Scream.

Scream.

Its what I want to do right now.

For some reason, I want to run around like a crazy person and scream at the top of my lungs.

Why, you ask?

Because I'm currently being haunted by my patients today. I didn't have but three patients today and one of them is going to haunt me all day. Something in my gut is screaming that I missed something. Something also confirms that its probably true, that I missed something.

The strange part - I miss things all the time. I miss stuff - its what makes me human. I dont have all the answers nor to I claim to...

However, my patients rely on me to be their god and therefore I am currently driving myself crazy aspiring to become one.

Fruitless but still tempting at the same time.

This might be the beginning of a paranoia in which I neurotically scour every part of a patients visit in order to discover my error. The peculiar part is that I already know I will find many errors. Therein the dilemma. Why search for something that is theoretically already found?

My errors are secret and known at the same time. There, hiding in the cracks, waiting to be found, but I already know they are there.

The ugly part of this whole business is when someone else finds the error or the error of my ways is made known when maleficence befalls a patient, I am on trial for my life...

and all I can do is scream. Right now and in that moment that is waiting for me in the future.

Scream and hope my fate is better than the ones that come before me...

Confessions of a...

I think I'm finally admitting to myself something I have known for a long time. That I am completely and utterly compulsive.

I literally cannot control myself and have very little discipline.

Tonight, for example, I literally cannot stop eating. I can't. I have barely any food in my house and yet I am stuffing my face with processed "food".

So, I admit that I'm compulsive... and impulsive I guess.

Things you should know about me right now:

I am sleeping on an air matress.

I do not have a fridge in my house nor do I have a washer dryer.

I'm working at a job where I get paid more than 80% of the worlds population for helping perhaps only 1% of the AZ population.

I love Halloween and cannot stop eating candy corn to save my life, or anyone elses for that matter.

Something to think about:

How awesome your mom was when you were growing up and how she managed to work and cook dinner all in the same day. We take that for granted but I can barely take care of myself. You're mom might not have been exactly the same but I've been thinking about how although my parents weren't perfect, that they did more things right than wrong.

YUMA!

I had to write "YUMA" in capital letters to express the fact that I just want to yell it out. I need to get it out of my system because I'm going back there soon. Why you ask? Why must I go to Yuma. In a word, Money. I need money - badly. Its strange, but I'm going to be chasing money for the majority of my life. I already have bills and no paycheck. Bizarro.

Right now - I'm living in limbo. I always feel like I write the most when I'm in a strange place in my life. Limbo. The transitional time where I'm not particularly busy but going almost mad trying to move on with my life.

Its funny - being done with grad school doesn't mean anything anymore. Not a damn thing, if you ask me. Its just an illusion of having completed something... the funny part is that is just a step in a million others that come after it.

So, I'm going to Yuma. I keep trying to t tell myself that I can deal with living there. I keep thinking things like "oh, there is at least a Target and a Costco" and "I'll just drive to San Diego on the weekends." I'm having to convince myself along with everyone else that its going to be fine but I really have no clue. I guess this is the next sacrifice/ compromise in a long line of them. But who knows, it could be my permanent home.

Now thats a strange concept - permanence. Can you imagine living somewhere for the rest of your life? I sure can't... but it never ceases to amaze me how people can never leave a place.

Yuma's population practically triples during the winter. The snow birds... East Coast people who have the luxury of leaving the bitter cold. I sure don't blame them. Someone told me that I'm going to be a reverse snowbird. Running away from Yuma. ha.

Yuma is one of the hottest and sunniest places to live in the US. Highest temp in the past has been 124. Welcome to the desert and my new home.

Reflections from the Grave

This is where I died

And was reborn.

In a fire

Not metphorically or metphysically

But literally, in a fire.

I die each day with a new fire

Not my own

But everyone else's.

And there isn't enough pain medicine

Not enough to make my mind not

Remember

This is where I die each day

The pains: acheydeepdullradiatingsharpclenchingbreathtakingexquisiteconstantburningagonizingboaring

Approaching the end.

