Next Step

So I've now completed my Primary Care, Psychiatry and Emergency Medicine rotations. 6 to go.

Next up in Long Term Care. This rotation is normally a big snooze, but I've heard that I'll see some really complicated patients and that the preceptor loves to teach. I'm actually looking forward to it. It's not going to take place in an actual long term care site. We'll rotate through a hospital visiting the preceptor's private practice patients and also rotate through an acute care/rehab facility. There is also a nursing home that we're officially affiliated with, but I've heard we spend minimal time there. It should be a good experience.

As graduation comes closer plans need to start to be made. We all know that I'm a big planner. Love me some planning. Right now it looks like I'll be moving from my apartment at the end of the summer, and most likely leaving my roommate. I don't know if he's aware of this. But since he's going and getting all engaged this summer (and consequently married the next summer) I'm looking for someone a little more long term. So I'm going to be moving in with a long time friend (who happens to have the name last name as my current roommate). His roommate (also a long time friend of mine) is going to be moving in with his girlfriend (another long time friend). (I have a lot of friends)

We're going to ignore the fact that a bunch of my friends are moving in with significant others.

I've started the wheels on some professional plans. I'm a little nervous to share these online, so I'll remain vague. I have already decided on a place I'm applying to. I'll be applying this upcoming spring, and will know if it's happening before I graduate (end of August). We'll call this "Plan A." We want Plan A to be successful, although it wouldn't be heart breaking if it didn't. Plan B is applying for jobs shortly before and following graduation. There is nothing special about that.

Want a short summary on Emergency Medicine? Okay!

It was ehhh. It's interesting to see totally random things, but it can often be slow. I also never got to work in the high acuity section. The patients I saw did often get admitted, but no one ever seemed to be in imminent danger. As soon as I had a patient that I found interesting they would be admitted. I would never get to see what happen to them. This is how I know Emergency Medicine isn't for me. Definitely would prefer a Hospitalist or maybe Critical Care job. Those rotations aren't until the very end. That's okay though. I should be well prepared to kick ass by then.

Do people actually want relationships?

It seems that at my age (24) everyone is looking for a relationship. Those who are not in them seem particularly miserable about it. But then I see my peers who are in relationships, and I don't find myself filled with envy. To be honest, I know very few couples that make me wish I had what they have.

I've realized that the "relationship" people want they've created in their minds. It's as if they've been incepted with this concept that they've never seen in real life. I think an english major friend of mine once told me that the idea of "relationships of love" didn't show up until the victorian era or something. I don't know whether that's true or not, but I feel this is where people base their desire for another.

I do realize that there is a biological component to this. There is the innate desire to reproduce and stay mated long enough to rear healthy offspring. I'm big into evolutionary psychology, but I've also learned that our natural instincts are full of shit. Cheating on each other is a natural instinct. It profits you by having more offspring. Look at the animal kingdom. Everything they do is instinctive. This is what defines humans from animals. Therefore people, quit listening to your instincts.

I come from all of this happy. I realize that seems odd. But realizing that a relationship isn't actually going to make you happy is liberating. I'm not saying I'm opposed to them. I'm saying that my happiness won't be defined by one. I'm happy now without a relationship, so why can't I be forever?

I wrote this for other people to benefit from. I want people to be happy. Stop thinking that you need something just because you feel you do. Look around you. People that have what you want are often not nearly as happy as you think you would be.

The grass is always greener on the other side, but I hate mowing.

Questions from the masses

Hey everyone! Psych is going really well. Love it so much. Would definitely consider a job in it, but since there aren't many PA jobs in psych I'm not going to be holding out for psych specifically. Actually, lately I've been thinking about moving to a different city after graduation, but that's for another post.

Below are some responses to an email I got today. Feel free to send me your own questions at GregoryHousePA@gmail.com

1) the fact that MD's really don’t have the horizontal movement PA's do between
specialties (so if you ever get burnt out doing EM for example, you could
switch to ortho, GI, or whatever)

There is no comparison to PAs in terms of horizontal mobility. This is one of the biggest things to bring up when comparing NP to PA. NPs are trained in a specific area of medicine, whereas PA are trained in all aspect of medicine. We're trained to be able to adapt to new specialties making us the most versatile members in health care. Granted if you do find one area of medicine that you truly love and only want to work in then you may feel slighted that you're not the MD and hesitate to go back to medical school. I know myself I'm not going to find one area of medicine that I'll want to stay in forever. I need change.

2) the ridiculous amount of time you spend in med school, and insane amount of
debt you rack up (especially considering how physicians salaries are likely to
go down in the future even though demand for health care is going up...seems
the golden age of doctors and medicine is over)

The golden age of medicine for doctors is over. These are the exact words that physicians have said to me when I asked them if they would go to medical school if they could make the decision all over again. You do spend a crazy amount of time in school and residency. I'm sure that when you're all done with your training it may be worth it. I had one PA tell me to go to medical school because I have time on my hands, since I'm so young (24). No other PA has ever said this. I didn't want to sacrifice my 20's for a career that isn't going to be the center of my life. Medicine is a job for me, not a life's passion. I enjoy the work and that's why I'm going into it.

As for the debt, I'm going to be 100K in debt for a Master's and looking at a starting salary around 80K. You can be more economical going to medical school depending on whether it's an instate tuition and such, but there are cheaper PA schools also. Mine is one of the more expensive.

3) the difference between the two in terms of LIFE balance (IE not working like
a dog for the rest of your life, having decent hours, being able to enjoy your
life outside of medicine, have a easier time meeting a partner/starting a
family, etc. This is probably the most important factor for me personally. What
is the point of the prestige and money of being a doctor, if you can’t enjoy it
like you should?)

