done with my night shifts. i really enjoyed them overall. learned so much from the doc. and i like being there at night. like a friend said- it kind of feels like belonging to a special club of especially tough and dedicated people. i got used to the schedule, too....got home about 6:30am each morning, saw my husband for maybe 30 mins. slept until 1 or 2 pm... woke up and cleaned the house a little or did some reading for a few hrs, saw my husband for an hour or two, then back to hospital by 6:30pm to do it all over again. i noticed i had more energy each night that i did it. the first morning, as soon as i got home I fell into a coma. the second night, (morning), when i got home i made breakfast, played w/ the dog, etc..and then fell into a coma. and this last night/morning, i could hardly fall asleep when i got home, i was still so wide awake. every morning when i left the hospital the morning shift was just getting there- all awake and chipper looking. nuts. that's the thing about 24 hr hospitals- it's never ending.
in the downtime...the quiet hours in the doctor's lounge, drinking coffee and chatting with the MD, dosing off now and then, i tended to drift into fantasies about what i was missing. mostly my warm bed w/ my husband in it. but it also occurred to me (in an alarming moment!) that if i worked this schedule all the time- when would i drink??!? i didn't want my nightly glass of wine when i got home at 7 in the morning w/ my cereal and i couldn't drink when i woke up, mere hours before going back to work....i felt a bit like an alcoholic when this realization caused me so much panic. ("fine, fine, fine, i'll work crazy hours, not sleep, and not see my family, BUT WHEN WILL I DRINK?"). i also started fantasizing about going to the beach, thanks to a Sandals Resort commercial playing on tv as i dosed off at 3am this morning. i even started looking up flights when i got home before i realized time and money are not on my side right now. (more reasons to drink).
i did make a few observations over the last few nights....
-went to a code (cardiac arrest) in the ICU and i shit you not, i counted 24 people in the room. nurses, residents, attendings, respiratory therapists, etc. they were all pretty calm...this was clearly routine...as they pushed drugs and did chest compressions. it was interesting to watch. i've bagged a patient once so far (we use an ambu bag to push air into lungs instead of having to do mouth-to-mouth), but haven't done chest compressions. guessing i will in ER. it's interesting to me that when patients are in really bad shape we rely on ventilators, vasopressors through IV, and all kinds of mechanical/chemical means to renew/sustain life...but when they are dying...heart stopped, breathing ceased- the best we have to offer is human contact w/ chest compressions. and that takes elbow grease. no machine for that.
-the nurses have started to look to me as if i have a clue. i'm sure someday i'll wish i had more respect than i'm bound to get as a PA, but now it seems like they give me more than i deserve as a lowly student. (maybe it's the tobacco pipe i keep clenched between my teeth at all times..maybe it makes me look too distinguished).
-it's amazing how many male sexual enhancement commercials there are late at night. evidently people stay up late thinking about their boner deficiencies.
Thursday, February 28, 2008
Tuesday, February 26, 2008
Night Shift (Unedited Emails to Myself Throughout the Night)
7:30pm: met the doctor i'll be working w/ this week and he's very kind, personable and seems to be a great teacher. i'm looking forward to it.
9:00pm: not much going on yet. answering calls and writing restraint orders, that kind of thing. getting hungry.
9:40pm: ate my leftovers. only 9 hours to go!
10:19pm: just had to "help" (watch/get in the way while the actual helpful people helped) intubate a patient who was going bad. 89 years old and about 100 pounds and wasting away. and full code. awesome. some other time for that ethics discussion.
12:02am: in negotiations with a very irritated patient who no one can draw blood on but who's potassium is through the roof. she's very savvy. using medical terms like "guide wire" and "contamination." been down this road a few times, i think.
3:10am: and i'm writing from the bathroom. my brain feels like a jello salad w/ bits of fruit hanging around but not offering a whole lot of content. mmm...i want whip cream. but maybe some cake to go under it instead of jello. i'm still off sweets.
3:27am: doc just told me I have good knowledge for only 2 yrs of study. tra-la!
3:35am: did you know that the ny times comes out to its on-line readers at 3am? geez. how much I miss from that which happens in the world after 3. maybe i'll actually read the articles since i'm here anyway and there's so much down time...instead of just skimming the headlines as
I usually do. I should definitely be more informed. man, i'm so pale. I need some sun. i'm practically transparent.
3:43am: getting kind of tired. want to go home and sleep. I wonder if i'd go to jail if I punched my dog like i've been threatening. she kept waking me up this morning whining....well, yesterday morning, i guess. she punches me all the time. when she gets excited, she prances and strikes out her legs. sometimes she hits me. she got me in the middle of my chest w/ a good right hook yesterday...(the day before? i don't know). I wonder what she's doing right now. sigh. i'm in the doctor's lounge in an extremely comfortable chair......i'll just close my eyes for a second.