I'm honestly lost for words (well not literally) but I feel like I physically cannot express how bizarre and frustrated and scared and confused I feel right now. I'm approaching the end of my career as a student and beginning my career as a PA. I have my graduation this friday and I couldn't be more afraid. Primarily because it marks the fact that I cannot turn back nor can I postpone the real world any longer. I think I'm experiencing the emotions of someone who just graduated from undergrad - but I managed to avoid it because I went straight to grad school (which was the best decision ever... it puts off everything scary for a couple more years).

I'm moving to Yuma to be a part of something that I think with rock my world. The physician group really cares about their patients and want to give them better care - that is where I step in. I'm excited to be a part of something patient centered. Plus the doctors all seem really great.

I think I'm beginning to rediscover "God". I'm not sure what that means right now which is why I use quotations marks. I'm beginning to embark on a journey of self discovery and spirituality and I think I might be onto something. Things are slow moving but I think I'm gonna make some headway on what I think about God and Jesus and all things spiritual. I mean, its not that I have lost faith - I'm just trying to revamp it and figure myself out in the process.

Things are happening - hopefully I'll survive when things stop happening so fast.

Where the wild things are...

Ok, so here's the scoop. I'm on my last rotations. MY LAST CLINICAL ROTATION EVER! I am totally freaked out and the real world is coming at me and gaining speed. I'm a complete mess and my heartburn has gotten worse and I think I need an endoscopy. Alas, I think I'll live.

Currently...

I'm looking for a job - a fruitless experiment in emailing hundreds of people who never get back to you. You shouldn't try it if you dont have to.

I'm getting my tonsils out in 11 days. I think its going to hurt.

I'm studying for the boards... a 6 hours test which is going to be hard on purpose.

I'm learning how to be a normal person - go on dates and make small talk without talking about medicine. Its quite hard.

I'm working on a speech for graduation and its going to be corny. I'm not sure how to fix that.

I'm about to take a ton of recycling. Lets save the world!

In the past...

Ok, so I left off at my second rotation. The next one was Psychiatry. Which was totally fun and goofy. I worked in Benson and the people were great and the hours were short and many times I got called and told not to come in because there were barely any patients. Psychiatry will be great for you. Its normally great hours and a breeze because it is very limited in scope. You just need to know your Axis diagnoses and your antipsychotics. The rotations went generally well with no hiccups. It was a nice vacation. Just make sure you dont turn into an idiot and forget all your general medicine stuff.

Moving on... My next rotations was dermatology. Which was good and bad. I love derm and I think its fascinating. The doctor was a bitch sometimes though. It made me sad because she was so stressed out that she couldn't treat anyone like a human being. She was so wealthy and so miserable that I felt like it was such a waste. Derm is general good to practice your suturing and doing all of the biopsies and stuff. My doctor was very conservative and she didn't let me do much but it was still a good experience overall. I'm glad I dont have to deal with it anymore but I think derm should be required for everyone. It was also good because I was at home and got to spend time with my parents. I would recommend it.

Ok, so fast forward to the worst rotation ever. So I started blogging on my ER rotation, which was excellent, and I think I have covered every rotations except for one... the most infamous of all time. My elective rotation at a county hospital burn unit. Word to the wise... dont waste an elective on something that you could potentially hate. Screen your elective rotations wisely. I happened to get lucky most of the time but this one I didn't. I didn't blog during this rotations because I was so angry all the time that I wanted to punch someone right in the mouth. I started to blog once but decided it was too inflammatory and slanderous so I didn't post it. The burn rotation was miserable for many reasons. 1 - One of the PA's there was a total bitch who was also the worst teacher ever and was totally miserable herself. I heard that she used to be a fun person and now she hates her life so she makes everyone else's miserable as well. 2 - Teaching hospitals suck for PA students because dealing with residents is the worst thing ever. They are rude and miserable and cocky SOB's (for the most part) and I hated being around them. 3- Miserable and mean staff = miserable rotation 4- being on the bottom of a very tall totem pole makes you feel like crap more often then not. All in all I give the rotation a thumbs down but I did learn what I needed to learn to manage burns appropriately so all wasnt lost.

