Rotation 1: week 2

This week has proved to be the busiest so far. I've been challenged in lots of ways. More than anything, I realized just how much I have to learn.

This week I saw everything from hernias, irregular menstrual bleeding, and sore throats, to allergic drug reactions, abscesses, and alcohol-induced pancreatitis. I even got to do my very first Pap smear and male genital exam. Cool! The most challenging case of all was a follow up interview with a grieving mother who had recently lost a child. This job is A LOT more involved than I thought it would be, and I guess the lesson in this is that we as future PA's do a lot more than stitch people up and give meds.

Alaska is a beautiful place. Could I see myself living here? Maybe, but not year round. The patient population is exactly what I thought it would be, and I am so happy that I chose to come here. The detective will be here next week. I've been dying to get out and explore all that Alaska has offer. I can't wait to share this experience with him.

Stay tuned!

Rotation 1: week 1

My first week here in Alaska has been absolutely amazing.  Aside from the snow-capped mountains and gorgeous weather, I work with the most inspiring, intelligent people.  I have a total of three preceptors, but I am learning so much from all the staff members.  Each one is so eager to share whatever knowledge they have, and that certainly is enriching my experience here.

Juneau is a small, rural town with a population of about 30,000.  There is one 55-bed hospital, and there are no cardiologists or Ob/GYN physicians.  There are a total of two radiologists who read everything from mammograms to ultrasounds to nuclear medicine studies.  The family practice providers deliver babies, do pap smears, suture minor lacerations, and everything in between.  The family practice clinic is the one stop shop for all medical intervention not deemed an emergency.  And I am so fortunate to be rotating in this kind of environment.  To work here one needs to be a jack of all trades.  There really is no such thing as specialization.  Everyone trains to practice medicine outside of their expected scope of practice.  The amazing thing is they all do a hell of a job.  I’ve never seen such competency.  I feel honored to be working with such intelligent, educated providers.

I spend four days of the week at a local family clinic and one day of the week at the local hospital.  I didn’t expect to be thrown into the fire so quickly, but my preceptor seems to think I’m more than ready.  So far, I’ve given vaccines, removed skin tags, heard murmurs, done breast exams, and seen patients all on my own.  At the hospital I work with the radiologist and look at dozens of films, scans and nuclear medicine studies.  What an opportunity!  I’m having the time of my life! 

It has been a challenge integrating all of the information I’ve learned in the classroom and applying it to a patient.  For instance, a young girl came in complaining of a cough, SOB, fatigue, myalgias, and sputum production.  On physical exam, her breath sounds were equal on both sides, however I heard abnormal sounds on the lower right section of her posterior chest wall, the same location that caused her pain when I palpated.  In the very same spot I heard egophony, and this caused concern for pneumonia.  She looked and sounded ill, but not toxic.  In retrospect I should have taken more time to listen, but I knew the sounds were abnormal as soon as my stethoscope touched her back.  I presented my case to my preceptor, and she immediately diagnosed her with bronchitis/walking pneumonia.  Not bad for the first case of the day, but my differentials need a lot of work.  I should have had at least five diagnoses on my list. 

This weekend I intend to rest and study.  My body still has not adapted to the 4 hour time difference.  I really haven’t had time to adjust, but I’m so busy when I’m at the clinic that I don’t recognize just how tired I am.  I love learning and I love using my hands.  My preceptor said to me yesterday, “You’re going to love being a PA!”  She’s absolutely right!

Sleepless in Seattle, headed for Alaska

Jet lag can be a killer. Especially when you're running on two hours of sleep. To make matters worse, I don't sleep well on airplanes. I don't know many who do.

I am currently sitting in the Seattle airport. One more flight and I'll be at my final destination. I'm looking forward to settling into my apartment in Juneau and acquainting myself with the area. More than that, I'm looking forward to a good night's sleep. It's not that I'm nervous, or even excited. I think I'm too tired to be excited. This past week has been so very busy.

