The Blues in PA Minor

so...i'm feeling bleh. it's rainy and dark and getting cold and everyone seems to have a sinus infection. i'm downing about 13 packs of emergen-c every day, trying to stave off whatever bug i might get. my tummy has been feeling rotten- i'm certain it's an ulcer/tumor/the plague. i have visions of a bleeding ulcer that needs to be operated on, and some new grad PA making a total mess out of me while i'm helpless under sedation in the OR.

*sniff*

that brings me to my next sad bastard point ("i've lost my tail..." - eeyore). i want to KNOW HOW TO DO STUFF ALREADY! i'm feeling like i'm still slow, in the way, dumb, clueless, miserable, chokey mcchokester...i want to be useful and keen and skilled and graceful and competent and busy and worth the money they're paying me!!! right now i'm still only like the 'best of' PA students. i feel like i'm not offering much and it might be a while before i do.

ack!! sometimes i wish i had some magic potion (not emergen-c, i've certainly tried that one) that would flash me forward to about 6 months from now. when i'll have a better handle on all this and not so much doubt and fear.

but, realistically, i don't want to wish any of this away. for one thing, the process is as (/more) important as the outcome. for another, in six months i'll have to be taking call and working afternoons/nights/weekends. this peaceful piece right now won't happen again.

so that's a nice something to look forward to.

just crabby, i guess. but i'm writing myself a list of things to accomplish this week, and lists usually make me feel a bit calmer. and i'm looking forward to a weekend away w/ my hubby and dog this weekend to the wilderness to celebrate our anniversary.

Highlights and Lowlights

- i saw the coolest surgery ever last week- WARNING, GRAPHIC MATERIAL AHEAD...a long time smoker had developed a mouth cancer and nerve tumor that had spread all over his neck, jaw, throat, and tongue. the Ears, Nose, Throat (ENT) surgeon did a 14 hr surgery on him (14 hours!!) that involved reflecting the skin on his jaw/face up and the skin on his neck down, tying off his jugular vein, and dissecting out all the tumor, cautiously picking through and avoiding other major vessels and nerves. to get all the tumors and their margins, they had to take most of his tongue, severed his jaw in half and took much of his inner cheek, soft palate, etc. it was incredible to see. i went in an checked it out in between cases. it was an amazing anatomy lesson. and i had actually met this patient in pre-op, and he was very full of faith and kept smiling and talking about how God had gotten him through this far, so knew He would stay w/ him for this....so as i watched the surgery in awe, i just kept praying over him- asking for God's protection and hand in this. i kind of thought that's what the patient would want. the next day i went and saw him in the surgical ICU, and other than the fact that he was breathing through a tracheotomy in his neck, fed through a feeding tube, and had a howdy doody looking line of sutures down his chin and around his jaw, his head was entirely put back together and he looked like himself. his recovery will be long and his long-term prognosis is still shaky. he will have to learn to speak again w/ a finger-width of tongue left...but this might have saved his life from an incredibly invasive and hard to reach cancer. so cool.

-i requested that my chief PA schedule me for as many laparoscopic cases as i could get this week, so that i could become proficient with using the long instruments and manipulating them inside the belly, using monitors to gage my actions. i did a few gall bladders in this way, which went really well....the whole thing is pretty counterintuitive, but i'm learning. i'm learning.

-so...on thursday, i was with a good 'ol boy surgeon who i'd never worked w/ before... a genuine cowboy. loud and crass and over the top. goes unpunished for telling horrible off-color jokes about race and sexuality, etc, etc. generally, the kind of dude i try to avoid. and we were doing a tricky hernia repair laparoscopically. so, as i was attempting to manipulate the hernia mesh patch w/ my instrument while using the monitor and 'feel' as a guide, it wasn't going well. (like i said, i'm learning. i'm learning). he, the lasso-wielding surgeon, the PA who was with me, and all the nurses in the room laughed hysterically at me. like tears-in-their-eyes, funniest thing they've ever seen, laughed. so that was fun. needless to say, i was a little jarred after that and so then bumbled around, contaminating myself, breaking a glove, even my sewing was not so hot...but the case eventually ended. thank God.