Well, I feel like I'm closing a little chapter of my life by summarizing pretty much everything I could about PA school. The blog isn't done but it feels good to not have much more material to write about concerning clinical rotations...

Steven Johnson Syndrome and Toxic Epidermal Necrolysis.

Sundrenched World :
I can't get to bed 
But I'm really tired 
The things in my head 
You used to admire 
In your sundrenched world 
It couldn't be worse 
Don't bother asking 
And here comes the nerves 
While I'm trying to bask 
In your sundrenched world 

I'm talking to you 
But you're not listening 
I don't know what to do 
My heart is blistering 
Writing this song 
Tell me I'm not wrong 

I close up my mouth 
When you're around now 
Suffocating in doubt 
I can't make a sound 
In your sundrenched world 
I always wanted to be 
The one you looked to 
For the answers in me 
I'm the one who took you 
To your sundrenched world 

I'm talking to you 
But you're not listening 
I don't know what to do 
My heart is blistering 
Writing this song 
Tell me I belong 

It's all been said 
Once before 
We f*****d around 
On your bedroom floor 

I'm talking to you 
But you're not listening 
I don't know what to do 
My hands are blistering 
Writing this song 
Tell me I belong 

Tell me I belong 
Tell me I belong
Tell me I belong

Today I was ran over by a train...

and his name was Dr. Patel. I've never met a doctor who could make me feel like shit the way he did today. It makes me thankful that I, as a PA, will never have to put up with residency and be harangued by doctors who make you feel like a retard all day. I was basically subjected to the most bizarre and random questions and then told that I didn't know how to think and that I wasn't trying at all. Hmmmm, thats funny because I didn't even learn that shit in school but whatever. It all ended up being not even remotely beneficial and left me holding back the tears in the car ride home. Case in point - a shit storm will come your way in the second year of PA school and it will almost destroy you. I have had my share of moments when I feel like I should just become a waiter and drop out but most days aren't like that. Thank god.

Don't get me wrong... its really hard to pick yourself up off the floor when everything about you has been broken down. It totally sucks but you know what? It actually doesn't matter. If you pass the boards you are more than a sufficient person and PA. So anyone who says otherwise should kiss it.

Ok, so a little update since the last time. I made it through my OBGYN rotations only slightly retarded and got to deliver a baby. Which was anticlimactic and totally sick. Besides that, I just did a lot of pap schmears and IUD inserts. Vaginas are strange and can get really gross when things go wrong. Enough said.

Now I'm in general surgery and its pretty much a mess. KNOW YOUR ANATOMY! I repeat - know your anatomy! Buy the surgical recall book - it should have most of what you need to know if your preceptor isn't a complete psychopath. Side note: beware of who you end up in surgery with. I would suggest screening them and know exactly what you are going into. Otherwise you will end up crying yourself to sleep at night. I'm serious. My roomate had a ortho-surgeon who threw things across the room at her and threw temper tantrums. And the PA that worked with her was a big douche bag and tried to get her into bed. So - screen your surgeons and you will do fine. One more thing - learn to tie. Get a board and some suture material and practice. Its not hard to do the two hand tie but you do have to learn it so get ready. 

Rotation #2: Remember the past

So I pretty much had a dream of a rotation for my second one. I had my internal medicine rotation at a hospital with the best hospitalist ever!!! I would highly recommend getting an inpatient internal medicine rotations. I'm actually going to repeat it. Some tips: Know your diabetes, hypertension, COPD, Pneumonia and PE/DVT. Thats probably 90 percent of what I saw and I think it generally reflects IM in a nutshell. Get the little maxwell book, itll help you write soap notes, know lab values, and dictate. Get ready to do full H&P's - I mean full ones with really good physical exams. It sounds exhaustive but you have to be really complete for the hospital. In the end, you get used to them and it really enhances your skills.

I would also recommend getting your hand on some standard protocols for admits and stuff before hand so you will be ready. Its up to your preceptor but you will get a good idea what to do from those. Hospital medicine will help you become really rounded and it was just what I needed. So take heed! Also, beware the IM outpatient can be excruciatingly boring and slow so if you want some action - try and sneak away to a hospital.