I kind of touched on this previously. I chose PA partly because medicine isn't my life, it's my job. Being a PA means that I have a ton of job opportunities. Varying types of atmospheres (hospital vs private practice), schedules (shift work jobs vs 9-5), getting per diem jobs on the side to make a little extra cash. It's a profession that allows me the greatest flexibility when designing my lifestyle. If I want to work a ton, I can. If I don't want to work crazy hours, then I simply don't take one of those jobs. But remember, you can't always get the job that pays what you want, is located where you want, and is in the specialty that you want. You need to compromise something somewhere probably.

So far browsing through the PA forums there have been a few people who say PA's
really don't have that great of a schedule compared to MD/DO's and sometimes
work even more (for less $$ too), but it seems like the greater majority of
PA's and PA students seem to agree that PA's do have better scheduling and more
time to enjoy outside interests (things like playing an instrument, family time,
training for triathlons, or whatever you have as a hobby). Has this been your
experience as a PA, with other PA’s you know, and the things you have seen so
far? I just don't want to go to PA school with some false ideas being the basis
for it. I guess the overall point of this letter was to ask you if any of the
reasons I have for wanting to be a PA are unfounded or untrue, and ask you why
you personally decided to be a PA as opposed to an MD, DO, NP, or any other
health care provider. If you could do anything over again, such as going the MD
route would you, or are you very happy as a PA?

Bottom line: I'm very happy with my decision. That being said I'm not a working PA yet. I haven't had to find a job. Some PAs complain about their hours and there pay. Those PAs should switch their jobs. There are lots of job opportunities. You can find a job that works for you. But this can be very dependent on where you live. The city I currently live in has lots of PA jobs, but not very well paying. I'm probably going to move to a different city because there are more opportunities and better pay. This works for me because I love that city and have always wanted to live there. This plan wouldn't work out for you if the city you want to live in has a shitty PA situation. I can't say that because you're a PA you're guaranteed to "have a life." But you should have the opportunities to, assuming the life you want doesn't require a 200K+ income. (You would have to work multiple jobs to make 200K as a PA)

I would have to apply for the 2012 PA class since I would first
have to take anatomy/physiology and the GRE this year then do the whole
interview process again next year if I got any (I think I am a decent
candidate, I have 3.9 GPA, worked on a collegiate student run rescue squad as
an EMT-B for 2.5 years, was a nurses assistant for 2 summers, have lots of
volunteer work and shadowing, etc). I would also need to find a job for next
year as well. I still have a lot of time though to sit on my acceptance/deferral
to med school and don’t have to tell VCU no until August/September of next year,
so until then I will definitely pursue this. Thanks again.

There are plenty of schools that don't require the GRE. I didn't apply to any schools that required it, mainly on the east coast. (18) As long as you get A+P done by the start of PA school then there isn't a reason you can't apply now, but late October is really late in the application process. You may not want to apply this cycle. I personally LOVED my year off between college and PA school. I got a job as a medical assistant in derm and it was fun. I learned how to act with patients and was well prepared for school because of it. Also that job definitely helped a lot getting into PA school, so having a job would offer you more school options.

Passive Aggressive

Since being on rotations I seem to have developed a rather passive aggressive behavior. It's one that my faculty told me to adopt whilst being on rotations, but I almost feel it's getting out of hand. When ever a preceptor tells me something blatantly wrong I never correct them. I'll tell them what I think, but if they say I'm wrong I don't fight it at all. I mean this is overall a good thing I guess. It makes me seem non-confrontational, but shouldn't the right answer prevail? I don't have an issue continuing like this, but I feel like I'm getting borderline aggressive with this tactic. I'm actually getting a kick out of people telling me the wrong thing. Internally I know that I'm right and they're wrong. That's all that matters to me.

I know this sounds terribly arrogant, but trust me this isn't occurring a hundred times a day. It may only be 1 occurrence a day, if even. And it's not even always about medical facts. It might just be about how I heard the healthy miner's were getting brought up first, then followed by the more frail miners. People disagreed about it with me, but I had literally heard that on the morning news an hour earlier. But whatever. Should it even matter?

PS - I'm currently on Psych and I'm loving it. I also think I take to it exceptionally well. I really want a job offer from this site. I don't think it's going to happen though, but only because there isn't a job opening.

Surprising Revelations

I can't believe I'm saying this, but I like primary care more than I thought I was going to. I thought I was just going to see colds all day, but so many things end up being something entirely different from what they seem. It's a nice surprise.

The thing I like the most about this specialty (can you even call it that) is that you're generally the first person to see a new problem. It has the highest degree of problem solving. And not only does it have a high degree of problem solving, but you also see the problem to its end. That's one of the things I hold against Emergency Medicine. You diagnose a problem but then you either admit and never hear from them again, or they leave the ER never to be heard of again. (I know that's a total lie.)

I would consider doing one of the two year commitments for loan repayment. But I'm seeing that they only offer 50k now. I could have sworn that use to be 80k. Another thing that's nice about those loan repayment programs is that you can find work in interesting places. Hawaii for 2 years? I bet I could make that happen.

Rotation Schedule

Primary Care - So happy I'm starting with this. I'm theory I'm best prepared for it. It's what I asked for and suppose to be a great site. Hopefully I'll be wrong about not liking Primary Care.

Psych - Far, far commute but suppose to be a great rotation site. Was told by many to sit in on Music Therapy.

Emergency Medicine - Didn't get what I wanted and felt a little taken advantage of, but it's a <15 minute commute and I've heard it's a good site.

