Brand new days are ahead...

The past:

I think that I blocked out most of the winter quarter so I used my report card to remind me of how it went (not that grades ever mattered much or reflected what I really learned but it refreshed my memory nonetheless). This quarter was hard. Christmas vacation just throws everything off - you feel like you can slack before and then it hits you when you get back that you have so much crap to learn and study and then its a beautiful chaotic thing by the end of the onslaught. Pharmacology will take over most your time - similar to anatomy. Memorization is the key - but this time its a little bit more applicable to clinical practice. You need to know this stuff and know it well. Most of everything else is pretty much same old same old. You will probably start learning skills - suturing, foreign body removal from the eye, IVs etc. This was a fun break for all of us. Take advantage of the time and practice your suturing. Otherwise you will have a mini-panic attack like me when you have to do it on a real person. My first patient was on an elderly woman's face. I was totally freaked out. So yeah, do yourself a favor and get your skills solid. The bane of my existence and the source of my stress was EKG. Nothing in medicine (unless you love cardiology) will be as frustrating as the elusive EKG. Its frustrating because you simple cant get away from it. You have to know it, whether you like it or not. Dont try and cram for this class. It wont end well. Try your best and learn to love those little 12 leads.

This quarter you might lose and find yourself. Its full of medicine which tends to suck you in. It was hard for me to find my way during this quarter. The halfway mark is hard and with clinicals around the corner, its hard to focus but if you do, itll pay off.

Remember that bond I told you to form with a second year - it should come in handy now. They hold the key to getting good preceptors and rotation sites. Talk to them and get the scoop.

Reality:

As I mentioned, I'm working in a pseudo- ER/ urgent care and its quite a rollercoaster. I have learned quickly that no matter what I do, what I think or what tests I order, I can never get it exactly right because each doctor I have worked with does it differently. Some order 50 tests and some dont order any. Its quite irritating because I feel like an idiot most of the time. Its like you have to customize your presentation of a case depending on the doctor. I feel like I'm taking crazy pills sometimes.

I genuinely like working urgent care though. Its faster than a normal office, diverse enough where you dont get bored and there is plenty to do. PA's have it great when it comes to urgent care work. They don't have to deal with any of the complex patients and we get to punt the really sever cases to another ER - all the while making 6 figures. I like it.

In regards to the real world, old haunts have re-surfaced and the complexities of certain relationships are getting confusing. It seems to me that old friends have a way of kicking you in the balls even when they are out of your life. Its frustrating to say the least. I reflect on how happy I am now but it seems like someone is trying to steal my joy even when they don't have anything to do with my life now. Its strange and interesting. Its like I have a pain somewhere inside but the source is buried so deep because its in the past. I would compare it to an internal scar getting stretched a little too much. Its just uncomfortable. 

Its nice to be a vagrant of sorts - moving every six weeks. How unusual to be a PA student?! I forget that we a very special niche - nomads of medicine if you will. Every six weeks a group of people that we have to schmooze and charm and get to know. Its so strange - and slightly fascinating. I definitely doesn't help with commitment issues though. I feel like I don't have to get to involved anywhere because I'll be gone soon enough. Its unhealthy if you really think about it.

I have a hard time thinking about settling down. Anything more than a year sounds sooooo long. I can't imagine living anywhere for more than that. I guess its irrational to think I can just move every year to a new location and start over. Who knows, maybe I could. 

So, I say to you - all of you who I have forgotten - please cease the attempts to hurt me in places that have healed and scarred from years in the past.

PS> I have officially finished the Twilight series. I not ashamed that I read a book for girls with a weird vampire fetish - Harry Potter will always be the best though, even if he doesn't have fangs.

What happens when something goes wrong?

The Past:

So, on we go to second quarter as I slowly work my way through compiling my thoughts about PA school til the present. Second quarter will feel better - I promise. Anatomy is done and you feel like you can do anything. Dont forget you are just getting started. Physical Exam skills are coming and they are coming quick. This is the point where you begin to build your clinical skills and the knowledge base to actually figure out what is going on. Take advantage of the time off (relatively speaking). The best thing I can say is to get the basics and start practicing. I would suggest spending a day or two with a practicioner to help you hone your skills. Make a connection with a second year to help you. A second year student is your best resource.

On physical exam: Practice, pay attention to detail and time yourself. I always went over time in test so time yourself doing a full wellness exam. Practice in your kitchen with your friends or on your family over break. The most comfortable you get the better.

