Normal chest x ray.
(Picture by http://www.anatomybox.com/).
Been looking for something like this for a while!
Sorry dudes for the lack of posts this past week. It was a wild ride. This past weekend I had the ceremony for my Masters of Health Science degree (although the PA will come a little later, after my last rotations are done), and it was crazy with family coming into town and doing sightseeing along the coast whenever I wasn’t be-speculum-ing women or watching babies swim on an ultrasound monitor.
I’m actually enjoying OB-GYN more than I thought I would. My preceptor is really great with both me and her patients and takes the time to teach me despite her crazy redonk schedule of 20-30 patients per day plus labor & deliveries and frantic after-hours calls from panicking pregnant ladies.
Most of the time everything has been good and healthy with the pregnancies, but I have seen some fetuses with heart defects and a few mothers not taking care of their health (uncontrolled diabetes, drug use, smoking, etc). I’ve also seen uterine didelphys (2 uteruses and 2 cervixes in one woman). It is also an underserved population so there are a lot of young mothers, some of them my age with 3-4 kids already. I can’t imagine taking care of anyone other than myself, especially in PA school!
No L&Ds yet, but we’ll see what this week brings.
I’m definitely happy about my decision to go back to PA school. Previously I’ve worked as a CNA, home health caregiver, lab rat, greenhouse plant waterer, pizza slinger, pretend park ranger, and deli manager, and really none of those comes close to making me as happy and excited to go to work as being a PA student. Well, the pretend park ranger is a close second ;-)
I can’t yet speak about what I don’t like about being a PA, since student clinical rotations and the real world are two different things, but I can tell you the things I don’t like about being a PA student: The constant stress and checklists of things to study and do, having a new job and sometimes relocating every month (this really gets me frazzled), having medical staff assume I’m dumb and have no experience or utility to them whatsoever, having preceptors that aren’t interested in teaching, needing to be very careful about spending money (although student loans are fairly generous I think), and having a few issues with my program treating me like a child (much better now than when I was a new student though). Really all of these things are temporary, though. If PA school teaches you one thing, it’s to learn to roll with the punches, smile and nod your head when you really want to punch someone, and function like a professional under lots of stress and very little sleep. All of the negatives have probably been good for me in the long run.
I’ve officially lost count of the rotation number I’m on. It’s come to that point in my PA career. Only a few more rotations left. And boy, do I still feel dumb! Totally thought I’d feel way smarter by this time when I finished my first year… Oh wellz. I just took the pre-SAT of the PA medical boards known as the PACKRAT. It’s a test designed by the Physician Assistant Education Association to simulate the real deal I have to take in a few months, the PANCE. And the results? I did the exact same raw number as last year, BEFORE I began my clinical year. Yup, really hoping that it was harder this year or it officially means I haven’t gotten any smarter in the past 9 months or so of actually working in medicine. Which I know isn’t true, but in terms of taking the test it’s what really counts and determines whether or not you become a PA-C.
Anyways, moving on… I’m starting a new rotation! Goodbye to the ED! I will miss the fast pace and the interesting cases, but I was getting tired of ordering so dern many tests on things and constantly having to think about “what will kill the patient” versus what was really at the top of my differential. And not working things up all the way. That drives me nuts!
What now? Obstetrics and gynecology. I’ll need to travel quite a ways away from my home base and live in student housing for a month. The awesome thing is I’ll be on the coast. Delivering babies and surfing the waves, dude. Rad. Truthfully, though, I’m quite nervous. OB-GYN is not my strong suit. I had absolutely zero work experience in this area in my former career as a CNA. I also heard my preceptor is one tough cookie. Yikes! Hoping I won’t cry??
Last day in the ED. I got put in the level 1 trauma/resuscitation area. Gulp. Let’s hope it’s not as crazy as last time. I’ve decided I’m not a total adrenaline junkie.
Me (to pt with known drinking problem): “Sir, do you drink alcohol”
Bob: “No… Maybe a beer sometimes.”
Me: “OK, how many beers per week? Or per night?”
Bob: “I don’t know.”
Me: “Well, do you drink a few beers every night? Or more like just sometimes throughout the week?”
Bob (giving me a severe look): “Girl, you don’t know the first thing about drinking beer, do you!”
Me: “Sir, I’m from Wisconsin. I know all about drinking beer.”
Bob: “Well, then you should know that you don’t remember how many you drink after the first beer!!”