Long Term Care - Again, taken advantage of because I have a car. There were two sites 15 minutes from me but they give me the one 1 hour away (before traffic). Oh well, not the end of the world.

Pediatrics (ER) - Got what I asked for, for better or worse. Another really short commute at the same site I have EM. They're going to get to know me there.

Surgery - Got what I asked for. I'm at a site that has like zero students and is very one-on-one with the surgeon. Lots of OR time, again for better or worse.

OBGYN - Easy commute. Heard you don't do much. That is a blessing.

Internal Medicine - Been hearing mixed reviews about this site. I'm very happy it's one of my last rotations. I'll be better prepared for the site, which is important because I want to excel at that site. I'm hoping I can get a job offer at this site.

ICU - This is my elective. It's pure perfection that it's my last rotation AND right after Internal Medicine at the SAME hospital as Internal Medicine.

At first I was feeling taken advantage of because I said I had a car and could live with my family (which is closer to other sites). But you know, none of the sites have bad reviews. I thought it over and realized that this is probably going to be a great experience. Hopefully it means more interesting posts. I'm really excited and eager to start rotations. I feel surprisingly ready for them. My experience of working somewhere that I had no prior experience helps a great deal. I'm not afraid to interject myself, get criticized and say "I don't know."

Start date: Tuesday September 7.

Phase One: Complete

Friday the 13th. The day of the cumulative didactic year final exam.

I'm sorry that we haven't spoken until now. But to be honest I haven't had anything exciting to talk about this semester of PA school. Well I have become more serious about Buddhism. Maybe I'll talk about that in the future.

Psychiatry, Orthopedics, Geriatrics, Rheumatology, Emergency Medicine, Pediatrics. They've all been completed. I really stopped trying nearly as hard as I did during the rest of the year. And I mean I really didn't work very hard. I would read over the lectures a max of once. I'm sure there were topics I didn't read at all, especially Emergency Medicine and Geriatrics. I also stopped going to lecture once Emergency Medicine and Pediatrics came around. I just can't put my sanity through lecture anymore. You know what? I don't regret it at all. I'm probably going to get a B+ in Medicine III and I'm totally cool with that.

I can't say I'm really that nervous for tomorrow's test. Although I am having a hard time falling asleep tonight, so that's probably not entirely true. (I've also been sleeping until 12PM everyday and going to bed at 2-3AM, so that probably plays a role also) I haven't studied that crazily for this test. I've done well in my Medicine class the entire year. I retain the things I learn very well for the long term. I can't imagine they're going to start asking about the thing I wasn't able to learn for the short term. And as mentioned before, I haven't really been studying for tests this semester. It has yet to bite me in the ass. We'll see what happens.

After the test tomorrow I become a Clinical Year student. Should provide much better material to share with all of you. :-)

CODE BLUE

Today we were getting ACLS certified and I was called upon to be the team leader. Previous to class starting everyone was freaking out memorizing their algorithms during a fire drill. I decided not to cause I'm sick of studying 24/7 and wanted to enjoy my iced latte.

The instructors showed a video that ran through a code a couple of times. Made it look very systematic and methodical. No big deal right? Follow the algorithm. They stressed to use that it's recommended that you carry your algorithm on you even while a practicing PA. How hard could this be?! They're telling me to carry and refer to a cheat sheet.

The class then broke into groups, but we basically were running through codes at each station. The instructors called on different people to be the team leader and use the group for their team members. I got to see a couple of classmates go through it, but no one was very confident and most were stumbling through it.

As most stories go, I then got called on to be team leader. And this is the part were you expect to here about how I crashed and burned after being put on the spot. I would then learn my lesson for being cocky and grow a little as human being.

TWIST!

I fucking rocked it. I set up my team no sweat. Got my ABC's down. Recognized the rhythm and ordered all the right meds and shocks. After I was finished the head instructor praised me for my job well done and said that I was on par with many cardiologists that he teaches.

I basically had a repeat performance with the other two groups. The token hard ass physician instructor called on me to be team leader once. He picked me out after talking about how easy it is to see what people are doing wrong when you're not the team leader. He really thought he was going to get me when the EKG was a Second Degree Type 2 heart block. I got that shit. I knew I got his approval when all he said at the end was "Good work. You're off the hook."

SAVE ACCUTANE!!!!

Today we were learning about adolescent medicine. This is the only type of primary care I could ever practice. I don't have the bubbliness to get babies to like me and I don't have the patience for the bullshit adults come in with. But I get teenagers, I respect them, and they like me back. I also feel for them cause I had plenty of their same issues growing up.

There is a new advertisement on TV that attacks Accutane making claims that it gives your Chrone's disease. I challenge those lawyers to show me the evidence based medicine behind that. Accutane is a MIRACLE drug. This is no exaggeration. Cystic acne is a horrible, life scarring condition. I had it and treated it late. My face shows the damage. I've worked in dermatology. I know there is NOTHING the touches the results Accutane produces. The only lasting side effect I have from Accutane is dry lips. I'll fucking take it. My aunt and uncle went on Accutane 30 years ago. They're perfectly healthy. My uncle has even donated part of his liver. THAT'S HOW HEALTHY HIS LIVER WAS AFTERWARDS.

Anyone who's reading this, I ask you not only to have a positive view on Accutane, but advocate for it to stay on the market.

Whine Central

Okay so I was really enjoying running. My feet were doing great. My feet were always the reason I couldn't run. Shoes solved the problem.

Evidently if I run for more than 2 weeks then my knee give me the finger. I'm walking like a 90 year old man with horrible arthritis. I'm dependent on NSAIDs and I don't like it. Until my knees feel absolutely fine without NSAIDs I'm on a running hiatus. I have no idea what I'm going to start doing for aerobic exercise. Boooooo

Eff This

Ugh. +3.0lbs.