3:46am: gary busy's crazy.
4:16am: just declared time of death on someone. i wonder if it will ever stop being eerie seeing dead bodies.
5:36am: lying on couch in doctor's lounge watching dawson's creek reruns on giant doctors' tv meant for news programming. i'm awesome.
9:00pm: not much going on yet. answering calls and writing restraint orders, that kind of thing. getting hungry.
9:40pm: ate my leftovers. only 9 hours to go!
10:19pm: just had to "help" (watch/get in the way while the actual helpful people helped) intubate a patient who was going bad. 89 years old and about 100 pounds and wasting away. and full code. awesome. some other time for that ethics discussion.
12:02am: in negotiations with a very irritated patient who no one can draw blood on but who's potassium is through the roof. she's very savvy. using medical terms like "guide wire" and "contamination." been down this road a few times, i think.
3:10am: and i'm writing from the bathroom. my brain feels like a jello salad w/ bits of fruit hanging around but not offering a whole lot of content. mmm...i want whip cream. but maybe some cake to go under it instead of jello. i'm still off sweets.
3:27am: doc just told me I have good knowledge for only 2 yrs of study. tra-la!
3:35am: did you know that the ny times comes out to its on-line readers at 3am? geez. how much I miss from that which happens in the world after 3. maybe i'll actually read the articles since i'm here anyway and there's so much down time...instead of just skimming the headlines as
I usually do. I should definitely be more informed. man, i'm so pale. I need some sun. i'm practically transparent.
3:43am: getting kind of tired. want to go home and sleep. I wonder if i'd go to jail if I punched my dog like i've been threatening. she kept waking me up this morning whining....well, yesterday morning, i guess. she punches me all the time. when she gets excited, she prances and strikes out her legs. sometimes she hits me. she got me in the middle of my chest w/ a good right hook yesterday...(the day before? i don't know). I wonder what she's doing right now. sigh. i'm in the doctor's lounge in an extremely comfortable chair......i'll just close my eyes for a second.
3:46am: gary busy's crazy.
4:16am: just declared time of death on someone. i wonder if it will ever stop being eerie seeing dead bodies.
5:36am: lying on couch in doctor's lounge watching dawson's creek reruns on giant doctors' tv meant for news programming. i'm awesome.
Sunday, February 24, 2008
OSCAR MADNESS
in case you didn't want to devote 7 hours of your sunday night to watching an awards show- i'll catch you up. i'm only including the awards that i'm interested in. if you're, like, a documentary film geek or something, start your own damned blog.
1. best picture- "No Country for Old Men." (i totally called it).
2. best actor- Daniel Day-Lewis in "There Will be Blood" (looking foxy, foxy, foxy fine)
3. best actress- Marion Cotillard in "La Vie en Rose" (as Edith Piaf- crazy broad parts always win)
4. best supporting actor- Javier Bardem in "NCFOM"
5. best supporting actress- Tilda Swinton in "Michael Clayton"
6. best animated film- "Ratatouille" (i concur)
7. best cinematography- "There Will be Blood"
8. best writing, adapted screenplay- "NCFOM"
9. best writing, original- "Juno" (the writer, Diablo Cody, has quite a past)
10. best directing- "NCFOM"
1. best picture- "No Country for Old Men." (i totally called it).
2. best actor- Daniel Day-Lewis in "There Will be Blood" (looking foxy, foxy, foxy fine)
3. best actress- Marion Cotillard in "La Vie en Rose" (as Edith Piaf- crazy broad parts always win)
4. best supporting actor- Javier Bardem in "NCFOM"
5. best supporting actress- Tilda Swinton in "Michael Clayton"
6. best animated film- "Ratatouille" (i concur)
7. best cinematography- "There Will be Blood"
8. best writing, adapted screenplay- "NCFOM"
9. best writing, original- "Juno" (the writer, Diablo Cody, has quite a past)
10. best directing- "NCFOM"
Wicked Good
great weekend. spent time with friends, enjoyed the sunshine out at the zoo yesterday (and in a dark movie theater today). generally feeling relaxed and happy. amazing how sunlight can make such a difference to the psyches of us human beans.
and i’m enjoying internal medicine now. i’ve seen a variety of conditions and am getting a little more comfortable in at least initiating medical care for new admits. this next week i’m working
i also just found out that one of my BFF classmates will be with me at the same hospital next month on my ER rotation. i immediately went into a daydream about us working side by side like a well-oiled machine, communicating complex instructions to one another with a mere twitch of an eyebrow, doing chest compressions on a patient across from each other and when we heroically revive the patient, giving each other a high five in slow motion over the patient’s chest while the nurses all clap…. i expressed this vision to my classmate and he said, “you know we’re not on a ‘Scrubs’ episode, right?” of course he’s right. it will be nothing like that.
