Updates

Hello November...so nice to see you!

I'm counting down the days to the end of the semester. I'm amazed at how quickly time has passed. We have been extremely busy lately, as usual. And grades are on the rise! Woo-hoo!

So, what's been going on? Well, lots! We began our POME module two weeks ago. This is our version of problem-based learning, where we are given a chief complaint and must come up with a differential diagnosis and primary diagnosis with only the use of a history and physical exam findings. I love learning this way! It forces you to commit to a disease process, even when you don't have all the answers. It forces you to think. It forces you to ask yourself some serious questions. The bottom line is you must know your diseases. If you don't know a disease exists, you won't consider it. You must know how to perform a thorough physical exam. If you don't you will miss important findings that may steer you in the wrong direction. And finally, you must know how to take a good history. It's true when they say that most diagnoses can be figured out based on the history alone!

This weeks' CC was abdominal pain. As a class we rattled our brains to come up with diseases that would manifest in abdominal pain: neoplasm, GI bleed, acute pancreatitis, Ulcerative Colitis, Crohn's, AAA, pyelonephritis, peritonitis, appendicitis, ishcemic bowel, biliary ostruction, cholecystitis. We ended up with 99 potential diagnoses! We were split up into three groups and were given a history based on the questions we asked. If we didn't ask the question, we didn't get that part of the history. The next day in lab, we asked for physical exam findings. I'm happy to say that our group got the diagnosis correct. I'm even happier to say that the correct diagnosis, acute pancreatitis, was my primary diagnosis even before getting physical exam findings. The history was textbook acute pancreatitis! I love this stuff!

I think what I love most about PBL is the feeling of really becoming a clinician! PAs are sleuths, detectives, investigators. They ask questions, and use their senses (ears, eyes, nose, etc.) to detect disease. It's amazing what we are able to do without the help of sophisticated diagnostic equipment. Thank goodness we have it to confirm our suspicions, but we do quite well without it most times.

We had no class last Friday, so salsa was definitely on the list of things to do last weekend. And Salsa y Control, Boston's top salsa crew, came through to give workshops and to perform. I had a ball, and I shared a dance with both brothers! AMAZING! A few dancers from neighboring states came by also, and I got a chance to dance with brand new dancers...and they were fabulous!!! It's always fun meeting and dancing with new people.

Two exams down this week, and one more left to go tomorrow. The next few weeks should be smooth sailing, but the weeks leading towards finals week will be hellish for sure. I look at it as my rite of passage. If/when I emerge victoriously, I will have 6 whole weeks of bliss to look forward to. I can't wait!

RIP Dame Joan Sutherland

One of the most beautiful voices of our time. It's amazing...I told a friend the other day that the legends are leaving us. It's bizarre because although I never saw Sutherland live, I always considered her a great talent. She will be sorely missed.

Ace in the Hole

Just completed my first clinical medicine cardiology exam, and I must say I killed it! Feels good...especially when I've been bombarded with one to many C's lately. I don't like C's.


I am in need of a serious break. I'm looking forward to tomorrow night. One of the local salseros is moving up and out to pursue his dancing career. He is a fantastic lead and I've been privileged to dance with him many times in social settings. It's always a great dance. I hate to see him go. He's one of the few On2 dancers we have here, and it sucks because the On2 scene can't grow without On2 dancers. Oh well, I won't be here forever. I'll finish PA school, head back to the South, and I'll have my fill of On2 dancers!!!! Speaking of which, the Atlanta Salsa Congress kicks off tomorrow. Damn it...I wish I could go! It's sad, really...after a year and 1/2 of dancing, I've never been to a Congress. I'm hoping to make my way to one very soon. Maybe I can schedule on of the clinical rotations based on the congresses going on around the country. I better get on that soon!

Well, back to the books. Another test awaits me tomorrow, and then 5 exams next week. Looks like it's gonna be a long weekend.

Staying Alive...

...and doin' a pretty good job of it, too!

It's another gloomy day here in the Northeast. Lots of rain, very little sun, but lots of things to do to keep me busy. Honestly, this semester is flying by. October is soon to arrive, and before we know it, December will be here. I'm looking forward to a break already!

