When I Grow Up

my dreams for my life have changed some since i was a wee tot, but not much. this is my career process, over my life so far....what i wanted to be "when i grow up"...

*age 4= my mom

*age 6= ballerina or doctor

*age 9= ballet is too much work and your feet get all mushed, horse racing jockey or doctor

*age 10= too tall to be jockey, how about a gymnast? dolphin trainer? or doctor

*age 12= too gangly and uncoordinated to be gymnast, dolphins smell bad, how about a movie star? or doctor

*age 15= too dark and mysterious to want to be in film, how about a stage actor? or doctor

*age 16= not digging the science and mathy classes, prefer the brooding theater ones, actor

*age 18= evidently actual talent is needed to succeed in theater and i like poor people but don't want to be one, social servant

*age 23= love working in the hospital but tired of being social slave, how about a doctor?

*age 24= part time science classes going pretty well, under a surgeon's wing, how about a surgeon?

*age 24 and 2 minutes= DO YOU KNOW HOW LONG IT TAKES TO BECOME A SURGEON?? how about a nurse? or a respiratory therapist? or a physician assistant? hmmmm.....

*age 25= starts PA school, in admission essays described interest in surgery but unsure of what discipline for sure, PA of some sort

*age 26/27= found niche in Ob/Gyn, likes all parts of it, including surgery, Ob/Gyn PA

*age 27, yesterday= accepted position in general surgery w/ a focus on Ob/Gyn cases, Surgical PA


so....in a lot of ways, this is full circle for me. working in the medical field, where i originally wanted to be. back to surgery, which i loved from even before i started my PA training...it's an incredible opportunity and offer. and i put this extremely difficult decision in God's hands, and i'm totally confident that He dropped it on me. it's awesome. and i plan to pursue my women's health training both in the OR cases i get at this job and through volunteer/part time work elsewhere... and possibly will still pursue a residency in the future.

we'll see.

but for now, i'm just so content and happy. and blessed. and the job is such good hours, so flexible, and such lovely boat loads of money that i might be able to buy a racehorse or a dolphin to fulfill some of my other dreams. and i still kind of want to be my mom when i grow up, for the record.

:)

It Hurts So Good...

...that i'm celebrating/decompressing by drinking a bottle of cheap white wine on my couch while watching "hellboy."

it's been a long, long, long few weeks. i've marched out my professional suit and smile so many times the suit's starting to smell like stink and i have charm permanently etched into the corners of my mouth. i'm so tired of talking myself up...i can list my best qualities alphabetically, chronologically, however you want 'em ( a is for ambitious, b is for bright, c is for calista flockhart, or i was potty trained at 6 weeks, learned to ride a bike while simultaneously throwing flawless sutures at age 4, graduated from harvard cambridge yale medical law school at age 15, and so on).

but things are going really well. i'm getting these generous, amazing offers from the interviews i'm going to (no doubt, if my resume is padded like all that, right?). i'm totally geeked- but they're all different enough that i have a lot to consider before i make a committment. stressing, but good kind of stress, i guess. it's like, "do you want this pile of awesomeness over hyah, or would you prefer this pile of rad over hyah?" so all's well, just nerves flying all over the place as i make this tough decision.

quickly over the course of this series of interviews, i've discovered that not only are people not worried about my ineptitudes like i am, but they are actually trying to win me over and to convince me to come to their practices! that's wild. i keep thinking, "i don't have to beg or bribe you, AND you want to give me HOW MUCH money? are you sure?" i hope my poker face isn't revealing these thoughts too much. but man, alive. i think all this sweating over the books over the last few years was worth it.

What now?

just finished my surgery interview. i think it went....oh, i don't know. it was scary. first in front of an HR rep for an hour then in front of a panel of 3 PA administrators for another hour. i wonder if they could tell i was terrified, or if i hid it well.

and if i get it...what then? what do i do- which job? AAAAAAHHH!!!

but it seemed likely that it will be one of these two jobs. not just because they are awesome opportunities....but also because i spilled some "green machine" health drink on my suit pants as i was leaving the hospital. and i really hate dry cleaning.

but just as i was about to hang my soiled suit up until years from now when i have occasion again to go through this painful process, i got a call from a residency program interested in interviewing me, and another call from a local private ob/gyn interested in interviewing me. so i'm of course also looking at these options- although might be interviewing pantsless. that would certainly make me stand out from the other applicants, wouldn't it? maybe i'll borrow some tap shoes from someone and some shiny tights and really complete the picture. maybe not.

so the questions is- what do i want to do? what am i willing to do? what will propel my career forward in the direction i want?

shel silverstien says i'll know what's right...and that it's ok if i don't wear pants...or shoes, maybe.