(it will be exactly like that. i’m just sure of it. shun the non-believers).
i’m really hoping paul reubens wins best actor by a write-in vote.
Wednesday, February 20, 2008
Raindrops on Kittens and Whiskers on Roses
a better last few days. i'm feeling healthier and maybe sorta kinda getting into the internal medicine groove.
i'm working 3pm-11pm right now and i love the hospital when it's all dark and quiet and there aren't so many people bustling around. it actually has kind of a tucked-in, safe feeling after dark. at least at this little hospital. i spend most of my time admitting patients to the floor (either to a regular medical/surgical floor or to the ICU) from the ER. at night the ER is pretty consistently busy, which is fun. i should have known better than to expect the ER to be like how it seems on TV. first of all, unless it's a trauma 1 center (which this is not), you're not getting much mayhem. most of the time i am ruling out heart attacks and strokes, treating pneumonias, anemia...that kind of thing. there are patients in the hallways on stretchers and there's a lot of activity, but there's no gore or screaming and panicking and such. it's actually got a great rhythm. also, i know the PA service takes 2nd place to the residents, so it's likely that the more dramatic trauma cases get snatched up by them. which is fine. i'm learning a lot in how to manage the common problems.
and i always feared that i'd be responsible for remembering every evidence-based recommendation for each condition, but there are a lot of protocols we follow.... standard diagnostic screening and treatment approaches used across the country for various complaints or suspected ailments (based on the interventions that have been shown to decrease morbidity and mortality). for example, if you felt chest pain, you would (should) be treated pretty much the same way in any hospital across the US.
(side note: you all know that the first thing you should do at home if you feel chest pain is to chew a full aspirin, right? or the equivalent= 4 baby aspirin).
so i'm getting more familiar with how things are done and with some of the routine patient problems. the PA i've been w/ the last few days is very sweet and generous. and that certainly helps. i'm trying to cut myself more slack and allow mistakes. and occasionally i'm even getting some things right.
and working this shift means i get to sleep in in the morning, get stuff done during the day, and stay up really stinkin' late "decompressing" (ie: watching south park reruns). speaking of late....i'm off to sleep.
goodnight, intarweb.
i'm working 3pm-11pm right now and i love the hospital when it's all dark and quiet and there aren't so many people bustling around. it actually has kind of a tucked-in, safe feeling after dark. at least at this little hospital. i spend most of my time admitting patients to the floor (either to a regular medical/surgical floor or to the ICU) from the ER. at night the ER is pretty consistently busy, which is fun. i should have known better than to expect the ER to be like how it seems on TV. first of all, unless it's a trauma 1 center (which this is not), you're not getting much mayhem. most of the time i am ruling out heart attacks and strokes, treating pneumonias, anemia...that kind of thing. there are patients in the hallways on stretchers and there's a lot of activity, but there's no gore or screaming and panicking and such. it's actually got a great rhythm. also, i know the PA service takes 2nd place to the residents, so it's likely that the more dramatic trauma cases get snatched up by them. which is fine. i'm learning a lot in how to manage the common problems.
and i always feared that i'd be responsible for remembering every evidence-based recommendation for each condition, but there are a lot of protocols we follow.... standard diagnostic screening and treatment approaches used across the country for various complaints or suspected ailments (based on the interventions that have been shown to decrease morbidity and mortality). for example, if you felt chest pain, you would (should) be treated pretty much the same way in any hospital across the US.
(side note: you all know that the first thing you should do at home if you feel chest pain is to chew a full aspirin, right? or the equivalent= 4 baby aspirin).
so i'm getting more familiar with how things are done and with some of the routine patient problems. the PA i've been w/ the last few days is very sweet and generous. and that certainly helps. i'm trying to cut myself more slack and allow mistakes. and occasionally i'm even getting some things right.
and working this shift means i get to sleep in in the morning, get stuff done during the day, and stay up really stinkin' late "decompressing" (ie: watching south park reruns). speaking of late....i'm off to sleep.
goodnight, intarweb.