-friday, they let me scrub by myself for four cases w/ a surgeon. and overall, they went really well. that helped re-build my little shaky self esteem a little bit.

-also, apparently, i'm a legend. i ran into the chief of surgery in the hallway the other day. he had been fond of me when i was a student there last year- i think he was instrumental in getting me hired. anyway, if you've been reading my blog all along, you might remember a particular story about when i made an ass out of myself (i'll clarify- i know that doesn't help) when i asked for the "bent retractor" instead of the "Bennett retractor" during an ortho case. he told me that i'm remembered for this and that now the whole orthopedics department refers to it as the "bent retractor." fan-friggin-tastic. :) i guess infamy is better than no-famy, eh?

-what else? my weekends are becoming more and more important to me. and we've got busy ones back-to-back for the next few months. i'm taking advantage of the fact that i don't have to take call yet. this particular weekend, we went to a traveling broadway show called "avenue q" which is sort of a raunchy, hilarious musical puppet show w/ such favorite numbers as "the internet is for porn." good times were had by all.

Up to My Armpits in A-Holes

and i'm not talking about the staff. they're all being wonderful, actually. there are a few ball buster surgeons, but so far the PA mafia has kept me pretty much protected from their evil doings.

i'm noticing my improvements in cases, too. my job right now is to get to know each doctor's methods for different procedures and to get to know them well enough that they trust me to assist them. and also to become adept at all the various things the 1st assistant does...sewing and cutting and holding and cauterizing and tying and prepping and closing the patient...generally making the surgeon's life easier. sometimes we're just another pair of hands. but those hands have to be graceful and move with dexterity and ease. more on that later. hands are a big part of my job (and my life, in fact).

so about those a-holes. i did two bowel cases today w/ the "butt boys." these are the colorectal surgeons who work to remove colon tumors, clean up messy diverticular disasters, etc. so when you take the diseased part of the bowel out, you have to somehow connect the top part of the tube above where you cut to the bottom part of the tube, below where you cut. or poop will go everywhere inside the patient. and this is frowned on. so in order to do this, one person has to prepare the above bowel (in the belly) and another person has to prepare the below bowel (in the rectum). this means that someone (me) is sticking a 2 ft long stick w/ a stapler on the end up someone's bum. the stapler both affixes the 2 ends of colon, but also makes a hole (lumen) through the middle of them so they're nice and attached and open wide for 'passage.' it's very complicated. and very awesome. and extremely disgusting. i felt like i needed to send that patient flowers after i violated her in her most holiest of holies. ("hole-ies?") :)

so it was very interesting. two cases, one laparoscopic and one open, took us a total of 10 hrs w/ just a short break between them. so i'm tired. but i'm already accumulating overtime hrs, which is pretty cool. what i'll do w/ all this time off, i have no idea. i'll need to start thinking sabatical-in-europe or time-to-have-a-baby-and-go-on-maternity-leave thoughts to figure out how to take advantage of my vacation plus all these extra hours i'll be working that i get to keep to use.

a very good problem to have.

and i'm in a great mood. perfect weather. i love these days where i can still wear sandals on my feet, but need a big fuzzy sweatshirt on top. fantastic.

and both my anniversary and birthday (and Christmas) are coming up, so i'm excited for all that, too.

