Weekend Warriors.

A tear in my brain
Allows the voices in
They wanna push you off the path
With their frequency wires

And you can do no wrong
In my eyes
In my eyes
You can do no wrong
In my eyes
In my eyes

A drunken salesman
Your hearing damage
Your mind is restless
They say you’re getting better
But you don’t feel any better

Your speakers are blowing
Your ears are wrecking
Your hearing damage
You wish you felt better
You wish you felt better

You can do no wrong
In my eyes
In my eyes
You can do no wrong
In my eyes
In my eyes
In my

In my eyes
In my eyes
In my eyes


Hearing Damage by Thom Yorke.

Maybe if we made hospitals like they were supposed to be for sick people people wouldn't want to go to them...

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. ;)