On clinical medicine: they are going to want you to remember all kinds of details. But try and widdle it down to essentials first. Flash cards will help.

On the other classes: Be a sponge.

On life: Things will get better - Breathe and realize this will seem easier every day.

Take home points:

1 - Practice your physical exam --> consider it your weapons arsenal

2 - Connect with a second year

3 - Volunteer - it will energize you and get you the perspective and practice you need.

Reality: The past 48 hours

I did a paracentesis (the insertion of a needle/ catheter into the abdomen to drain off fluid) yesterday. I was scared shitless and really confident at the same time. I knew I could do it but was super freaked out by the details. Everything went fine and the patient and doctor were super cooperative. The worst part was after... did I puncture something? What if the patient has internal bleeding later tonight or tomorrow? What if I did something wrong and ruin not only my career but my supervising doctors career?

I guess I'm faced with these questions everyday but it was slightly more tangible after a more complex procedure rather than a routine check... I guess I can never forget about how crucial every move I make is. 

Here comes the vent -->The ironic part is the patients - they expect everything to be flawless, fast and easy. What a joke right? Only God or Ghandi could pull off something like that. The sad thing is that everyone is under the illusion that its possible at every given moment. On top of that, they expect it to be done immediately. Tons of patients complain about waiting at an urgent care... I'm sorry, its not my fault nor my problem because I'm trying to take care of really sick people. On top of that, I can't do a flawless job if you (the patient) keep complaining about the wait.  It actually might occur in a timely fashion if I wasn't so concerned about getting sued or missing the most minute detail which might actually lead to some other patients demise or if I didn't have to do pages and pages of paper work to actually get a dime out of the insurance companies. But go ahead patients, complain to me because apparently it doesn't mean anything to anyone that some of us have invested over 100k in what we are doing... Sheesh.

First quarter: Now and then.

Ok, so the first quarter of PA school was scary. Embarking on that journey was scary. In the first two days you are bombarded with information. Don't bother to try and digest all of it, just things you think are important. Use some discretion (not discrimination like my friends today said by mistake - oh, nursie.) I'd liken the first quarter orientation to getting pulled (til your joints pop out) in 2 opposite directions. They tell you - its going to be so hard, the hardest thing ever, harder than ever before, difficult beyond measure yadayadayada... and the others tell you - relax, you'll get through it, you'll be fine, it won't kill you. I'll tell you right now, don't freak out but don't blow it off. First quarter is mind over matter guys - psychologically take PA school by the balls and don't let up. You control the program, don't let the program control you. Anatomy and Biochem are going to be hard, but never skip a lunch break or snack break to cram a few more facts. They almost never work and you need to feed yourself and caffeinate yourself in order to digest those facts anyways. I have no good things to say about which class is harder or easier, which is better or worse. Just learn - its not the first time you've heard it and its not going to be the last. Breathe. Just breathe through the first quarter. I made myself sick over studying and I got so stressed I had to go to the doctor for some muscle relaxers and narcotics to stop a headache. Don't do this - just chill. Take your time, learn the information.

Take home points from first quarter PA school:

1- don't listen to anyone who thinks they know whats coming or what you should do. Do your thing, explore how it works for you. Sift through the bullshit and arrive at spot of oneness with the chaos.

2 - Anatomy is your friend, not your foe. Have fun with it - make songs, dances, flashcards and color coded snacks if you want. After a while, staring at a page 5-6 times is not going to work.

3 - Please make friends and try and go have a drink or watch a movie or cook something on the weekend. Take a break and a mind vacation.

Back to reality,

This weekend was interesting. I came to the realization that us medical types are a glutton for punishment. I'm currently overbooked with work and play and cannot stop planning for myself. Its a disease that I'm trying to cure myself of. Type A may get you places in life, but it won't get you rest thats for sure. I'm either exhausted from work or fun, and even both. This weekend was an exhaustive amount of fun and now I'm tired and have to go to work.

I was thinking about the quote "You can sleep when you are dead" and "When I ever stop moving I'll be dead" and other quotes like that and wonder if its good or bad. Do we accomplish more or less when we get overbooked...

Side note: I saw Twilight today. I'm not ashamed and I'm glad I can laugh about how silly it is to be reading about vampires and teenage girls. Its not really surprising that I kinda liked it though. Its refreshing from work and the news. So then, I'll declare it with pride.

In the beginning.