Sunday, February 17, 2008
Confessions of a Disgruntled PA Student
i try to stay upbeat on this blog. in fact, having this kind of public diary helps me focus on the funny, sweet things that happen during my days as a student and not dwell so much on my mistakes, errors in judgment and the insane volume of work i still have in front of me.
but i must confess in the name of being entirely forthright and in an attempt to demonstrate my experiences as they genuinely are.....this has been a rough couple of weeks. practicing hospital medicine for the first time (with really sick patients usually with multiple complicated illnesses) i am still missing things that i shouldn't be, still stumped on simple concepts and unsure how to proceed in many circumstances. when presenting cases or making a treatment plan, i say stupid, senseless things to my preceptors all the time and have no idea if they are as shocked by my ineptitude as i am, or if they're used to hearing dumb things out of the mouths of students. i hope the latter. i have this constant fear that i am the least competent, least intelligent of the bunch and that they might fail me from this rotation, from the school all together, possibly even from life. (alright, that may be a bit of an exaggeration. i don't think they can actually vote me off the life island. but maybe.).
it doesn't help that my head is still full of snot and so my thoughts are all coming through a cloudy haze. for example, earlier today while playing cribbage with my husband, i added up 7 and 9 and made 26. and a few days ago i could not for the life of me come up with the short, curly-haired actor who was the male star in "when harry met sally." so translate my bad math and weak movie trivia thinking to trying to recall detailed medical knowledge, and you can see how i've been in trouble. and it's not just higher thinking things like IV antibiotic dosing or grading a heart murmur or decubitus ulcer. oh no. it's stupid stuff like actually charting and then reporting to my preceptor that a patient had left middle lobe pneumonia. that would be fine and good if WE HUMANS HAD 3 LOBES ON THE LEFT SIDE. but we don't. there are only two- an upper and lower. and 3 on the right side. a foolish, rookie thing to say/write/think and should not be happening at this point in my education. how many chest xrays have i seen? how many times have i learned pulmonary anatomy and physiology? garh! why, brain, why? and why, mouth, are you an accomplice?
so anyway. it hasn't been a great period for my self confidence. but i'm sure it will get better. and that eventually my snotty head will clear up and i will think clearly again.
thanks for listening. and it's billy crystal, by the way. but i'm sure you knew that. (because everyone on the planet is smarter than i am. sob.)
but even when i'm feeling low....i can't help it- this always cheers me up.
but i must confess in the name of being entirely forthright and in an attempt to demonstrate my experiences as they genuinely are.....this has been a rough couple of weeks. practicing hospital medicine for the first time (with really sick patients usually with multiple complicated illnesses) i am still missing things that i shouldn't be, still stumped on simple concepts and unsure how to proceed in many circumstances. when presenting cases or making a treatment plan, i say stupid, senseless things to my preceptors all the time and have no idea if they are as shocked by my ineptitude as i am, or if they're used to hearing dumb things out of the mouths of students. i hope the latter. i have this constant fear that i am the least competent, least intelligent of the bunch and that they might fail me from this rotation, from the school all together, possibly even from life. (alright, that may be a bit of an exaggeration. i don't think they can actually vote me off the life island. but maybe.).
it doesn't help that my head is still full of snot and so my thoughts are all coming through a cloudy haze. for example, earlier today while playing cribbage with my husband, i added up 7 and 9 and made 26. and a few days ago i could not for the life of me come up with the short, curly-haired actor who was the male star in "when harry met sally." so translate my bad math and weak movie trivia thinking to trying to recall detailed medical knowledge, and you can see how i've been in trouble. and it's not just higher thinking things like IV antibiotic dosing or grading a heart murmur or decubitus ulcer. oh no. it's stupid stuff like actually charting and then reporting to my preceptor that a patient had left middle lobe pneumonia. that would be fine and good if WE HUMANS HAD 3 LOBES ON THE LEFT SIDE. but we don't. there are only two- an upper and lower. and 3 on the right side. a foolish, rookie thing to say/write/think and should not be happening at this point in my education. how many chest xrays have i seen? how many times have i learned pulmonary anatomy and physiology? garh! why, brain, why? and why, mouth, are you an accomplice?
so anyway. it hasn't been a great period for my self confidence. but i'm sure it will get better. and that eventually my snotty head will clear up and i will think clearly again.
thanks for listening. and it's billy crystal, by the way. but i'm sure you knew that. (because everyone on the planet is smarter than i am. sob.)
but even when i'm feeling low....i can't help it- this always cheers me up.