Someone just get me lipo.

Running

Eating right, and lifting weights hasn't really been doing much for my weight. For the record I'm not overweight. I'm just not in love with certain aspects about my body, and would just like to work on having a lower body fat percentage.

I have however had improvements with my shoulders and chest. So that's nice. I didn't increase my caloric intake once I started working out, but have incorporated much more protein into my diet, via whey protein. I attribute this to the gross muscle growth.

I have the diet in place - avoid sugar, increase protein. I've got the weight training - hit all muscles groups not just the showy ones. There was just one thing I've been missing - aerobics. I think that because I never do aerobics I never deplete the glycogen reserves in my liver and skeletal muscles. My diet has been enough to help with any repairs my body needs from the weight lifting, but not so much that I've been gaining fat. But what I need is for my body to need to go into the reserves (aka body fat). By running I help deplete those glycogen reserves and make my body go to the body fat for energy.

I have avoided running because I'm a bad pronator. I get horrible leg pains that have always deterred me from running. But I decided I need to change something about what I was doing if I want to see improvements. So I went out to a running store and get fitted for shoes that would help my pronating. The shoes are amazing. I actually enjoy running now. I follow the training method of Doctor Mama to the "t."

The only downside is that I get lots of random aches an pains. They generally subsdie after a day or two and don't return to the same spot. I unfortunately can't say this about the pain in my knees. Coincidentally I'm now learning orthopedics in class. I think I've got some patellafemoral syndrome pain going on. I'm hoping it's going to subside with time, but I've got PT exercises printed out just in case. I also think that for this condition it's okay to treat with NSAIDs. They sure do help, but I reserve them for pre-treating before a run. What I really need to do is starting icing after running.

Tomorrow is a weight in day. Let's hope I continue losing 2 weeks in a row!

Theory on Flamboyance

I recently met a couple of gay guys through friends. They were in short, "flamers." I'm pretty far from ever being called a flamer, and this obvious difference sometimes make me feel like an outcast in my own society.

I feel like you never see as many older flamers. Is being excessively flamboyant a stage? I'm starting to think it is. I started thinking about what the major differences between the 20 somethings and the 30+ somethings are.

One thing that stands out is that those that are 30+ are often more professional stabile. When I think back to the two guys I met there was a distinct commonality they shared. At one point they both made it clear that they were proud of where they were in life. They didn't like their current jobs, weren't meeting the goals and such.

Could the flamboyance be an act? People have always coupled homosexuality with flamboyance. But what if flamboyance was a defense mechanism to come off more confident than they actually felt. This could be a defense mechanism that is specific to homosexuals, as opposed to a standard trait specific to homosexuals.

Hell, this defense mechanism may not be specific to homos at all. I think straight men, women, lesbians probably all put this front up in one way or another. They like to go out and be the center of attention and pretend like nothing bothers them. They try to make it look like they are totally cool with where they are in life, who they are, etc. Maybe this pumped up faux-confidence just turns the volume up on the already present feminine/flamboyant qualities of homosexuals.

Of course I'm speaking in general terms. I'm sure there are some people that truly are that confident, and THAT GAY.

DADT

Over on the Physician Assistant Forum there was a discussion about Don't Ask Don't tell. There were some diverse opinions on the matter. You can refer to the link to see the spectrum. Some people were totally against gays in the military, some supported DADT, some thought gays should be able to serve openly. It was a fiery debate. I like to think that my response was one of the more cool, calm and collected:

I read the first 6 pages of this thread, so I feel I got a good sense of what's going on. Why not throw my $0.02. Where to start...

I'm gay. (That makes like 2 people total here, right?) I use to consider myself a Republican, but then realized current Republicans weren't actually Republican. So I have no real party affiliation or team bias. I've never served. I could give my religion, but don't see how that's relevant since we live in a country based off secularism. As a side note, being "secular" doesn't mean being godless or without morals. It means being respectful of all people regardless of their personal beliefs.

I understand where these disapproving people come from when they say, "I don't want gays checking out my junk." That's fair, you're uncomfortable, and women and men have always been split apart. You want some mutual respect. My response is that I don't understand why women and men need to be split apart. Aren't they all adults on a mission? IDK - I've never served so maybe I'm missing something here. When I'm seen as a patient, or seeing a patient I don't care about gender. But if it's really that big of a need to split men from women, then yes it should be done by sexual orientation also. Men have rights too.

Outside of this living condition situation I think it's ridiculous that gays shouldn't be able to serve openly in the military. What part of being gay is a hinderance to service? Oh, it makes some good old boys uncomfortable and they make up a large percentage of the military? I dare say that a number of people felt just as uncomfortable next to blacks when they started serving without segregation. People are different. Get over it. You would be shocked that you might actually like and respect these people.

As for whether homosexuality is a "lifestyle choice" or not - does it matter? If people don't approve or respect me because of my "choices" then so be it. It's not like I have to approve of you either. I'll still show you respect. I'm not touching the "sin" aspect because that is purely up for interpretation based off you religion.

Which leads me to this last ridiculous question about being gay and a Christian musician. Believe it or not, there are sects of Christianity that don't believe homosexuality is a sin. Crazy I know. They're the same groups that also believe in evolution, women's right and that slavery is out of fashion. What is this world coming to.

Addition:
To people who support gays via DADT: Why are heteros allowed to talk about their families and spouses and maybe daresay occasionally their sexual desires, while gays aren't allowed to express anything similarly? I listen to my straight friends talk all day about their raunchy desires. If I say "I want to see Prince of Persia simply for Jake Gyllenhall," then damn(!) let me get that off my chest! It's not like I'm humping your leg!

