school and show support for the "Day Without Immigrants" rallies planned across the country. Or perhaps I'll just boycott big business for the day.

I'm hoping that a lot of good comes out of these demonstrations.

Every girl has a dream...

http://news.yahoo.com/s/ap/20060430/ap_on_re_us/immigration_boycott_day

Jet Lag Recovery

2006-04-24T19:07:00.000-05:00

I will never complain about last minute scheduling changes again!! (yeah, right!)

Well, luck is on my "Jet-lag recovery" side. Today's opthalmology exam was fair. And our Dermatology class from 4-8pm was cancelled! Then we were informed that our Cardiology final exam was being rescheduled for Wednesday morning! Apparently, the MD forgot to fax the exam to the office before he left for his Las Vegas vacation!

Thank God MDs are human!!!

This gives me another night to get back on track. I'm finding it really odd that I've been in bed by 10pm and up by 6am every day...I know that's normal for most normal people...but, it's really odd for me. Especially since I'm studying early in the morning instead of late at night.

But, I'm sure I'll be back to my normal 2am, lights-out, routine by the end of the week.

Oh, there's also a rumor that we will be getting a 3 week vacation in August...right before we start our clinical rotations in September!

I'm already trying to figure out where to go next...

Post-Nippon Blues

2006-04-23T20:26:00.000-05:00

My trip to Japan was wonderful. Unfortunately, I do not have the time to write about it. Which is a real shame. I have two exams over the next two days and Jet Lag is kicking my butt. It's always harder coming home...even harder trying to study!!!

My greatest piece of advice to prospective PA students has been to simplify your life as best you can. Well, my trip to Japan blew open the doors I had steadfastly closed shut for the last couple of years. Now that they're open, I'm not so willing to close them back up.

I'm distracted. I'm daydreaming. I'm totally preoccupied. I'm longing for another chance to go..."on the road."

I did have a lucid nightmare in Japan, about showing up to school totally unprepared for an exam. So, school was never too far from my mind. And I know that once I see my classmates tomorrow, reality will sink in and I'll get back into the race.

But, for now...I'm dreaming of cherry blossoms and clinging to the love that radiates from a country 6,000 miles away.

Most things in Japan get "lost in translation"...but love never does.

It just never does.

Full Circle

2006-04-10T11:12:00.000-05:00

I've been pretty busy studying and preparing for my trip to Japan. By preparing, I mean bringing over enough "omiyage" (gifts) in order to make sure I don't offend anyone. I basically have to bring a gift to every home that I visit...and it's also wise to have some extra gifts handy just in case I wind up somewhere unexpected (like back at the school where I used to teach etc. )

I've been really enjoying getting to know my classmates. First semester was about surviving and proving to myself (and others) that I do indeed belong there. Second semester has been about stressing less about passing tests and more about strengthening bonds with people in the class. Before you start PA school, everyone tells you that your PA class will become your second family....and that truly is the case once second semester rolls around.

I feel as though the experiences I've had in the past are definitely carrying me through this semester as well as enriching my life as far as being able to connect with others. My experiences traveling the world is on top of the list. My Cambodian classmate is going back to Cambodia during spring break but must fly to Vietnam first. I've been helping him out with his plans. He originally planned on crossing the Mekong Delta in a canoe, but realized over the weekend that because of the "Dry Season", there's not enough water to carry him over and walking it would take too long. My father bought him the Lonely Planet travel "bible" on Cambodia and I sat down with him this morning and we mapped out a plan for him. It's also a much safer plan than the one he originally proposed. There are still plenty of mines that haven't been detonated in the forest between Vietnam and Cambodia...something he hadn't considered.

I also have a classmate that was a corpsman in Iraq. He saw a lot of death and destruction and he asked me about my father's experiences in Vietnam. So, I showed him an article that I wrote about my father's trip back to Vietnam in 2000 and now they're email buddies.

My experiences working for an AIDS organization has given me the opportunity to work more closely with some of the administrators/instructors of my program. I've been asked to help out in finding a Doc/PA/NP to come in and teach our class about HIV medications. I'm also hoping that I will be able to lecture my classmates on HIV/AIDS disease progression and dispelling the myths that still surround HIV. Unfortunately, some of the experienced medical professionals that have taught us about HIV are addressing topics insensitively and misinterpreting the laws regarding partner notification.