Thursday, February 14, 2008
Happy Freakin' Valentines Day
so flowers all over the hospital today. they were selling roses in the lobby for staff and visitors alike to give to their beloveds. and while i have the best sweetie on the planet and have no beef with love, i have never really gotten into this holiday. i think mostly it's because in high school they did a carnation fund raiser thing where you could buy flowers (to your credit or anonymously) for $1 each and have them delivered to your recipients during class at the end of the day by a cheerleader (i'm seriously not making this up). so, naturally, all the popular girls would end up with, like, 27 flowers each and be all shiny and chatty about secret admirers and stuff...and i would leave for home at the end of the day with one dying flower that i got "anonymously" from my best friend signed something like "From Your Loving Tom Cruise (you know Nicole has nothin' on your hot bunz)."
and thinking about high school got me thinking about how much my life as a PA student is so frighteningly similar to how my life was as a high school freshman. this morning i was on time (for the first time in...ever) for a grand rounds presentation. so i stopped and got coffee and a bagel, went to the bathroom, went to my locker and meandered down to the room where we were allegedly meeting. to my horror, all the lights were off and no one was milling around. a friendly janitor told me, "oh, no, dear, that meeting (read: geometry class) is always held in the other building (read: by the old gym, all the way across school)." so i'm flying through the hospital with my waaay too heavy lab coat (ie: backpack) stuffed to the brim with medical text books and cheat sheets, my stethescope, penlight and writing utensils and a few crumpled dollar bills (plus a huge wad of toilet paper to sop up my still draining nose) while precariously balancing my coffee and bagel and searching for my badge in one of my many pockets.
i get to the actual meeting many minutes late and have to take a seat by (OH GOD!) the residents, since all the med student spots are filled. all the residents are beautiful, obviously successful, collected, and casually chatting and laughing with the attendings. i want to date a senior varsity athlete, too!! i want to be hip and hip-ly laugh with the upper classmen/residents!!! only i can't. because i'm only a freshman. i mean a PA-student. and they get weirded out when i stand too close and laugh out loud inappropriately during their conversations. so the speaker speaks and what do you know? i sort of got it. i knew what language he was speaking. i can hang with the big kids. i'm hip. i'm cool...but then at the noon lecture...the one on the 'various types of DNA transcriptors found-in acute myeloid leukemia and the use of arsenic derivatives as treatment in china'-- where i appeared to be the ONLY person in the room not able to differentiate the little purple cell abnormality from the small violet cell abnormality on the slides, i felt less smart and more like a the eager but naive freshman.
even how i'm addressed is as demeaning as it was then. we were called "frosh" at age 14, now i am very often merely referred to as "student" and not by my real name (Dame Paddy).
the hierarchy of medicine is truly something to behold. this is a teaching hospital, so there are med students and residents and attendings all doing this little respect and power jig. the attendings pimp the residents, the residents pimp the med students (and i sit praying silently in the corner that they'll just let me eat my bagel in peace). the residents fear the attendings, the med students fear everybody...there's even unspoken rules about where people can sit during meetings and lectures, based on rank.
and medicine is known for its ruthless teaching style- "the Socratic method" is what it's diplomatically called. what it means is that you as the student will be put on the spot and made to sweat and will be grilled until you get something wrong and then either mocked for not knowing the answer or told to look it up and give a full report on it tomorrow. usually, both. but the idea is that then you will never forget that concept and will someday, in turn, pass the torch and teach your charges in the same manner. it's how it's done. my preceptors do this to me, too, just not in front of hundreds of people. it's fascinating to watch. especially as a PA student outsider. at these teaching events there are no other PA's or PA students, so i'm kind of an anomaly. but, they offer free food, so i'm a fat and happy anomaly. as long as i keep my head down and don't get noticed (or God forbid-called on!), i should be fine.
the rest of the rotation is going pretty well. i'm pimped by the PA's all day long and criticized for pretty much everything i say and do. but alas, that's life as a fledgling student in internal medicine. and at least tom cruise loves me.
and thinking about high school got me thinking about how much my life as a PA student is so frighteningly similar to how my life was as a high school freshman. this morning i was on time (for the first time in...ever) for a grand rounds presentation. so i stopped and got coffee and a bagel, went to the bathroom, went to my locker and meandered down to the room where we were allegedly meeting. to my horror, all the lights were off and no one was milling around. a friendly janitor told me, "oh, no, dear, that meeting (read: geometry class) is always held in the other building (read: by the old gym, all the way across school)." so i'm flying through the hospital with my waaay too heavy lab coat (ie: backpack) stuffed to the brim with medical text books and cheat sheets, my stethescope, penlight and writing utensils and a few crumpled dollar bills (plus a huge wad of toilet paper to sop up my still draining nose) while precariously balancing my coffee and bagel and searching for my badge in one of my many pockets.