"Tryin' On Clothes"

I tried on a farmer's hat.
Didn't fit...
A little too small--just a bit.
Too floppy.
Couldn't get used to it.
Took it off.
Tried on the dancer's shoes,
A little too loose.
Not the kind you could use
For walkin'.
Didn't feel right in 'em.
Kicked 'em off.
I tried on the summer sun.
Felt good.
Nice and warm--knew it would.
Tried the grass beneath bare feet
Felt neat.
Finally, finally felt well dressed,
Nature's clothes fit me best.

-Shel Silverstien

The Bloodsuckers Sucked a Little Less This Time

i gave blood again. i've been avoiding the red cross people at all costs since my last draining (experience). but some how they found me hiding under the bed and convinced me that we're in a state of EMERGENCY right now. and since the patients i take care of at the hospital rely on many bags of blood every day to survive, i do feel some social responsibility as a healthy citizen to do my part.

so since i had a short day at the hospital today, i decided to go give blood. a few hours before i went, i worked out at the gym for a wee little while...and then panicked that i dehydrated myself and that they would have to squeeze me like an under-ripe fruit again to get any blood out. so i drank my weight in water, ate all the salty protein-y food i could find in the house, and thought lots of happy zen blood flow thoughts.

and it worked. on my first fateful visit to the vampire den, the coven of witches came over to fiddle w/ my blood bag about 40 times before they finally disconnected me, all the while berating me for not having had enough water during the day. it took so long, i thought for sure they were filling their gas tanks with my life juice.

but today, whether it was because my pressure was up a bit, they were more competent or just not as evil, everything went smooth sailing. the one and only time they came over to check on me it was to take the needle out and send me home. even the oreo cookie snack pack seemed bigger this time.

so just wanted to give you some follow up from my previous post on the subject. my fellow americans, (and occasionally canadians, when you accidentally stumble across my blog- Eh to you, too, there!) it is the right and honorable thing to donate blood. and if you don't otherwise have high blood pressure problems, i recommend eating a bag of pretzels and a gallon of water before you go. your pump will work much better if you do. :)

update on PA stuff: a surgery interview tomorrow and will decide on job by the end of this week most likely. crazy stressed. the oreos helped.

Medicine Shmedicine

as obsessed as i've been with specializing in the treatment of the fairer sex, i have to say that i've really been enjoying internal medicine this summer. (internal medicine just means primary care for hospitalized patients- you're usually the ring leader monitoring and treating the basic issues (diabetes, hypertension, etc), ordering consults from the specialists when needed, and kind of in charge of the patient's hospital course).

i think i have my rhythm down. i'm getting pretty good at diagnostics and guessing in the ballpark what appropriate treatment plan to order. i'm still off on med dosing sometimes by a scary amount (i wrote for 32mg of something the other day, should have been 4, for example- what? so sue me! no one died!)...but so far i've either caught myself or been gently (indeed) corrected by a nurse or MD. my trusty PDA isn't always so trusty. i'm glad nursing and pharmacy will be checking and balancing me while i'm still getting it down.

while i don't want to do this everyday for the rest of my life, there are some really neat things about medicine and some amazing moments that i've shared in my time in the hospital. (by the way, "medicine" refers to all fields of primary medicine-family, internal, etc, as opposed to a specialty or surgery or something. the first time i heard a PA say, "i never thought i'd go into medicine, but here i am" when referring to how she chose her area of practice, i thought, "now that's odd...didn't you know when you started PA school that you'd be studying medicine? did you think it was, like, clown school or something?). aaaaanyway.....

certainly some encounters stand out.