So, what has happened since the end of undergraduate and the beginning of PA school. Many things - most of which I have already forgotten, but hopefully as I write I will remember.

I graduated on cinco de mayo and it was such a blur. I don't think I was scared because I already knew what I was doing afterwards but it was much scarier for most of my friends. I couldn't imagine what it would be like to leave such a cushioned environment and throw yourself out into the real world. My time is coming soon enough but I would have been horrified. We all survived but I'm glad I made plans.

I had 25 days - yes, only 25- before I started PA school in Arizona. My family and I went on a cruise out of NYC. It was awesome and kinda sad because I blew all of my money but c'est la vie. I moved to AZ just before the month ended and with the help of my mother and grandparents, I furnished a new apartment and was ready for school. I was scared and sad. I think I cried more than ever before when my family and I parted ways. My grandpa started the whole thing - he never cries which caught us all off and then it spiraled from there.

Anywho, move complete and apartment full of Ikea - I prepared for the longest journey to date. The dreaded gross anatomy and physiology. To be continued...

PA school Tips: (yes, even before I got to PA school I had/ have tips)

1. Give yourself time (or don't). The best thing to do is cool off before PA school. Get it out of your system. Pound some beers, visit friends, lay on a beach. Savor time because you must be ready.
2. Decide whether its better to live alone or with a roommate before you start. It'll make your life easier.
3. Be prepared to scout out every coffee shop in a 20 mile radius of your house - consider it a pre-emptive strike. You'll thank me if you do.

Back to the future.

Ok, so this first post I stole from my "about me section" on myspace. I think it pretty much says way too much about me but everyone seems to like it. This blog is going to backwards and then forwards again. I decided I wanted to plot out my journey through graduate school as a PA and beyond. This isn't a blog about how to get into PA school or how to pass anatomy but hopefully some more philosophical reflections on medicine, people, faith and the whole shabang. Onwards and upwards - an introduction.

I love to clean, but I hate vacuuming. I hate the way it is spelled and I hate how the cord gets in theway no matter what you do with it. Plus you have to change the bag or the filter or something like that and I always spill it on the carpet again anyways. I just hate vacuuming.

Christmas is my favorite time of year, but Halloween parties always make the best memories. I wish we could all go to a costume party every weekend (think Marie Antoinette).

I'm terrified of the opposite sex. They are all over my facebook but they still scare me. They're tricky and mostly make me crazy. One minute they like you, then they get bored if you're too nice, then they move on and when you stop liking them, they like you again. Then you have to have a DTR and then its just too much and you get all bitter. And then there was eHarmony.

I'm a big science nerd (more like was in undergrad, now I'm a big medical nerd) and I'm pretty much ok with that. Most people don't realize that its possible to be cool and be into science. Contrary to popular belief, I have met more popular science majors than business majors. Business majors think they are cool because they are business majors, which simply isn't the case.

I love my family. Plain and simple. I love having a meal with the fam and relaxing. They are stubborn and weird and quirky and I love them more everyday. My brother is getting married before me and I'm glad about it. Now I don't have to worry about having kids just to make grandbabies.

I  hate being disrespected but people do it all the time - no matter how much they care about me. I wish people knew how to live out the word RECIPROCITY... I think of my insecurity as a strength, not a weakness. I hate drama, and I hate that I have to mention that I hate drama.

I'm a visionary and I don't live by boundaries. I love to root for the underdog because I feel like one myself most of the time. I love experiencing new things - even if its just once for kicks. Building new relationships keeps me going. I take things personal.

I have a secret obsession with jeans. I have way too many pairs (think one different pair for 2 weeks straight). My feet are claustrophobic and I hate to wear shoes. I'm slowly coming to the realization that flip flops are not appropriate at all times though. 

I wish I were a pirate so that I wouldn't have to shave or have manners. I would have body odor and drink rum all day because its what pirates do. Plus, I desperately want to be called a swashbuckler. Who wouldn't?

I would love to write a book someday - about medicine and traveling and philosophy one day. I feel trapped most of the time and its necessary for me to leave the country at least once a year. I wish I was married so I could have a permanent traveling buddy (well not really but its romantic at least).

I love music but its bizarrely powerful. I have to choose it wisely so I don't go crazy. Music makes everything better in my opinion. Its like adding a soundtrack to a movie. Life is better when there is music. I write songs that no one can read. Its better that way. I love are but most people never see my art either. I love to drive and listen to music with the windows down and the heater blasting.

I use elipses way too much...