Previously, on LOST...

I don't think I can refer to myself as House anymore. I cried during every single Flashback in the LOST finale, and was then inconsolable for a half hour after the show ended. There are still specific scenes that could make me lose it at the mere thought.

I'm such a little bitch.

A Lesson in PR

Remember when I was all excited because AAPA was using a quote from me in the latest edition of PA Professional? Well they did use the quote, but didn't mention the name of my blog. I think that's a pretty dick move.

wompcity.

Grades

I am one very, very lucky boy.

I comfortably got an A in Pharmacology and A- in Evidence Based Medicine.

By the skin of my teeth I got an A- in Clinical Medicine (89.97). And when I didn't think I had any skin on my teeth left I get another A- in Clinical Applications (89.60!!!).

I got a B+ in Lab Medicine, but whatever. The A in Pharm evens it out to an A- average. I'm doing so so so much better in grad school than undergrad. w00t!

Yellowstone

Big Sky Country

I passed all my finals - most better than expected. Though I have to say I'm a little surprised at how many people have to remediate.

I'm off to Big Sky Country for the weekend . Catch you never!!

Finals Syndrome

For the past month or so I've gained about 8lbs. The funny thing is I've started regularly working out during this time and have maintained my (snack free) diet. I've especially been noticing the inner-tube around my gut getting larger. My reaction has been WTF?!?!!

I have also recently come down with a sore throat. I would generally attributed this to a post-nasal drip 2˚ to allergies. But I've been really good with my Zyrtec and have had barely a sniffle. Again, WTF?!?!?

I have my Medicine final tomorrow. I'm really worried. I failed the Infectious Disease test and didn't do that hot on OB/GYN. I dedicated a full day to each of those topics, which leaves me with one day for Cardio, Neph/Uro, Neuro and Endo. The saddest thing about this is that I don't even feel remotely comfortable with ID or OBGYN. I'm stressed.

So I'm sitting here studying Endo and it dawns on me. This past month I've had a test every week. 4 finals last week. A case study that I had to remediate TWICE, among numerous other assignments due at the end of the semester. I've been stressed. Stress leads to increase cortisol. Increased cortisol inhibits the immune system and stimulates lipogenesis, especially abdominally.

FUCK FINALS!!!!!!

The Amazing Race

I simply cannot get enough of this show. When when when am I going to be able to have the time to do the show and someone to do it wiiiiiiithhh??????? I've been watching this shows since the first season and I still haven't had the opportunity, but have printed the application numerous times.

Maybe the Army is right for me...

Clearly DADT isn't keeping anyone out of the Army.

Speaking of mentoring...

A former co-worker of mine called out of a the blue at 12AM. She claimed the reason she called was because she wanted to know if I would be facebook friends with her. I told her sure, but that you don't generally ask permission to friend request someone.

She then went from that topic to asking if I think it's okay for girls to call back guys. (Random...)

She then asked if I was still gay. (More random) She thought that since I'm around so many girls that I must have turned straight by now. Her cultural background traditionally doesn't quite understand (read as: approve of) homosexuality. But this is a common trend in her life. She often doesn't understand her own desires or behaviors, let alone others'. As introspective as she thinks she is, she generally comes up from the depths of her mind empty handed.

She then said that she knew what she was doing about medical school, but wasn't ready to tell me. She said this without me asking about medical school. I told her she didn't have to tell me, but that she obviously wanted to since she brought it up on her own. Evidently she's planning on going to Cuba and was very afraid of my reaction. I don't even know why she would care. I barely ever speak to her and haven't seen her in real life since working with her.

The conversation only got stranger from this point. In fact it was so strange that I don't think I can even summarize. It basically came down to me calling her out on not living in reality. She gets so caught up in the future, that she's not seeing the world around. I went a little Buddha on her ass. All she thinks about is the "dream life" that she wants. Now I'm all about having goals and such, but you can't become that blinded by them. I truly believe that she's going to be miserable going through this process and that the outcome isn't going to be what she suspects it to be.

Sometimes I wonder if I'm all that successful at Buddhism. But then I see people like this, and I realized how far along I really am. I try to help her "see the light" but it's difficult. How bodhicitta of me.

Mentals!

A couple of people in my class decided they wanted to organize a mentor group for the incoming PA class. This is so standard of our class. We're always so nice to each other, and helping each other, and doing all these Q+A sessions during the applicant. A group of effing saints. So unlike the current senior class. They want absolutely nothing to do with us, and nothing to do with each other. And if you thought the whining was bad in my class, it's nothing compared to the seniors. The faculty despises them, as do we. But I digress...

So I was asked to take part in this mentor project and I eagerly agreed! I love mentoring people. Back in the day I wanted to be a psychologist because I love talking people through life issues. I'm good at helping putting things into perspective.

This new development has really made me happy and gotten me out of my finals depression.

Class Etiquette: Grade bitching

Our class recently got back a SOAP note assignment. Many people failed. But many more weren't happy with their passing grades. It was an ugly scene. I think it was interesting that the people that didn't fail complained way more about their grade than those who didn't. I'm not surprised about this because the people that complain about grades are generally the more OCD, whiney, gunner students. It therefore makes sense that they were the ones that passed. But for the love of god people don't say things like:

I can't believe the grade I got. I practically copied what someone else did and they got 15 more points than me. With this grade I have a 97 average and I mean that's only 3 point away from not getting an A. There is no reason someone shouldn't get an A in Clinical Application. But you know I really don't care that much about grades.