Me: “Ok Ms. C, I’m all done with your rectal exam.” (Moves to discreetly pull pts panties up for her so she’s not flashing the world)
Ms. C: “AAAHHHHH! WIPE MAH BUTT! AAAAHHH!”
Resident: “Ma’am, there’s no need to scream like that at us!”
Ms. C: “I SAID WIPE IT!!!”
I have just finished rushing to see a 88 year old walky talky older gentleman brought in by EMS after having a fall at home and I’m trying to read his prior medical records when an 8th year trauma surgery resident strolls in and demands “Who’s seeing Mr. So and So??”
Me (glancing nervously around and seeing my PA preceptor has disappeared): “Uhh, me, I guess. I saw him with the PA.”
Trauma surg resident: “Well… So???”
Me: “Uh… Well he looks pretty good…”
Trauma surg resident: “Well so why was he levelled then, huh?”
Trauma surg resident (glancing over my shoulder at the patient’s EMR): “Oh, he’s on Coumadin. That’s why.”
Me (awkward-er): “Hee hee. Sure…”
Trauma surg resident: “Well, what else can you tell me? What did you see on secondary survey?”
Me (looking at him like he’s from another planet): “What?”
Trauma surg resident (throwing up his hands): “Spinal tenderness, deformities, hemotympanum, what did you see??”
Me: “Oh, ok. No spinal tenderness. Some tenderness over the left greater trochanter. A mild scalp laceration, I don’t think he’ll need stitches. And I saw a small TM perforation in his right ear but no blood.”
Trauma surg resident: “WHAT? He has a perf in his TM? Did you tell someone?”
Me (nervous but positive that’s what I saw): “Yeah, yeah, I told the PA. I don’t know but I think that’s what I saw. Maybe it was old. But no blood though.”
Trauma surg resident (exasperated): “People don’t just walk around with holes in their ears you know! … Ugh! Ok, what about the rectal?”
Me: “Oh, we didn’t do a rectal.”
Trauma surg resident (eyes about to bug out of his head): “WHAT?? WHY DIDN’T YOU DO A RECTAL?!?!”
Students Dissecting a Cadaver, c. 1900.
Standards for dissection have changed a bit in the past hundred years. From the photograph description:
The cadaver lies on a ceramic anatomy-table. A gas lamp is above the corpse. A student has placed a book on the cadaver’s forearm as if the cadaver were holding it for him. Two of the men are smoking pipes.
Oh man. What an interesting picture. Can you believe how much has changed?
Said the program director to the group of interviewees at my first PA school interview 2 years ago. Damn good advice it was! But sometimes life doesn’t wait for you to finish PA school.
I got engaged about a year ago. For me, it was the right time. But recently things have started to get a little crazy. I’ve done the majority of planning and preparing for a wedding that will take place across the country from where I’m living right now over breaks and weekends. That’s been ok. But trying to plan for 250 guests on a post-PA school budget is rough. Making and hand-addressing save the dates and invites when you’ve got an end of rotation exam coming up is anxiety-inducing. Getting the exercise in and avoiding the 4am hospital cafeteria carbs so I can lose my PA school pounds in time for the wedding is sometimes the last thing I want to do.
On top of that, I don’t know where I’m going to be after PA school. I’ve taken a leap of faith and applied for a postgraduate residency that starts immediately following graduation, the same month as my wedding. Which also means I need to take my PANCE as soon as I can after graduation, leaving just a 7-10 days to study for it all. And if I don’t get in, I need to start looking for jobs because the financial aid runs out a few weeks after graduation. And then my > $100,000 in student loans comes due.
Deep breaths! I will make it through this all!
My Wife’s Fight With Breast Cancer
one of the saddest and most beautiful photo essays I’ve ever seen
I don’t think I could ever be this open photographically showing my wife slowly dying. I couldn’t do it, but this is beautiful.
my fucking heart.
The second to last picture - with the stockings in the background - hits so painfully close to home.
Click the link, see the full photo set and read the story.
I had to do a pelvic in the ED the other day on a 32 year old with breast cancer and all I could think about was this photoset I’d seen the day before, and how much I hoped it didn’t end like that for her. It made me want to go into primary care, though, as before the physician left the room he accidentally made it sound like she’d gotten herpes from her partner being unfaithful (I’ve found the ED peops to generally be a little rough around the edges when it comes to bedside manner). I reassured her that the majority of the population tests positive for one form of herpes or another and likely she’d had it for a long time, only the chemo made her immunocompromised and caused it to surface at the worst possible time in her life. She felt a lot better after that.