The weeks thus far have been insanely busy. We were warned in advance that Fall semester would indeed be the busiest. They weren't lying. This week, for instance, started with a Pulmonary exam, class from 8am to 9pm, practical exams today and tomorrow, a cardio exam on Thursday, and a Hem/Onc exam on Friday. Next week we have 6 exams and 1 practical exam.

For the readers out there who are beginning the application process, or for those who have been accepted and are awaiting the start of their program, be mindful of the commitment you are making. PA school, though not the be all-end all of life, will be your top priority...but only for a while. There are some semesters that are easier to manage, and others where you feel you are drowning in information. I'll be the first to admit that my grades this semester are nowhere near where they have been in the past. I've come to love B's, and I don't stress out about the ten-point quiz that I fail. Of course, those A's do wonders for one's ego! I'm being honest....you learn to pick and choose your battles. For me, I choose to spend my time on pathobiology, anatomy, pharmacology, clinical medicine, and procedures. If I know these things pretty well, I should be able to work through most problems I encounter in a hospital setting. PA school is not about being the perfect A student. It's about making it through, learning as much as you can, and knowing how to APPLY what you learn to a real patient. I'm truly looking forward to clinical year.

Another thing: If you find yourself unhappy with your program, the instruction, the professors....by all means LEAVE! Don't ever forget the following words...

You applied, you accepted the invitation, you decided to attend. And only you can decide to stay. You will be among the same people and work with the same instructors for the next 2 and 1/2 years. Why be miserable? Do yourself, and those around you, a favor and just leave. Why be unhappy? Why complain? Complain after you leave. I know...you're thinking, "But I want to be a PA and this is my only shot." Wrong. Just apply to a different school and maybe things will be different there! (yeah, right!)

I'm sure some of you current PA-S can relate.

Ok, folks. I aced my practical today ( btw, it was genital/rectal exams and Pap smear). Time for some much deserved rest and relaxation.

The Future of Opera

Hey gang!  I’m exhausted.  I’ve spent the last 12 hours on campus studying for a boat load of tests and practical exams.  But before I retire, I thought I’d stop by for a quick rant that has absolutely nothing to do with medicine.

I love opera.  I love classical music.  It has been a love of mine for many years.  I’ve spent more than a decade devoting my time and energy to perfecting and cementing techniques that take years to comprehend, let alone practically apply.  I no longer sing for a living, but I am a singer.  I no longer create music for others to enjoy, but I am a musician.  My body was my instrument, and I took great pride in producing  the type of sound that did not depend on a microphone for amplification.   I did my best to become the character I was portraying.  I knew every word of every language I sang in.  The emotion I conveyed stayed true to the lyrics and the music.  More importantly, I listened and studied the great artists.  I watched them and emulated them (sometimes to the detriment of my own technique).  More importantly still, I had a one of a kind vocal coach/teacher (the combination is quite rare) who was  master and teaching the Swedish/Italian school of classical singing.  Moreover, she was a master at teaching me.  She gave me what I could handle at the time.  She never pushed my voice.  She always encouraged me to ease into heavier repertoire.  She never hesitated to steer me clear from things that would hinder my progress.  She believed in me and my talent.

The title opera singer is being tossed around a lot these days.  Let’s be clear:  dressing up in fancy costumes and expensive clothing and singing song from operatic works does not make you an opera singer;  being young and cute and charming does not make you an opera singer; sounding like an adult singer (even though the sound is being manufactured) when you are only ten years old does not make you an opera singer.  It boggles my mind that people who have never stepped foot inside an opera theater, or couldn’t name one member of the Bel Canto Trio, or name the principal characters in Die Zauberflote (or the composer for that matter…and this is one of the easy ones) are judging the talent, or lack thereof, of these “opera singers.”  Are these performers singers?  Absolutely!  Are they opera singers?  Not in the least.