OMG. STFU. The entire class doesn't want to hear you go on and on and on about your passing grade. Grades don't matter. Your grades especially don't matter to me. And don't tell me you don't care about grades when all you do is bitch about your grades and compare them with other students'.

I was one of the people who failed. I'm fairly indifferent about this. Grades really don't matter when it comes to getting a job. I definitely learned a lot from this assignment. I think it was a positive experience overall. I think things stick with you more when you get them wrong, and then realize why you're wrong. That's not to say that people should aim to get things wrong... But I wish some of my classmates would care more about the comments left on their paper and less about the number on the top.

Scratch that. I'm getting passive aggressively attacked about why I
wanted pa over np and how np is better.

Is it suppose to be a good thing that you have to do less CMEs? Damn
If I had known that then I definitely would have been an NP...

Sent from my iPhone

Today I did something I've never done before. I was so stressed out tonight I had a beer to calm down. Not a fan of this.

Missed Pneumothorax?

My physical went fine today. The NP was nice and we chatted a little. Anytime I mentioned anything about what I'm doing in school she totally ignored it. What eves.

I have self-diagnosed myself with Marfans Syndrome. I didn't tell her this, but she had all the necessary information to make a diagnosis. Tall and thin with long digits, mitral valve prolapse murmur, she also thought she heard a different murmur, borderline glaucoma when I was younger, scoliosis (she did this exam but didn't comment on it), nearsighted, low muscle tone.

So when I was asked about chest pain I told her that I sometimes get stabbing chest pain over my right chest with aerobic exercise. This has been going on since HS. I've never been to concerned about it because it would go away with rest and I never got dizzy. I told her that I actually think it may be a spontaneous pneumothorax. She looked at me totally skeptical. Then I said I'm probably just a crazy PA student that over thinks thing. But I actually do think I have this since I definitely have to some degree Marfans, am a tall white male and spontaneous pneumothorax is a common complication of both of those. And it if you've had one you're more likely to have them again. It's a pneumothorax we're not talking about, not a tail growing out of my arm. They happen.

I guess since I wasn't playing basketball when I got these chest pains then it doesn't count...

Scared of the NP

I have my annual physical coming up. I have to use my school's health center, because I use my school's insurance and they call the shots. My school has a large nursing program and the student health center I think is run entirely by NPs. I personally have no beef with NPs. This is unfortunately not the case on their end.

Almost every nurse I've met has given me shit about being a PA student. They all question why I would want to be a PA and "never work under your own license." Little do they know I will have my own medical license. I honestly don't even know why they care. They think that because I chose PA over RN/NP that I'm saying it's better than them. How about the fact that I was never a nurse to begin with, so why would I go through that extra training? Also, I don't want to be an RN. I never want to have to work as an RN. It's a thankless, miserable job. I respect RNs, but I definitely don't want to have to do what they do. Hell I did do what they do when I was a medical assistant. I literally had the same responsibilities as the actual nurse at my job, and it SUCKED.

So I know that I don't actually have to worry about how my physical exam is going to go. But I would really prefer if they didn't know I was a PA student. Unfortunately my pages of paper work that I need them to fill out is going to give it away.

womp womp.

Silly Breeders

I had the most horrid Infectious Disease exam today. It was all parasites, hepatitis testing and CD4 count related illnesses. Where was the sepsis, pneumonia, TB, STDs?!?! I wouldn't complain about the hepatitis testing questions if the lecturer had actually explained clearly what each test measured. And when am I ever going to be given ONLY a CD4 count and asked to diagnosis the HIV complication. I mean really people. Throw me ONE symptom.

There was one question though that I unknowingly had an advantage on.

Who is at the highest risk of contracting HIV?

The catcher (anal)
The pitcher (anal)
The pitcher (vaginal)
The catcher (oral)

Score 1 for team gay. Evidently the whole class was really thrown by the question.

Let's Get Real

I've been doing a lot of reading of what is required of people to join the military.  One of the biggest things is that you have to be ready and willing to get shot and killed.  This sounds like a bunch of bullshit.  You think that all those kids coming out of high school have really thought about getting shot and killed seriously?

I ask a question like: what is the likelihood of getting seriously harmed as an Army Medical Specialist (PA) Officer and these are the answers I get.  YOU MUST BE READY AND WILLING TO BE KILLED.  This is not helpful for the logically inclined.  Yes, I'm aware of the dangers.  Could you please answer my question now?

Follow Up

When I'm going through a case study with a faculty member and they start justifying their treatment plans because it avoids litigation it makes the Army sound better and better. I refuse to practice defensive, CYA (cover your ass) medicine.

I say this now...

Military?

For a few years the idea of being a military PA has always crossed my mind. I have no idea why. I don't come from a military family. The only members that have been in the armed forced are my grandfathers who were drafted. Unfortunately the only one who saw action died before I could get to know him. So I don't even really know what military life is like. I'm seriously perplexed as to why this interest keeps popping up.

I really have no interest in seeing any action. In fact I would try my hardest to pick the safest branch of the military possible, without having to work in family medicine. Nothing in the world could be worse that working family medicine.

When I think about the areas of medicine I'm interested in (Critical Care, ER, Hospitalist) it might make some sense. I really only want to see sick patients. I want to treat people that actually need medical attention. Clearly in the military you would be seeing this. I don't have a huge reserve for seeing patients that just like to bitch and moan and just like the idea of being sick, as opposed to wanting to know how to get better.

I'm definitely not going to rush into anything. How about we wait until a graduate and pass the PANCE. We'll see what kind of job offers I get and if I'm doing anything with my life.