I have no doubt that Alaska will be a wonderful rotation. My preceptor seems excited to have me work with her, and I am looking forward to being exposed to a rural population unlike any other in the country. I am to arrive at the clinic every day at 7:30am, except for Thursdays. Every Thursday I am to report to the local hospital to work with the Radiologists there. I am really looking forward to this opportunity.

As I embark upon this portion of my training, it is my intention to relay my experiences to the readers of this blog as clearly and honestly as I can without compromising the privacy of my patients. I hope you will enjoy reading as much as I will enjoy sharing. I start Wednesday morning. Stay tuned!

One more notch in my belt

Just completed ACLS training this afternoon, and now I am ACLS certified! And I feel like I know absolutely NOTHING.

Perfectly normal feeling, right? Many of you who are well into PA school can attest to this, I'm sure. The more you know and learn, the more you realize just how little you do know. Today as we ran mock codes, I found myself stopping and thinking about the algorhythms (which have recently changed a bit), second guessing my choice of drug and doubting that the intervention I suggested was correct, all while the "patient" lay there dying. Talk about pressure. It didn't help that the instructor at my station was sharp as a tack and tough as nails. I always manage to get the BEST instructors who give just a little bit more education that what is called for.

Again, it's all about integration. How can I take this piece of information that I learned months ago and apply it to this new information today. It's like building blocks, really. This is when medicine becomes fun! I have some fun moments. Moments when answers to questions just fly out of my mouth without a thought. And then I have not so fun moments when the only words that come to mind are, "I don't know."

I have many reasons for being so excited about clinical year. First, I'm tired of the classroom. There's no real fun in learning lots of medicine if one can't practically apply it. I'm a hands on type of person, and I learn by doing. Second, I miss the patients. I love the interaction with patients and I miss talking with them and hearing the stories they tell. Third, I love to travel. I love moving around. I look forward to being in a new environment with new people every 5 weeks! We will see if I eat those words 2 months from now.

Good night, folks!

3 months in, 1 month out

Warning...this will be a long blog. Why? It's the least I can do for being away so long.

Hey gang! Wow...where do I begin? I can't believe I've let this much time pass since my last entry. I see I've gained a few more readers. Thanks to all of you who read the blog. I hope it is serving a purpose and answering questions. At the very least I hope it's allowing you to live vicariously through me while I journey through this thing called PA school. So, without further ado....

I'm three months in, and so far this semester has been another rollercoaster ride, albeit much easier than last semester in that I know what is expected of me, and I know what type of work ethic it will take to successfully complete it. The material is very interesting, and this semester we are really learning how to integrate. Early on the instructors stressed the importance of NOT integrating to avoid confusion. At this stage of the game, integration is key. Now I'm expected to take the anatomy I learned this time last year and apply it to the Neurology and Nephrology that I'm learning now. Not an easy task, but when it's done it makes learning a lot easier. Medicine becomes fun because you now are able to answer the most important question: why?

I'm enjoying the material for the most part. I would guess my weakest subjects this semester are endocrinology and neurology. My strongest subjects are nephrology, ortho, and EM. I've discovered that I'm really good with my hands and calm under pressure. I've also discovered that I need to work on developing a better differential list, and on my physical exam techniques. We all have strengths and weaknesses. It's important to acknowledge them, pat yourself on the back for the strengths, and work on the weaknesses.

Today we began our ACLS training. How exciting!! Recent changes have been made in BLS and ACLS, so we began learning the BLS changes (its CAB's now, and not ABC's), then we went on to learn how to intubate and place IO lines. Out of all the skills we learned today, I think intubation was my favorite. I got it in the very first time with no help, and the instructor praised me when I finished. Talk about an ego boost. Keep in mind, we practiced on dummies. Let's see how good I am when I intubate my first real patient...old school style, without a Glide-o-scope!

In the midst of studying for 3-5 exams per week, being in class from 4-8 hours a day, and having a social life, we've had to prepare for the clinical year, which officially begins one month from now. I'll be heading off to Juneau, Alaska to complete my primary care rotation. I can't express how excited I am about this opportunity. This is a wonderful site that will allow you to do what you want as long as you are competent and confident. I will be working both in the clinic and the hospital, and I'll even be working with the radiologist on occasion. I'll be sure to take lots of pictures, and if I remember to bring the appropriate equipment, I will post them here for those who are interested.