i get to the actual meeting many minutes late and have to take a seat by (OH GOD!) the residents, since all the med student spots are filled. all the residents are beautiful, obviously successful, collected, and casually chatting and laughing with the attendings. i want to date a senior varsity athlete, too!! i want to be hip and hip-ly laugh with the upper classmen/residents!!! only i can't. because i'm only a freshman. i mean a PA-student. and they get weirded out when i stand too close and laugh out loud inappropriately during their conversations. so the speaker speaks and what do you know? i sort of got it. i knew what language he was speaking. i can hang with the big kids. i'm hip. i'm cool...but then at the noon lecture...the one on the 'various types of DNA transcriptors found-in acute myeloid leukemia and the use of arsenic derivatives as treatment in china'-- where i appeared to be the ONLY person in the room not able to differentiate the little purple cell abnormality from the small violet cell abnormality on the slides, i felt less smart and more like a the eager but naive freshman.
even how i'm addressed is as demeaning as it was then. we were called "frosh" at age 14, now i am very often merely referred to as "student" and not by my real name (Dame Paddy).
the hierarchy of medicine is truly something to behold. this is a teaching hospital, so there are med students and residents and attendings all doing this little respect and power jig. the attendings pimp the residents, the residents pimp the med students (and i sit praying silently in the corner that they'll just let me eat my bagel in peace). the residents fear the attendings, the med students fear everybody...there's even unspoken rules about where people can sit during meetings and lectures, based on rank.
and medicine is known for its ruthless teaching style- "the Socratic method" is what it's diplomatically called. what it means is that you as the student will be put on the spot and made to sweat and will be grilled until you get something wrong and then either mocked for not knowing the answer or told to look it up and give a full report on it tomorrow. usually, both. but the idea is that then you will never forget that concept and will someday, in turn, pass the torch and teach your charges in the same manner. it's how it's done. my preceptors do this to me, too, just not in front of hundreds of people. it's fascinating to watch. especially as a PA student outsider. at these teaching events there are no other PA's or PA students, so i'm kind of an anomaly. but, they offer free food, so i'm a fat and happy anomaly. as long as i keep my head down and don't get noticed (or God forbid-called on!), i should be fine.
the rest of the rotation is going pretty well. i'm pimped by the PA's all day long and criticized for pretty much everything i say and do. but alas, that's life as a fledgling student in internal medicine. and at least tom cruise loves me.
Tuesday, February 12, 2008
Aaaaaaaahsss.
that's how i feel. i've been sick with snotty nose, sore throat, big cough, headache. i slept for something like 16 hours today and still not feeling so hot. blah. you know that feeling where you want to spike one of those maple syrup collector-things into your sinuses and hang a bucket off of it to finally be rid of all the snot? that's how i feel. just drain me. and here i was feeling all cocky that i got through peds without catching any bugs. they were just collecting, joining forces for a full invasion. argh.
but i started my rotation this week and i think it will be good. a few weeks with the PA service doing admissions (histories and physicals), then a few wks w/ an MD following patients in the hospital and at his clinic. then a week of rapid response night call. which is perfect timing- because after that i'll go into a month of ER.
so i've been trying to brush up on ekg's in my haze. they no longer are going to allow me to be the amazing ekg-less PA student- evidently how the heart is working is sort of an important thing to examine. go figure.
i'll write more soon when i can breathe/focus my eyes/don't have 10 tons of snot welling up behind my eyes and pushing my brain out through my nose. plop.
how's that for graphic?
but i started my rotation this week and i think it will be good. a few weeks with the PA service doing admissions (histories and physicals), then a few wks w/ an MD following patients in the hospital and at his clinic. then a week of rapid response night call. which is perfect timing- because after that i'll go into a month of ER.
so i've been trying to brush up on ekg's in my haze. they no longer are going to allow me to be the amazing ekg-less PA student- evidently how the heart is working is sort of an important thing to examine. go figure.
i'll write more soon when i can breathe/focus my eyes/don't have 10 tons of snot welling up behind my eyes and pushing my brain out through my nose. plop.
how's that for graphic?