Sticklers

I just did my neuro physical exam practical. It overall went fine. I think it's amazing how strictly we're graded on Barbara Bate's method. For instance, to test for light touch I lightly touched my patient with my hammer. I got points off because a hammer isn't considered light. Last time I checked the hammer isn't exerting a force on its own. The pressure I supply determines whether it's light or not. But alas, I got point off for that.

There are some things we never have to perform and just need to describe such as taking femoral pulse, creamasteric reflex and anal wink reflex. They will give me full credit for describing how to do the test, but when I forget a paper clip I get no credit for describing how to perform 2-point discrimination perfectly. I guess the joke is on them since I have never successfully found a femoral pulse, yet the grade says I have.

Vent over. Be present. Be the Buddha.

Tonight a girl in my class was getting hit on by a guy she didn't want
anything to do with. I showed up at the bar and she told the guy she
was with me from across the room. He promptly left her alone. I'm the
man.

Sent from my iPhone

Out Gay'd

My straight guy friend are in and intense conversation about American
idol. I'm just staring with a look of disbelief. I can never get shit
for watching project runway ever again.

Sent from my iPhone

Class Etiquette

People in class like to get into groups and split up lecture topics to write study guides for. Someone people freely hand out their study guides to whomever wants them, regardless of getting something back. Others don't like people leeching off their work unless they're getting something in return. If you work in a study group don't hand out the notes that you receive from other people in the group. It just creates tension within the group.

I personally don't take part in any of these groups. I don't like being on a deadline and being held to other people's crazy studying standards. I've never even look at the Course Objectives, let alone create a comprehensive study guide for them. I also NEVER ask for study guides from people and rarely accept them when offered. There are a couple of times when I accept them because I'll offend someone if I don't. I rarely use these guides since 1. I don't trust most people in my class, 2. They are so overly in depth that I find them impractical.

I like that I still have a little House left in me.

Hmmm. Blogging from my phone. This should be interesting....

Sent from my iPhone

Speaking of Anonymity

I was just asked by the PA Professional magazine to give a quote on the pro's and con's of blogging anonymously and why I choose it. That's pretty neat.

Anonymity Compromised!

I try to keep this website anonymous. It doesn't help when you accidentally send out two e-mails using your blogging address to people who know you. Damn you Apple Mail! You can't say that it's from Personal e-mail, but then send it through Blogger e-mail. That's not cool.

Soooo..

Dearest Pharmacology Professor,
I love you. You're wonderful. And everyone agrees that you have the most smoking body post-2 children ever. I feel proficient at diabetes medications and will correct every patient's blood glucose levels that I meet. I will become a diabetes managing animal because of you.

Please don't tell anyone about my blog!

G

I think there is a greater likelihood of her not searching my address name and finding this site, but lets hope I don't need to self-destruct this site's ass. Not like I really write anything to scandalous anyway. My grandmother has more to lose at this point than I do.

Crap.

For some reason I was talking to my grandmother about weight loss methods. I mentioned the pill Alli and how it works. I half heartedly suggested that my overweight uncle should give it a try, since obviously the diet he's perpetually starting "tomorrow" isn't cutting it. And that clearly he's letting himself cheat more than he should be.

Today my grandmother started asking me all these questions about Alli again. Would it be considered a supplement, vitamin, etc? Where would one find it? How do you spell it? As she asked all this I was assuming she was thinking about buying it for my uncle, but I decided to confirm this. NOPE. She wants to use it herself.

For those of you would don't know how Alli works: dietary fat is blocked from being absorbed and is excreted with feces. This can often lead to oily (read as: explosive) bowel movements, increased frequency, etc. It's really more of a behavioral modification tool. It's to get people to stop eating too much fat because otherwise they're going to shit their brains out.

I never meant to suggest this to my grandmother. I had no idea she would consider this for herself. I should have known better. I'm trying to think of a way to tell her not to do this. If she was one of my patients I wouldn't have an issue with this, but when it's my grandmother I feel condescending. I think I'm just going to be a straight shooter with her and tell her the gory details. I have told her the possible side effects, but I don't think she's following me. She has a hard time following me on most things.

What a literally shitty situation.

I hate anatomy.

That is all.

Anesthesiologists: Are they using their own gas?

Maybe it's that more anesthesiologists visit The Underwear Drawer that other specialities, but it seems none of them know the role of PAs. The only people that have said unintentionally (or intentionally) disrespectful things about the PA have been anesthesiologist. What gives?

I just had a really funny moment. I had commented on The Underwear Drawer about what the role of a Physician Assistant was. You know, a professional one with a high level of training. One where there actually is a certain degree of autonomy, regardless of what the title implies.

An anesthesiologist (not the author) commented back that a PA is "no where close to being a physician and never will be." I literally laughed out loud at that. It's just such an obviously moronic comment. This is a typical example of someone who thinks that just because he went to medical school only he knows all the magic words. Guess what pal, patients are coming into office speaking accurate medical-ese. You do not have to go to medical school in order to be intelligent in a subject. In fact, I bet there are people who have gone to medical school that are totally moronic about what they're supposedly an expert of.

I think someone is a little bitter that they're never really the head of the OR, and never will be. It's okay, he can trounce on the mid-levelers all he wants. It's not going to stop me from getting a job and being happy. It will however make his life harder having a few less people willing to help him out. I hope someone points out to him that he's not the puppet master. There are no orders he can write that I have to carry out.

Humility shows wisdom.
Karma's a bitch.

Landlord Underestimates Me

I told my landlord that our washer is leaking. He responded that he's having a stress test done tomorrow (s/p MI 3 mos ago) and that he needs a couple days of rest afterwards. He's going to get back to me next week.

Who does he think he's kidding? I know perfectly well that you don't need a few days rest after a 20 minutes treadmill workout. Clearly he doesn't take the PA profession seriously.