History lesson, folks!  The great opera singers-Caballe, Callas, Di Stefano, Nilsson, Gigli, Bjorling, Ludwig, Fischer-Dieskau, de los Angeles, Verrett, Sutherland, Carerras, Flagstad, Milanov, Gedda, Ghiaurov, Caruso, Galli-Curci, Pons, Grist, Horne, Sills, Corelli, et al (notice I did not mention Pavarotti’s name…he’s great, but there are so many others that are overlooked)- these are opera singers.  Study them.  Listen to them.  Watch them.  This is what the classically trained voice sounds like.  Now, compare and contrast.  Put any of the above in a concert hall, and they would rip the paint off of the walls with no microphone.  Put today’s “opera singers” next to any one of the above, and you wouldn’t even know they were singing.  Theatrics are great.  A cute face and a smile is great, but it does little to mask the fact that you’re simply going through the motions, and playing on the emotions of an ignorant audience. 

Now, I’m not referring to the vocal talent of these “opera singers.”  In fact, I think they are talented.  They would do well in amateur competitions, karaoke nights at the local bar, and Christmas sing-a-longs.  There are many people who have good voices.  There are very few who have operatic voices.  This takes training…and from what I hear, every single “opera singer” today lacks the training.  If your ear is trained to hear it, you will pick up on a myriad of things:  chest breathing with a closed pharynx, pulled down pharyngeal posture which creates a low soft palate, flat/retracted tongue posture, and poor breath management.  Simply put, you have bad crooning!  What’s worse is many of these things can shorten the life of the singing voice.  This is horrible to think of when you consider some of these “opera singers” have barely begun to live life.

The future of opera is bleak.  It’s full of watered down singers who shove mics down their throats.  It lacks the grandeur of the old days when you could walk into the theater one way, and walk out of the theater a changed human being.  Life changing performances are still occurring.  I recall my account of a concertized version of Dr. Atomic that I entered here a few years ago…changed my life!  It’s these emotional journeys that make music so precious.  Taking a score written 2 centuries ago, performed a million times, and transforming it into something brand new!  I get chills just thinking about it.  I fear these kinds of performances are becoming more extinct as time goes on.  It’s ok!  Go ahead and cheer on these “opera singers.”  I’ll keep listening to the legends!

Sunday Morning

Good morning, readers!

I love Sundays. I usually sleep in late, wake up and prepare a delicious breakfast, and lounge around until late afternoon. Not so today. There's just too much work to be done. And I'm loving every minute of it. And I'm happy to be enjoying it as much as I am, because if I weren't, I'd have some serious thinking to do. Yes, PAs make great money. Yes, PAs get to "help people." And they get to do things to other human beings that most will never do. But there isn't enough money in the world that could keep me here if I were miserable!

It just hit me last week that in less than 9 months, I will inside an office or hospital somewhere dealing with real patients. They will be sharing intimate information with me, and they will instill a great deal of trust in me. They will disrobe and allow me to see them and touch them. They will listen to what I say as if it is law, and they will follow whatever regimen I prescribe, many without hesitation. What an honor, what a gift! I believe it was the cardio lecture last week that really got me thinking. Our adjunct instructor, who is an internist, impressed on us the importance of reading, researching literature, and learning as much as we can NOW. He stressed the importance of touch, and explained how therapeutic it is for patients. He stressed the importance of listening (the overwhelming majority of patients can be diagnosed simply from taking a great history and performing an excellent physical exam). He stressed the importance of good physical exam techniques. This is the time to absorb as much as possible, because once out in the field, there is no going back. It's important to learn now, to set a strong foundation now.

I didn't come to PA school to become an average practitioner. I came here to be the best!

One Week In...

...and we've hit the ground running...sprinting!

18 credits, 8 classes, early mornings and late nights. I practically live in the library. But I feel like this is the semester when things will start to come together. I'm already beginning to connect the dots between my current classes and classes I took two semesters ago. It's amazing the volume of information you go through month after month, but as I go along, I realize just how important it is to revisit the old handouts, powerpoints, and note cards to keep the information fresh in my mind.

This semester I plan to begin studying specifically for the PANCE. I've begun looking at a few test questions online, but have yet to purchase a review book. With so many choices out there, I'm reluctant to make a quick purchase. Any suggestions??