So, Being a Certified PA Was Cool and All, But...

being a PAID certified PA is way better!!

best. day. ever.

i was told last monday at orientation that i wouldn't get paid until next week. but THEN THIS MORNING one of my fellow certified and paid PA's mentioned that tomorrow was pay day. my little heart skipped a little beat, but i dared not hope. and then i got home tonight and TRA-LA, there was the most lovely bit in my mailbox! so i tossed my dog in the car (she weighs 65 pounds, so "toss" might be a bit aggressive a word...perhaps "coaxed" or "requested" is better) and we hightailed it to the bank to deposit it into my anemic bank account.

it felt great. it's been such a long time since i've brought in money that wasn't acquired by gift, loan, or bank robbery.

and i had a great day at work. i did a vaginal hysterectomy and a rectocele/ cystocele repair (pouch from bladder and rectum into vagina- happens often in older ladies who have had a bunch of kids, caused incontinence, difficulty going to the bathroom, etc) with an Ob/Gyn and a uro-surgeon. fun, fun, fun.

things are going really well. i'm catching on slowly, slowly. and it's tons of fun. they hooked me up with a really nice, patient mentor- so i'm learning a lot from her. we'll call her "McAwesome." a patient's wife asked me yesterday how similar working in surgery is to "grey's anatomy." she looked really hopeful, so i told her that i had to remember to get my underwear from the call room where i'd left them after my earlier shtup and then i excused myself to go check on the bomb in a patient down the hall. :) i think she was sorry she asked.

and mcawesome is really into healthy eating and fitness, so we've been talking about that a lot. this week i've been eating pretty well and have lost a few BMI points (my wii fit is keeping close track of this for me- it actually beams your weight from the balance board on the floor to the TV- no wires or anything. i think it's a miracle or sorcery. leaning toward sorcery).

so all in all, i'm feeling good and enjoying my new gig at MBH.

I Almost Sewed My Head to My Arm

things are going well. but, i am impatient to know stuff and be good at doing stuff sooner rather than later. i am developing a list of all things "i wish i could..." such as:

-suture properly w/o needing supervision and having to totally re-do some incisions because they're only slightly less of a gaping wound when i'm done sewing on them than when i started
-name all the instruments and suture type and not sound like a buffoon asking for 'that pointy thing' or 'the purple string'
-steer well when driving the camera/trochanter instruments when doing a lap procedure
-remember all the tendons, vessels, and landmarks of the anatomy (or any of them, really)
-know how to find my way from the PA office to my locker and maybe even to my car without having to ask a janitor for directions (they’re very helpful)
-not take 5 times as long as the 'real' PA's to do an intake history and physical
-transfer money from checking to savings instead of vice-versa JUST ONCE IN MY LIFE...(this one will happen soon, which is some of why i'm working so diligently on the previous ones. i'm only a week and a half out from my first big kid pay check!)
-make heads or tails out of my loans/try not to default too much and lose my house
-adjust to the idea that i will be waking up at 0:500 every morning and learn to not secretly try to count in my head how many weeks i have left of this 'rotation.'


...so that's my wish list. but overall, like i said, things are going swimmingly. and since i'm starting this new chapter of my life, i figured it was time to clean other things up, too. so, i cold turkey withdrew myself from caffeine. i had become dependent and found that i was compensating for its side effects (teeth whitening tooth paste for yellowed coffee stained teeth (that's totally hot), trying to come up w/ non-caffeine related reasons while my breastesses might be achy (TMI?), the awful headaches when coming down from it, etc, etc). now it's been about a week and a half, and the headaches and cold sweats are mostly gone. i still allow myself decaf lattes and such (to all my starbucks benefactors, a million coffee breath kisses...). i'm also working out and watching my diet. not as strictly as i soon will, but better. we bought wii fit, which is pretty much the coolest thing ever, and i've been compulsively playing that...and i might even go back to my gym sometime soon (for the last few months i've looked at my membership fee like a donation to the thin, tan, pretty people who work there). and i'm making more time for God and exploring my faith. that should put me back on track.