This blog will no doubt morph into something quite different as I embark on my clinical year. I plan on sharing as much information as I can with the readers here, being careful to maintain the anonymity of my patients. I'll let you know what I see regularly, and what I'm allowed to do. Something I would love to do is post student cases here. If time allows I will surely do that.

Ok...not much else to say other than have a good weekend, and if you're in the NW part of the country, try to stay dry!!

Let's get back to work

I've three more days before I board the plane that will take me back to PA school. These six weeks have come and gone so quickly. By far this has been the best school break ever. I think my mind and body were so exhausted; I definitely needed every hour, every minute of this break. Now it's back to work!

I've already outlined what lies ahead of us this semester. Looking at the spring calendar is like looking at the calendar for last semester. We'll be as busy as ever, but this time we know what to expect. I say bring it on!

Happy New Year!

Hey gang. I hope all is well, and I trust you all had a Merry Christmas and a wonderful New Year's Eve/Day. Time is just flying by.

I am officially a second-year PA student. In retrospect, I'm amazed that I have three semesters behind me. I've learned a lot, but there's so much more to learn, and now that clinical year is 5 months away I've got to kick it into high gear. What I love about my program is we have some say in where we want to go, and we are allowed to pursue preceptorship in any area of the country. The bad news is each and every one of my prospective rotation sites here at home have fallen through. But who cares! The great news is...

I'm going to Alaska!!

Our program is affiliated with a private Primary Care office in Juneau that has state of the art facilities: labs, micro, xray are all on site! They also have hospital privileges so I will have a chance to participate in that as well. Needless to say I am excited and appreciative. What a great opportunity this is for me. I will be the second student from my program to attend this site. The first student to go gave this site rave reviews, so I'm expecting to learn a lot. No word yet on any other rotation sites, but I feel like I will end up exactly where I need to be.

Now, the following is for any pre-PA students out there. Repeat after me: there are no shortcuts. There are no shortcuts. One more time...There are no shortcuts. Good!

I recall mentioning this before, but it bears repeating. PA school is a well demarcated path etched in the road. There are many side paths that feed into it, but there is no one way that will get you to your destination (a seat in PA school) the fastest. There are no shortcuts. Yes, PAs make a comfortable living and they are an integral part of the healthcare system, and they get to wear the cool white coat. Before you can begin to enjoy these perks, you've got to get your "C," and before you get your "C" you've got to graduate and pass the PANCE, and before that you must do well in your respective program. And in order to do well in your program you must lay the ground work.

There are many common threads floating around on the forum as of late, the most common being "What are my chances," and "Am I competitive." The most recent one to irritate the heck out of me is "Which schools don't require HCE." My response is if you don't have the time to acquire direct HCE you may want to reassess your goals. I have personally journaled my experiences in the unit where I racked up my hours, and you can refer to the 2009 entries to learn more about it. It sealed the deal for me in more ways than one. Not only was I touching patients, sticking them, drawing blood, run EKG's and do preliminary interpretation, doing wound dressings, talking one on one with patients' families, doing post mortem care, and drawing flushes for codes, I got a chance to stand bedside as I watched lines being put in and ventriculostomies being performed, and in my down time I read SOAP notes, learned how to read a basic chest xray, read lab values, etc. You can't begin to understand how this has helped me during didactic year. And I bet I won't truly appreciate my time on the unit until I reach clinical year.

The question is do you want to hit the ground running or do you want to play catch up? When questions like this come up, it screams that many of us coming into this profession don't know its history. No one expects you to know it all. No one expects you to be a PA on the first day of PA school. Knowing the basics, however, goes a long way in prepping you for success during didactic year and clinical year, and it just might help you land the job you want once you graduate. It's a snowball effect. Ok, I'm done.

I have two weeks left until we start up again. I am renewed and refreshed, in part because I know this is my last semester in the classroom. I couldn't be any happier about that! I miss the patients.