i have a little sheet of notebook paper i've kept on my desk since my ER rotation that, in my hurried handwriting, says "THERE IS BLOOD IN YOUR STOMACH. WE'RE TAKING IT OUT WITH THAT TUBE. LEAVE IT ALONE. YOU'RE GOING TO THE ICU TO GET A BLOOD TRANSFUSION. YOU ARE VERY SICK. YOU ALMOST DIED." i kept the note, but i would never forget this patient anyway. he was a 19 y/o kid who had snorted so much heroin he had massive internal bleeding, was going into shock, and had completely lost his hearing. i will always remember his wide-eyed terror as he tried to pull his nasal gastric tube out and asked "am i going to be OK?". i keep the note to remind me that even on my dumb days, i have my moments. i was the only 'staff' in the room who had the common sense to, instead of just shouting louder when the kid shook his head and insisted he couldn't hear anything we said, got out a pen and paper and started writing to him, asking him the pertinent ??'s and trying to answer his. i may not have known what meds to push or how to intubate him, but i did know how to get through. and i guess i'm proud of that. something to hang onto.

i've had a few other moments that also felt like things are coming together for me. i've made a few pretty astute observations and diagnoses lately and i've had a few patients over the year who have gotten attached to me or i to them. we have one lady right now who is in a deep funk and in serious trouble medically, but who lights up every time i enter the room- we laugh together even while she's being dialyzed (kidney failure- machine does what your kidneys can't), on a rescue breathing machine, and dealing with pain from all the various surgeries she's endured. again- she's complicated, has a lot that needs to be tended to...which i'm starting to know how to tend....and she needs some kindness and attention...which i certainly know how to provide.

so i guess i like that things are making more sense to me and i'm more useful. (even though some days i'm still just a scut monkey). i'm again, over and over, so glad that i chose to become a PA. it's pretty darned cool.

One Down

i get all worked up for interviews and then i usually do just fine. today's went well. i feel really blessed to have opportunities like this available when i'm out looking-even if they're few and far between. i think they liked me....but you never know. i might have squealed "I LOVE OBGYN! PICK ME! PICK ME!" one too many times. i'll have to wait to hear from them before i party like a rock star (when i actually do get a job i foresee hanging goats from chandeliers, trashing hotel rooms, snorting human remains, things such as these).

i'll keep you posted....


addendum: 3 hrs after i left the interview they called with a job offer! i couldn't be more excited. i don't know a lot of details yet (HR to contact me) but i am skipping around the house never the less with a big stupid grin on my face.

hide your goats.

And Now for Your Viewing Pleasure

to celebrate my 100th post and being exactly 4 weeks away from graduation, i am submitting to you, my dear bloggies, some hilarity. go forth and be merry whilst i go to 2 very important interviews this week. i am both scared and super excited. i think i'll pee.

The Great Debate

what do i want to be when i grow up? i kind of hoped i'd already answered that question. but now, when faced with all the possible disciplines and settings in which to practice medicine as a PA, i'm again feeling uncertain. the range of facilities is astounding, the quality of care each place provides, the hours, the scope of practice the PA gets, the benefits and salary...everything varies job to job. it's like comparing apples to kumquats. so i have to look at what i'm passionate for (like i LOVE and feel energized by obgyn but HATE and feel like throwing myself into a bus by pediatrics), quality of life, and money.

location: first of all, i hate commuting...so i'm sticking within a 30 min radius of my house. but my house is pretty central, so that leaves a lot of possibilities. there are positions both in swanky suburban spa-like clinics and in the ghett-o. (see it's less offensive if you call it "the ghett-o" with some flare...it's all about how you spin it). for example, i interviewed last week for a women's health job in a place with bars on the receptionist's window and a strip club 2 doors down....which might mean lots of business, but isn't very confidence inspiring.

mission: what kind of service do i want to provide? the folks in the low income clinic might have more need and be more vulnerable, more requiring my advocacy, education, and kindness. but i can do a lot of good in this discipline regardless of socioeconomics. and i will have more resources and maybe feel more safe in higher income areas. PLUS, with the position mentioned above, i happen to be from a totally different culture and speak a totally different language than the patient population there...when my goal is to really reach and teach folks, would i have that impact coming from such a different place?

scope of practice: how much will i be able to do as a PA in each job? are there other PA's? how will i be treated? i've heard tell that some groups that have never had a PA before don't really know what to do with their first one...and since i'll be a first-timer, that might be difficult. on the other hand, if you're the first, you set the contract. as far as ob/gyn goes...some hospitals allow their PA's, with many hours of supervision, to deliver on their own, 1st assist in C-sections and other surgeries, etc. and in other hospitals you're in triage, just ruling out labor and prescribing tylenol, rest and fluids. and in the clinic setting, you're doing prenatal and annual visits, maybe some colposcopies (takes some skill- this is a cervical exam w/ a microscope, looking to abnormal tissue to biopsy)...but no deliveries or surgeries. it just all varies.