Wednesday, February 6, 2008
Why Become a PA? (When I Could Have Been a Mime)
so, off my sugar, but i'm doing ok so far. i don't have much time to eat in the hospital anyway, so i just kind of grab what i can, when i can. i have eaten something like 1500 free bagels from the residents' lounge in the last 2 weeks. and even if they're stale and the cream cheese might have turned, they're FREE, so they're delectable.
it's come to my attention recently that maybe i should 'splain the role of the PA in the medical world. it's a relatively new medical profession and lots of people still aren't sure what we do. if you haven't already at some point been treated by a PA, you will- since we are taking over the world. (mwah hah hah). i've never really talked about why i chose the PA profession or what PA's do among the other health professionals and some of you out there might be curious. maybe, with some clarification, you can share these insights with your friends. perhaps it will make for good party conversation or an excellent diversion when stuck in an elevator. if you have a lot of interest or are thinking about pursuing a PA degree yourself, or are shopping for a PA to use as your primary care practitioner, go to the national organization- aapa.org. tell them i sent you.
what a PA is: a licensed health care professional, practicing underneath the supervision of an MD. as a patient, you would never really tell a difference between an MD and a PA as far as what they do for patients- PA's do physical exams and diagnose and treat illness and injuries, order and interpret tests, assist in surgery, perform many procedures (casting, suturing, joint injections, etc, etc), and write orders and prescriptions (PA's have their own prescriber's ID, and the script also includes the MD's name and ID). PA's practice in many settings- they may work closely w/ their MD in a hospital/clinic, or may work autonomously (especially in rural settings) and just have an MD in the vicinity officially sign off for them. the exact scope of practice and prescribing rights varies state to state, but all 50 states do now have practicing PA's. a PA is similar (but not identical) to a nurse practitioner. NP's have been around longer and more people are familiar with them. they have a bit more independence than PA's do, but practice from the nursing model of medicine rather than the physician model, and have to have a bachelor's in nursing background instead of the varied backgrounds you find in PA's.
what a PA is not: not a doctor, not a nurse, not a nurse practitioner, not a medical assistant (an "MA" takes vital signs, gives shots, does filing/billing- it's 6 months of training without an undergraduate degree- totally different from a PA), not a scullery maid.
what is the training and what to call PA's: historically, the PA degree was a 4 year degree. now it's a master's, so it's 2-3 years in addition to an undergraduate degree. there are PA residency programs available post graduation, but most people don't do them. many patients have issue with not calling their PA "doctor" (many will do it anyway, no matter how many times we explain the difference). most PA's just go by their first name or by Ms./Mr. eventually, there will be a PhD upgrade option for PA's, which will make the whole confusion even more confusing. i think i will just have my patients call me "Paddy" for "practically-a-doctor"-dy. that should clear up everything. or maybe i'll get myself knighted by the queen so i can have the title "dame..."
what is the history of the PA: the PA role came about in the 1960's when practitioners were needed quickly to keep up with the patient demand. the first PA's were predominantly military personnel who had already been trained/worked in the field during Vietnam as medical corpsmen, and wanted to practice medicine upon return to civilian life w/o going through all of medical school.
why i chose to be a PA instead of an MD or a mime: in my previous career, i was already practicing in a hospital and didn't want to leave patient care long enough to go to med school (7-9 years of med school versus 2-3 of PA school). and i liked that PA's seem to have more time with patients, more opportunity to educate and care for them and don't have to worry so much about cost efficient practice as MD's do. also, the training is very practical- very nuts and bolts, daily practice stuff, and less germ theory and genetics and all the hard science stuff that MD's have to learn. and as far as job satisfaction- PA's are some very happy people. there is less liability, overall better hours and more flexibility as a PA than an MD. and good money for not all that much schooling. and i knew i could handle always ultimately answering to someone. i don't have an ego that needs total autonomy. and i decided not to pursue miming because, while i'm ok w/ hitting a glass ceiling, i didn't really want to be struggling to get out of an invisible box the rest of my life.
hope that helps!
it's come to my attention recently that maybe i should 'splain the role of the PA in the medical world. it's a relatively new medical profession and lots of people still aren't sure what we do. if you haven't already at some point been treated by a PA, you will- since we are taking over the world. (mwah hah hah). i've never really talked about why i chose the PA profession or what PA's do among the other health professionals and some of you out there might be curious. maybe, with some clarification, you can share these insights with your friends. perhaps it will make for good party conversation or an excellent diversion when stuck in an elevator. if you have a lot of interest or are thinking about pursuing a PA degree yourself, or are shopping for a PA to use as your primary care practitioner, go to the national organization- aapa.org. tell them i sent you.
what a PA is: a licensed health care professional, practicing underneath the supervision of an MD. as a patient, you would never really tell a difference between an MD and a PA as far as what they do for patients- PA's do physical exams and diagnose and treat illness and injuries, order and interpret tests, assist in surgery, perform many procedures (casting, suturing, joint injections, etc, etc), and write orders and prescriptions (PA's have their own prescriber's ID, and the script also includes the MD's name and ID). PA's practice in many settings- they may work closely w/ their MD in a hospital/clinic, or may work autonomously (especially in rural settings) and just have an MD in the vicinity officially sign off for them. the exact scope of practice and prescribing rights varies state to state, but all 50 states do now have practicing PA's. a PA is similar (but not identical) to a nurse practitioner. NP's have been around longer and more people are familiar with them. they have a bit more independence than PA's do, but practice from the nursing model of medicine rather than the physician model, and have to have a bachelor's in nursing background instead of the varied backgrounds you find in PA's.