I also need to start caring about school again. I've been slacking majorly since starting this semester. I don't care about having high grades just like the faculty has stressed to us. But failing your oral presentation because you were too lackadaisical is totally unacceptable. And that OB/GYN test was an eye opener too. However, I did end up passing it.

New leaf turned.

Ban on Gay Blood

A classmate's family member is working on a PSA to have the ban on gay men donating blood lifted. Classmate asked if anyone in the class wanted to be a part of this effort. Being one of the two gay males in class I felt I had to give this especially close consideration.

After thinking about it I've decided that I don't support this. Whether we like it or not gay men are a high risk group of carrying HIV. It's the FDA's job to protect the integrity of the blood bank resources, which includes using effective screening protocols. It's not as if gay men are the only people denied this option. If anything, I believe that there are groups of people that are less likely to have AIDS that are also banned.

I'm a man of science and statistics. I would be doing a disservice to my patients to be basing medical decisions often off statistics, yet saying statistics shouldn't be used as a screening tool because of it being "stereotypical." I've said for a long time that stereotypes don't come from no where. There is often a statistical correlation to back them up. I stand by my word.

So much for OB/GYN

While we're on the topic of not knowing female anatomy, I also don't seem to know much in the ways of female medicine.

OB/GYN, I think not...

FML

I did what people think is the impossible.

Anatomy Practical of the Pelvis and Perineum

A: My answer = uterine artery
Actual answer = vas deferens

B: My answer = ovary
Actual answer = seminal vesicle

Summary: I put male organs. The answers were female organs.

In my defense they removed all the organs inside the pelvis and I'm pretty sure you couldn't see external genitalia.

Fail.

Blogging Therapy

One of my PA-S friends suggested that I go on vacation with him and his husband over spring break. My obvious hesitation is being the third wheel. I've expressed these concerns but he assures me that after being together 6+ years they don't get all cutesy in public and that I'm not going to feel like a third wheel. I still have my hesitations.

These hesitations were confirmed last night when I went out with them. As any normal couple does after a few drinks they were all upon each other. It was okay last night because there was a fourth person (who they were trying to set me up with), but I wouldn't be able to handle it alone. It wouldn't even be that it's awkward, it's more depressing for me than anything.

I don't know how deeply into my personal life I want to get on my blog, but I'll quickly share my latest match.com story. Over break I went on 3 dates with this guy and things seemed to be going okay. My only problem was that I initiated EVERYTHING. Granted he went along with anything I suggested. I'm a very good conversationalist, but I was struggling by the 3rd date. So the day after the third date I just said "hi" to him online and decided I was tired of always being the pursuer and that I was going to leave it up to him to show any kind of initiative. Haven't heard from him since. This doesn't bother me that much because it's not like I was head-over-heels for this guy. I just wish he could have at least taken the initiative to say, "thanks but I'm not feeling it." I don't like being taken for a ride.

So now I'm hypersensitive about my single life. I don't like being like this. It completely goes against the personality I thought I had. (Being House-ish) I've definitely been losing this personality more and more lately. Blaaaahhhh. It's because all my friends in school are very emotional, and touchy-feely with each other, and overall really nice people. They're rubbing off on me. Bahh humbug. This will teach me to spend my entire weekend being surrounded by my close friends who are in relationships.

My Two Cents: Same-Sex Marriage

With all this news surrounding the Same-Sex Marriage debate, I figure I should share my opinion. Hell it's my blog, I can do whatever I want.

My position is definitely not an original one, but not necessarily one of the mainstream viewpoints. I think it's ridiculous that marriage is a government regulated institution. Last time I checked a marriage was generally based off religion. Marriage is traditionally the bonding of two people, under the same faith, that are going to spread their seed and consequentially their religion. Isn't this a country that's suppose to separate the beliefs of church and state.

Not only is this an example of religion's influence on government, but also government's control over religion. People are suppose to be able to practice their religion without the government getting in the way. But government gets directly involved in the practices of a religion when they determine who can get married, and who cannot. Should government really be allowed to determine which religion's marriages count and which don't?

Then what about the growing atheist population? They have no religion and will still be allowed the same "Marriage License" that those of faith get. Shouldn't they only be allowed to get Civil Unions, since they have no religion to officiate their marriage? Why don't all the Christianites ever try to stop these marriages?

Bottom line: I think marriage should be a strictly religious institution and that everyone who wants tax benefits (etc) should be required to get Civil Unions. Granted, then you'll probably have the same arguments made against Same-Sex Civil Unions, but I don't see how it could hold up. In order to have a Civil Union you must be able to procreate? What about those who don't plan, or cannot have children?

Winter Break 2009: recap

Accomplished all goals of the break except seeing Nine. But from what I hear that might be for the best. I guess I'm waiting for that one on DVD.

Classes restart Monday. First topic: the breast exam. (gaaaaah)

They told us that we MUST by the OB/GYN text book. I refuse since I didn't use a single text book last semester. Let this be a lesson to anyone starting PA school, don't buy the textbooks.

They also told us to read the EKG textbook over the break. I didn't do it, but is not something I would discourage people from doing. We have a total of 4 lectures dedicated to interpreting EKGs. That is a huge amount of time. I'm slightly nervous, but refuse to spend my break reading PA things, since that's all I do when I'm in school.

Review: The Twilight Saga

This book has given me the confidence that I could write a fiction series that would be successful. I mean hell, if an angsty 16 year old high school girl can do it, who obviously didn't have an old school Catholic HS grammar/writing education, then surely I can do it.

This may be one of the rare cases where the movies are better than the book.