passionate pursuit: i know that i love ob/gyn but there aren't many jobs in it and i might not be able to find the perfect one right now....so i got kind of a miraculous call the other day from a surgical dept looking for a general surgery PA and although i had to quickly amend my resume to read "surgery is my life" instead of "obgyn is my life" it's not too much of a stretch, since i love being in the OR and it would still be really good training for eventually working in ob/gyn. but then i also got a call from a labor and delivery dept looking for a PA to work nights....

hours: this also varies extremely. if you're salaried and work for a busy cardiologist, for example, you'll likely be working 60 hr weeks....but if you're hourly and working at a clinic or a hospital that's strict about overtime, you get your 40 in, and that's that. now because hospitals are open 24/7, this means there has to be night, weekend, and holiday coverage. sucks. in a clinic, it's usually better, but still weekends and evenings are often required. stupid health care. why can't people get sick from 9 to 5? so i'm considering working nights to get my foot in the door to a great ob/gyn job. it would be hard- i hear you lose friends and personality when you lose that much sleep over time and you're schedule is backwards from everyone you know...but i might find that i like it. and since it's 12 hr shifts, you only do 3 or 4 of them a week, and always have several days off each week.

income: PA's make good money for not a lot of schooling. it's just a fact. we make roughly 1/3rd of what the MD makes in our discipline. so since surgeons receive an ungodly amount of unmarked sacs of cash each year, surgical PA's also do really well....ob/gyn is less, but still good money, depending on the situation. it's very likely i'll get job offers that range in salary by 10's of thousands of dollars. eck. have you seen the "spongebob square pants" movie? every time i say the word 'money' i want to say it like mr. krabs does. "what's important to you in finding a job?" "why it's MONEY of course!"

training/further education: then, of course, i'm still thinking about a residency program that will beef up my ob/gyn skills...but will take my family across the country and completely disrupt our plans. most PA's are trained on the job and become "experts" in an area simply by having worked in it over time...while getting paid ("MONEY"). there's something appealing in that.

so....lots to think about. lots up in the air. but finally some really solid options that i'm extremely excited about. i flash between terror that i'm about to be released into the wild as a real life PA and excitement. i'm ready to not be a student anymore, i tell you that. on friday i almost backed my car over a nurse (i would have had to drive it into the hospital and to her department to do it) because she didn't trust that the orders i'd written were kosher from the MD i'm with and since i can't sign anything as my signature has no value/license behind it, we were squaring off in the nurses station.

and this is my 99th blog post! i'll have to find something super cool for my 100th one. stay tuned for that. thanks for hanging in there with me, being my sounding board, and laughing at my horrible jokes. :)

How to Get an "A" from a Preceptor

so life has been kind of nuts. i've been working a lot and making slow progress on job hunt and application for the residency program. i feel like i'm moving in slow motion, but also like i'm busy all the time. GARR! my classmates have been helping me out lately in the career quest, so that's been awesome.

you know what's not awesome? today the doc and myself were incising and draining a HUGE vulvar (outside lady parts) cyst on a poor patient. we sliced it open and compressed it and lots of stinky white puss and blood came out. you think that's gross? it is, but that's not all. just before the doc was about to pack the incision, i was examining the area and said out loud, "you know, this part here still seems really full and tense" and gave a little squeeze. and, well....out shoots a few tablespoons of this white/red nasty all over the front of the MD. on his shirt, arm, neck.....thank Allah he didn't have his mouth open. and that he has a good sense of humor. i couldn't help but giggle a bit. even the patient in her excruciating pain may have snickered some. it was disgusting.

but i love stuff like that (not dousing my MD in infected vagina juice)...procedures that are kind of gross but take a little finesse. i think it's cool.

so aside from that, i'm just pushing through each day, learning stuff and getting closer and closer to graduation. i have had one interview but there are about 15 reasons why it's not the job for me. and i really don't think i'm the one for them, either. but they're desperate for a female PA and i am one of those (well, will be....a PA i mean....already a female....k...) so they did offer me the job. but i have to keep trying, looking elsewhere.

lots to do! lots to do! i need a secretary or an agent to get resumes out for me and contact potential job sites. that would be cool. "hi, my name is stacey and i'm calling on behalf of an excellent young PA...let me tell you why your clinic/hospital department can't live without her..." that would be cool. but i can't so much afford an assistant on my salary of nothing. i guess i'll get after it my own self. sigh.