So we'll see how that goes...

I've got one more exam and three classes to get through before I can focus on my trip! I'll be up late Tuesday night packing....then heading to the airport Wednesday morning. I'm psyched about this trip. I've had my head in the books for the last 8 months and I need to get a grip on the BIG PICTURE. Leaving the U.S. always does it for me! I did have a hard time making the decision on whether or not to go...but I've definitely learned that I function better when I have more stuff on my plate. And my plate is definitely full...2 exams the first two days after break!!

But, I have two 14 hour flights....that's plenty of time to study!

This is my time to get back to living my life...

DVT

2006-04-03T21:40:00.000-05:00

So we're sitting in Pathology class and the prof is talking about DVT (deep vein thrombosis) and his example for DVT was, "a passenger on a 14 hour flight to Tokyo is at risk for DVT!"

I cracked up laughing and so did my friends around me. Although I have no other risk factors for DVT, it's definitely going to be on my mind. I'll be the annoying passenger telling others on the plane to walk around!

I have 4 exams to bulldoze through before I leave next Wednesday! Exams have been going really well and I'm encouraged by the fact that most have been board exam scenarios. I cannot believe the amount of material we have blasted through over the last 7 months...it's enough to make my head spin.

And it's enough to give me insomnia. Other than that...things are well.

I'm hoping jet lag will cure me!!!

Japan Bound

2006-04-01T00:15:00.000-05:00

I bought my ticket to Japan!

Japan Bound!!

2006-03-31T23:44:00.000-05:00

We finally got our April schedules...on March 31st. Waiting for the following month's schedule is perhaps the most frustrating aspect of my program. Especially when spring break is fast approaching!

I knew the dates of spring break, but I didn't know the exam schedule. To my surprise, April looks like a manageable month for exams. However, 2 more classes were added on: radiology and hematology. But, we're finishing up pathology and cardiology soon.

I've been weighing the pros and cons to taking an impromptu trip to Japan all week. The most obvious con is jet lag. BUT...I haven't slept well since the program began back in September!!! So, I know I can deal with it.

After I booked my trip, I felt relieved and excited! I have received welcoming emails from my friends in Japan. All I really want to do is visit the people that became my second family while living 3,000 miles from home. Life in Japan can be a very isolating experience. If you want a glimpse as to what I'm talking about, rent the movie "Lost in Translation".

When I decided to extend my teaching contract for a second year, I decided I would really focus on solidifying my relationships with my Japanese friends and surrogate families. And that decision has brought many blessings into my life.

And that is why I want to return to Japan.

Spring Break

2006-03-29T00:30:00.000-05:00

Big decision to make.

Spring break is quickly approaching. I've been thinking about going to Japan to visit my friends and "family" for some time now. I met some amazing people during the two years I lived there and it would be somewhat of a homecoming for me. I left Japan in 2000, visited in 2003...and it's now 2006.

My former JHS students are now in college! More friends have gotten married and more babies have been born.

And I'm a PA student.

It may be time to introduce the Japanese to the PA profession...

OB/GYN

2006-03-28T12:41:00.000-05:00

When it comes to OB/GYN...ignorance is bliss!!!!

OB/GYN

2006-03-26T21:41:00.000-05:00

We have an OB/GYN mid-term on Tuesday. During class today (sunday class, mind you)...the guy sitting next to me whispered, "I think I have PMS!" He was studying the OB/GYN notes and told me he was suffering from the following symptoms:

Weight Gain
Headaches
Irritability
Aggression
Tension
Anxiety
Depression
Lethargy
Insomnia
Appetite change
Loss of concentration
Poor coordination
Clumsiness

Although these are all somatic/psychological symptoms of PMS, I opted to diagnose him with the most obvious differential diagnosis: PA School Blues. Then I swiftly reminded him that his symptoms will resolve in 18 months. Unlike the rest of the females in the class...

But, perhaps that is why there are more females in PA school these days.

We're genetically programmed to handle the recurring and unrelenting stressful symptoms of both PA school and PMS!

Who knew PMS could be such a blessing?!?!?!