And remember, eventually you will be able to tell a doctor to kiss your ass when you are not a student so hold onto that... haha. Just kidding, but we can always think it. ;)

When bioterrorism takes over the world, I'm going to hunt zombies instead of being a PA...

So, this post is going to be a motley crue of ideas. I've got a bunch of things floating around in my mind right now so I'm just going to write until I feel like its mostly gone. Plus I can't sleep which is a rare occasion so I'm going to take advantage of it.

First order of business... I just turned 24. Probably the most anticlimactic birthday ever - to be honest. I felt like the general theme of this birthday was "I'd rather wipe my ass then do something for your birthday". hahaha. Me and my roomate coined that term when like 5 people bailed out of my birthday dinner with the lamest excuses ever. Its so funny because I know many people care about me, but they sure have a funny way of showing it sometimes. I think I'm not bitter or angry anymore but I keep making this list of people in my mind that didn't even text me to say happy birthday... the list is getting longer and longer - and its really irregular too. Some of my closest friends totally forgot and some of my friends who I barely speak to called me. I'm not even sure what to think anymore. I honestly am not seeking a pity party but I think I just want to use this outlet to say "What the f*ck people?" Aah, I already feel better. or maybe worse. I'm not sure yet. I guess it will all work itself out and I'll come to peace with my situation right now but its a little emotional.

The second realm of thoughts is a reflections on fantasy and reality and how they begin to melt together when you fill your life with too much entertainment, be it books, movies or music. I was reflecting on this because of Edward Cullen. Yes, Edward Cullen everyone. I admit, I did read the Twilight series, which I consider a pock mark on my reading list, but I read it nonetheless. While reading it, and after, I have been reflecting on how the book is ruining my chances with girls and how the reality of junior highers is being changes drastically. Not necessarily by Twilight but by whats behind it. My general fear is this: that more and more, entertainment is distorting our way to see the real world and what we expect of it. I know this idea isn't new but I need to comment on it as I have been pondering it for a while now. Point in case, junior high girls who have become obsessed with Twilight now expect to meet their soul mate who is (ironically) supposed to be the combination of a 150 man who is educated, suave, romantic and very mature but who also looks like a super model and is edgy and sexy. Twilight has distorted the expectations even more than the description I just gave. It scares me to think that girls are starting to expect real men to be like Edward Cullen. Not that girls shouldn't have fantasy about the perfect guy, but I guess I just wonder if girls are missing out on something great and REAL because they sit in their rooms pretending to be Bella while there is something great just a block away. I'm definitely not going to blame Stephanie Meyer for my romantic debacles and the fact that I'm not dating right now, but the book and movie really got me thinking about how I have so many false expectations about love and romance and sex because of the media. I think its the most frightening because most of what the media has told me about life has turned out to be the opposite of truth. It seems like this Edward Cullen business is the new, chic-er version of the knight in shining armour business now that I think about it. Either way, I think life is just a mess and sometimes if we abuse entertainment and use it as an escape, we can be drastically let down by it in the end.

Thirdly, I'm working on an eating makeover and I'm not sure what it looks like yet. I'm letting my intuition guide me but its going to mostly be based on a book by Michael Pollen called "In defense of Food". The generally premise is "Eat food, not too much, mostly vegetables". We'll see where it takes me but I'm trying to eat real food - which is the idea behind the eating makeover. I guess its comparable to the raw diet but not as extreme. We'll see where it goes...

El Pasado: Ok, so I'm trying to get back on track with the whole "writing about PA school and comprehensively leaving advice so if another PA student reads this they might actually get something from it..." so anyways, I left off at Spring quarter. Now you are onto rotations and your second year: which is a craps shoot at best. Most of the programs do it differently which means that you could have really awesome rotations for your second year or you could have really awful rotations or a mix, which you will probable end up with. The thing is that everyone thinks differently of rotations so it will all be relative in the end. First things first though, take a breath and relish in the fact that you just finished the first year and you are pretty much home free from here on out. Its gonna get so much better - I promise. It goes by faster and you learn way more than you could ever imagine. Everything is going to be fine from here on out - just as long as you dont get kicked out or get pregnant.