America is A-OK!

so happy Fourth of July, everyone! hope you enjoyed some brews and dogs and sparkly things on sticks and in the sky and enjoyed having a friday off. we had a great day, even though i worked for a few hrs in the morning....but mostly relaxed, picnicked with family and slept.


one thing i never do is reflect on the independence of our nation on that day. we americans are notorious for taking freedom for granted, since i think we feel safe and pretty much untouched by the foils of the rest of the world...comparatively, we've been attacked on our own soil very rarely. and in most of our lifetimes we've never been really pressed to go to bat (war) to protect our people...and, since freedom of speech is of such importance to us, we enjoy the freedom to bitch about our country and all of its blunders....so when we are sending soldiers to attack those who we think attacked us or might soon attack us, we certainly all share our opinions on that...

but it makes me wonder if we go too far. do we really know how good we have it? should we take at least this one day out a year to focus on the uniqueness, diversity, relative peace and freedom we enjoy rather than the gas prices, endless desert wars and scary/stupid politicians?


for the 4th of july, should i read up on our history of successful political movements our people have hatched instead of baking an american flag cake? would it be more productive if i investigated how i can do my small part to make us a more unified, kind people or to improve our image in the world instead of buying illegal fireworks from that guy down the street with the stained grey t-shirt with a bald eagle on it? maybe so.

alright, alright! don't look at me like that! i'll just eat my watermelon and be happy about it!

I'm a Muss

i stole that term from tony shalhoub's character 'adrien monk' in the very witty USA show "monk" about a phobia-driven OCD detective. he says in exasperation at one point that he's 1/2 man and 1/2 wuss....so he's a "muss." since i'm a WOman and a wuss, the fun word that makes is just "wuss" so that doesn't really work. i guess i could be 1/2 female and 1/2 wuss and be a "fuss" but that also doesn't have the same effect. still, i think "muss" works for me since right now i am definitely a combination of a 'wuss' and a 'mess.' (a "wess?" oh, i give up....)

so i've been a complete wreck over the last few weeks since i have not gotten any closer to acquiring a job and am even thinking about a major move for an Ob/Gyn residency program across the country. so much up in the air. and graduation looming not so far ahead. i want the perfect job and i hope i can be patient for it....but i also really could use some income. and the idea of selling plasma or going back to waiting tables isn't so appealing now that i'm 100 years old and will soon have a masters degree.

and you see that? see how i get ahead of myself? every thing's always so dire with me. i need to relax and keep the faith. grow some patience. and perhaps start using sedatives. :) no....a little red wine (and a lot of chocolate cake) is as close as i get to self-medication.

realistically, i'll be fine- just in a huge transition period. i was on my school's campus today to get a transcript and buy myself some school spirit and felt very mournful walking around the grounds i'll forever be leaving soon. school's been trying, but it's been wonderful....and now i'm about to be unleashed onto the world.

...and it's just that i get this anxiety when i actually pick up the phone to make the call to a potential employer. or have to write YET ANOTHER description of how awesome i am and why i would be THE BEST DARNED candidate for the position. i just hate the whole process. eck. i might have to get a body double to do the actual interviewing for me. (if you know any good actresses looking for work, let me know....actually, i'd even settle for a drag queen for the right price....maybe the large hands and unique gender perspective would actually help secure a job in women's health....ya think?)

but i have been more proactive this week- i sent out a half dozen resumes to area hospitals and clinics and have been following up with phone calls. even though i've been hearing a lot of "we're not hiring right now" i also get "...but i'll keep you in mind and will pass your info on to other people i know" so i'm hopeful that my networks will network for me. and i'm also applying for the residency program in case i don't find the right thing locally or i determine that i definetely want the training. and i still have a few more local leads to try....

so anyway....please send your prayers, thoughts, juju, mojo, and well wishes in my direction. especially while my mental wellness seems to be hanging by a fraying thread. :) thanks kindly. i appreciate the support.