what a PA is not: not a doctor, not a nurse, not a nurse practitioner, not a medical assistant (an "MA" takes vital signs, gives shots, does filing/billing- it's 6 months of training without an undergraduate degree- totally different from a PA), not a scullery maid.
what is the training and what to call PA's: historically, the PA degree was a 4 year degree. now it's a master's, so it's 2-3 years in addition to an undergraduate degree. there are PA residency programs available post graduation, but most people don't do them. many patients have issue with not calling their PA "doctor" (many will do it anyway, no matter how many times we explain the difference). most PA's just go by their first name or by Ms./Mr. eventually, there will be a PhD upgrade option for PA's, which will make the whole confusion even more confusing. i think i will just have my patients call me "Paddy" for "practically-a-doctor"-dy. that should clear up everything. or maybe i'll get myself knighted by the queen so i can have the title "dame..."
what is the history of the PA: the PA role came about in the 1960's when practitioners were needed quickly to keep up with the patient demand. the first PA's were predominantly military personnel who had already been trained/worked in the field during Vietnam as medical corpsmen, and wanted to practice medicine upon return to civilian life w/o going through all of medical school.
why i chose to be a PA instead of an MD or a mime: in my previous career, i was already practicing in a hospital and didn't want to leave patient care long enough to go to med school (7-9 years of med school versus 2-3 of PA school). and i liked that PA's seem to have more time with patients, more opportunity to educate and care for them and don't have to worry so much about cost efficient practice as MD's do. also, the training is very practical- very nuts and bolts, daily practice stuff, and less germ theory and genetics and all the hard science stuff that MD's have to learn. and as far as job satisfaction- PA's are some very happy people. there is less liability, overall better hours and more flexibility as a PA than an MD. and good money for not all that much schooling. and i knew i could handle always ultimately answering to someone. i don't have an ego that needs total autonomy. and i decided not to pursue miming because, while i'm ok w/ hitting a glass ceiling, i didn't really want to be struggling to get out of an invisible box the rest of my life.
hope that helps!
Tuesday, February 5, 2008
Happy Super Fat Tuesday
in case you live in a sad, pastry-less cave and are unaware...the above is a paczki (pronounced "poonch-ski"). it's a polish doughnut, traditionally served on fat tuesday (or fat thursday, in some parts) as a last minute treat before the Lenten fast begins on Ash Wednesday. it involves sugary goodness fruit or cream filling and a pastry crust which is sometimes enhanced with powdered or cinnamon sugar. the sweetness of the whole thing is cut with plenty of lard. so, if you're like me (and i know you are), today you indulged on paczki's, mardi gras booze, and sexual deviance as you prepare to settle in for the cold, dark, prudish months of february and march. i am giving up sugary foods starting tomorrow. it will be painful. perhaps more for those around me than for myself. i've been in a wicked crabby mood all week. this dark, gray, ecky weather gets me down. it feels like winter will never go away and the sun forgot us. (melancholy song inserted here). :(
and this last few days at the hospital has been kind of hectic, too. they've been long days and we've been busy. not only at the main hospital, but in out-pt dialysis units, the MD's clinic and another hospital in town, too. i'm learning so much, so quickly, but by the end of the day, my brain is mush. i have pages and pages of scribbled notes that i've taken as he's lectured to me. fluid and electrolyte formulas squished along side drug doses, differentials for different types of acid-base disorders, types of dialysis catheters and when to use them, what qualifies as chronic kidney disease versus acute and when to consider it kidney failure, what minerals to worry about at what levels and how to fix the abnormalities, how to determine exactly where in the renal system the failure occurred and the presumed causes, how to replace lost water volume, lost blood volume, etc, etc. ack.
and i so hate being wrong. and now not even having a good guess sometimes. the doc is so smart and so good at what he does, i'm often perplexed by his body of knowledge. his understanding of physiology is incredible and his recall of names, lab values, etc, is uncanny. he's often over my head, but i try to keep us. i think i'm putting a permanent wrinkle between my eyebrows as i constantly use my "i'm fascinated by what you have to say and you definitely did not lose me many minutes ago as you showed me how the Pythagorean Theorem explains that funky urine coming out of the lady in bed 303" furrowed eyebrow gaze.
i'm just tired. and grouchy. and now off of sugar. nice move. :)
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