My first rotation was pediatrics which was a good one to start out with. Start small, finish big is the general idea. Small people as I'm going to call them are both easy and hard. Parents can be totally inflammatory, especially new parents but if you can schmooze the parents you can pretty much do anything. If you are not a kid person, just fake it and they will love you. The more googily you are the better. Here are five things that I'm going to tell you about Pediatrics so I can be done and go to bed: 1- Give antibiotics even if you dont think they need them. Point in case - a little amoxicillin never hurt anyone and most bugs are resistant anyways. So if you think the patient doesn't need it, please all the worried moms out there anyways. If you think its a real infection than give out something better. You'll get the hang of it. 2- not every child is f-ing allergic to PCN! Just because they got a rash, dont blame it on the PCN. Most rashes are related to post viral infections anyways so take a chill pill parents. 3- Most of the visits there is nothing wrong and make sure to learn how to get around that from your doctor. They all know little ways to make the patient feel like they got something even if the kid is fine. Learn home remedies and OTC treatments. 4- Parents will probably not let you do a bunch of stuff on their kid and its ok. I got pissed and I realize now that it wasn't worth it. 5- Vaccination schedules are impossible but if you have to learn them, learn from the MA's. They are geniuses and your best friend.

Thats it kids. I think I'm finally tired.

Words from God’s walk in closet:
I’m not really sure why, but I feel inclined to write where I am writing from everytime I post something. But I think its funny, and actually relevant that you know I am writing from a parsonage. Apparently the organization that provides housing to students owns/ rents this strange parsonage from a church. Quite frankly, I think its haunted. Who knows, it might be God or it might be something else. Either way, it’s a parsonage.
I’m in one of those moods right now… a mood where you want to just run away from your life. A mood where you feel free and completely trapped at the same time. Inner conflict at its best. I don’t know about you, but I feel conflicted most of the time. At work, at school, spiritually, morally and personally.
I have this idea in my head of the way I would like to live – I would like to live consciously of my contribution, I want to recycle, join and organic co-op, not waste money and resources, take public transportation, feed the poor and take care of those in need, I want to be more active, explore nature, eat healthy and really care for people. I want to practice medicine the best way I can but also get people to live healthier without pills. I want to live what I might speak to people. I want to do bikram yoga most days of the week, I want a challenging relationship that I want to contribute to and not think it’s a chore. I want to be true to myself. These are just some of the wants.
It seems as though I don’t do anything that I really want (or think I want) – which begs the question, do I really want these things. Which I truly deep down think that I do – but I’m stuck. I’m scared that I wont ever do these things or anything else.
I feel like the dark in me want me to forget everything I really want for the sake of living a life worthy of anything. The dark part of me wants me to spend all my money on useless shit, be completely rich and wasteful and consume til I drown in it. Or it just wants me to go completely numb and not really care about anything but myself.

Tangent - I just watched Lost in Translation. Sophia Coppola did a magnificent job with that movie by the way. I’ve been to Japan a total of 3 times and the movie made me miss it even more than my basal level of longing to leave the country. For some reason I feel drawn to that place – the contrast between east and west is one of the best I have ever seen juxtaposed. You can experience ancient culture at a temple and then walk down the street and be tempted to spend all your savings at various designer stores. The people have the roots of the most interesting culture which is washed with the western consumer drive. Its amazing. No matter how western the outside appearance becomes, it is still Japan. Nothing less, nothing more.

Recently, I feel the deep need to be creative. To paint, to write and dream. Its probably related to the fact that I’m losing myself the more I work for everybody else. The hard part about what I do, is that I have to stay the same person to every patient I see. My persona in medicine must be steadfast and its excruciating sometimes. Then again, the real me is held back by personal choice in other social scenarios so I cant begrudgingly feel distraught about it. Its just a bizarre life to live and its hard for anyone to understand.

Well, that seems like enough to chew on and I’m going to bed.