so ANYway...my cases have been good. i had a cool 22 year old guy today who was having his gall bladder removed after he lost 170# in the last year. (gall stones are really common after significant weight loss). he did it all by diet and exercise. a very strict diet, mind you. a liquid diet, prescribed and monitored by a physician in a program....but still. he had intended to get gastric bypass- they told him he had to try to lose weight on his own first, and this is what he did. 100 and 70 whole pounds! we all ooh'd and aah'd all over him for his amazing accomplishment. he said he hoped we'd see him soon for a tummy tuck to get rid of all the excess skin. he was really cool. although, he did request to keep his gall stones. is that common? do any of you out there have gall stones that you wear on a necklace or something? it seemed like an odd request to me, but the doc said he hears it all the time.

just for the record, anything that comes out of me, can stay out. black market, trophy cabinet, whatever. i just don't really want it back.

one last thing...it seems like everyone i know is talking about becoming a PA these days. it's a good trend to be on. is anyone out there who reads this blog thinking about PA school? in PA school now? already a PA? i'd love to hear from you. post me a message.

The Knee Bone's Connected to the Head Bone, the....Oh, wait...

new job. good stuff. having fun so far. everyone's being exceedingly nice to me. i wonder if/when the other shoe-covered shoe will drop. they all seem to remember me from when i was a student...which is really flattering, since i was there last september and they go through about 25 students a year. but things are different now. they're invested in me. and they don't drill me with questions, but patiently, kindly answer mine as they come up. and unlike when i was a student, they want to know my personality, who i am. not just that i know how to not break sterile field or how not to trip on myself.

and it's the dream first job- they're giving me all the time in the world to learn what i need to learn- i have several months to get comfortable on all the different surgeries (again, recall we're talking about operating with some 20 different surgeons who all have different methods, and these surgeries range from thyroid to breast to hip to gall bladder to eyelids to heart to veins to brain...anything and everything). PLUS, i will learn how to be competent in internal medicine/surgical followup as i follow patients on the floor post-operatively...and i will learn to put central lines in, feeding tubes, difficult foley catheterizations, etc, etc.

and i love being in scrubs all day every day. i wake up in the morning (at about 5:15am-that part does suck), shower, throw my hair in a ponytail, put on jeans, and go to work. it's great. now all my clothing budget (right...) can go towards fun clothes, not work clothes. speaking of buying fun clothes, i treated myself to a new fancy winter coat that's semi practical and semi totally awesome. it's from H & M and is a bone color with big buttons and other fun features. i can't link to it, cuz their website is all fashion ad wizardry with videos and nothing functional, but trust me when i tell you, it's a very cool coat. i guess i just can't get enough of new white coats. :)

what else? did i mention that they're paying me bunches of money to be elbow deep in intestines every day? it's pretty awesome.

as i said, everyone's being pretty nice to me so far, BUT there are a lot of 'different' personalities in the OR. surgery is kind of notorious for attracting larger-than-life egos. and i've certainly encountered some of them. most of the PA's (there are 25 of us) are wonderful. most of the other staff (surgeons, scrub and circulating nurses, techs, etc) are also wonderful and helpful. but i worked with the #1 most notoriously moody and vicious surgeon on 6 cases on friday. he was kind of nasty to me a few times when i neglected to properly read his mind, but overall, things went fine. i'm in such a great mood with this fantastic new job and having passed my boards, that there wasn't much he could do to mess that up. plus, i am pretty good at letting things roll off of me. and there's lots of support from the other PA's. i'll always be able to vent if i need to. but there are stories (more like the stuff of lores) of surgeons throwing charts at people's heads, kicking staff out of the OR in a fury, scrub nurses smacking students, the list goes on.

i think i can handle it. we'll see. if you ever find me huddled under a desk in the fetal position, rocking and softly singing "when the dog bites, when the bees sting....", please just bring me some graham crackers and tell me everything is going to be ok. :)

by the way, in case it wasn't clear from my last manic post, i passed my boards and am now licensed. my official title is PA-C, which means PA-certified. i also have an MS, but nobody cares about that in the clinical setting. so now that i'm licensed, i'm working on getting my prescribing license and provider ID and stuff in place. boo-ya.

Not for Naught, I'm a Freakin' PA-C!