Thoughts from jail.

ok, so the heading says thoughts from jail, which is true. I am in jail, but not as a prisoner. I am doing part of my rotation in family practice at the Gila County jail. The irony of it all is that there is nothing "family" about jail but, nonetheless, I write from jail. Lots has happened since the last blog. I moved from California to Arizona, which was sad but a needed change. LA has a strange effect on my spending habits and I tend to blow money like water so I was glad to leave southern california. It really hit me as I left my rotation - what a strange life. Not many people know this, but PA students have to change there lives every 6 weeks. I have moved every 6 weeks to a new place with a new practice and a new doctor since May of 08. Its really sad if you think about it. I build relationships just to end them again in 6 weeks. It really is emotionally draining. In addition to moving back to Arizona, I moved to a little boony town of Globe. It is 60 miles from the nearest Target - which I'm using to quantify distance because I go to Target every tuesday and I have been slightly sad about not being able to go. Its been quite the tradition. Brittany (my roomate) and I would look forward to our "Target Tuesdays" during really hard weeks. The escape to target was much needed to survive the hellish weeks of anatomy, clinical medicine and physiology.
There is something comforting about being in a small town but also very un-nerving (sp?). The community is tight knit but tends to devour it own when things go wrong. I assume this is like most small towns, with the illusion of hierarchy and power. When that is disrupted, somebody gets eaten or torn to pieces.
I'm reading the book called The Shack and its really changing my view of community and relationships - natural and supernatural alike. I'm trying to teach myself a little submission when I enter into a community. Instead of exerting myself to be an individual, I'm practicing submission out of love. Its hard and there is no way around it. I'm beginning to see why community is hard, its more sacrifice than we would expect.
Which could possibly explain why marriages fail so easy - no one thinks about how much they must sacrifice, they just think about the gain. Its not that simple but most of us are just not ready to submit fully to each other.

Spring quarter:
Once you have walked through the fires of winter quarter of PA school - you can do anything. This is pretty much the collective attitude of classes as they pass into their last quarter. I remember my mind wandering into the future far too much when I was in my last quarter. It seems like old hat - new information, but with a sense of deja vu. Senioritis is a good word for it. Most of us were over the quarter before it started and ready for vacation. I don't have much advice for the quarter - its the last little push out into rotations. Dont loose sight of the grand scheme of things. There is a development going on and everything starts to build up to the culmination of a career.
Food for thought - We always joked about a quote from Grey's Anatomy - "We study science and time stops - we're socially retarded". It starts to become true more and more as you get obsessed with medicine. I say obsessed because you almost have to be obsessed with medicine to do it. Make a goal for yourself - spend time with people who have nothing to do with what you are doing. Old friends or people who dont have a medical back ground. Learn how to relate again. Learn to socialize without talking about what you are doing and dont use medical terms. You'll benefit from it in the long run...

Adventures in LA - no medicine needed.

Back to the Future: Today was so great. I felt like I was living - really living and it felt good. Friends, good food, good chai, biking on the beach, driving to pick up a towed car. It was just too good to be true really. Venice Beach and Santa Monica are two places that everyone needs to explore. So many characters to see, so many little places to explore. There is a little coffee shop called Novel Cafe that we grabbed chai at in Venice and its just too great. Its connected to a used book store and its just perfect. We explored Venice and the canals with bikes (which weren't allowed by the way) and I've decided if I ever have enough money I need a vacation house there - which would be more like a vacation room because it would be so outrageous to buy anything of decent size. Anywho, its too bad we didn't do this more often when we were in undergrad. LA has a lot to offer and I think we take it for granted when we are so caught up in our little bubbles of school. I have lived in LA for 4 years and moved away and I'm just finally getting to know my surroundings here. The Griffith Observatory, the Hollywood Sign, Melrose Ave, Santa Monica, Venice Beach, the Block, the Irvine Spectrum. We really are missing out. If you ever make it to LA - dont act too cool to be a tourist. We are all tourists.

Past - I have only a couple of minutes to talk about PA school. I'm on vacation and avoiding thinking about it. Make sure you go on rotations in places you might live and diversify your demographics. Work at places with wealth and poverty and a mix of the two. Go to a different state if you can... Go anywhere and dont settle for what you have been handed to you on a silver platter. There is always something better out there to explore than what you have done today.