Jerk Status

Wow it has been a very, very long time. No doubt at this point I'm speaking to nobody.

Here's the long and the short. I need to change the title of this blog to Gregory House, PA-C. Yeah, that just happened.

I'm going to be working in Internal Medicine at a big academic hospital in the ghetto, ghetto. It's going to be a crazy start. I'm currently waiting for credentialing to finish, but I'm looking to start in the next couple of weeks. I'll keep you posted.

PA school is behind me and bitching about it is no longer something I do. It's over. None of that matters anymore. In reality PA school was probably 2 of the most fun years of my life. But I'm definitely looking forward to having a paycheck. The last of the student loans are running out and I don't want to become a pan handler.

The Beginning of the End and the Start of a New Beginning.

This blog seems to only talk about PA school. Well it's really suppose to be about my general experiences in life. I, however, have very little life outside of PA school. But with the end in sight (2 rotations left) my fellow classmates/friends are making life decisions that extend past PA school.

My roommate got engaged yesterday. This isn't my first friend to get engaged. I have a pair of friends that got engaged a over a year ago. This is however my first friend that's getting engaged where I wasn't close friends with both parties. I'm also much closer to this friend than the others. I'm very happy for him. He was totally giddy on the phone when he told me. They've been dating forever, so this wasn't a surprise. However, I can't feel like this is the beginning of the end of the life I'm used to.

I follow Buddhism as a life philosophy. The focal teaching in Buddhism is that the only constant in life is change. In other words, nothing in life is forever. Change is inevitable and to fight change will be the cause of the suffering in your life.

I've been preparing myself for this event. It shouldn't be a big deal in the grand scheme of my life. I'm not the one getting married. But this will be a change to my life also. He has been one of my closest friends for the past 2 years. I do not foresee staying in touch with this friend as much as I would like for whatever number of reasons.

This isn't so much a life marker for me because of the distancing between us. It's more a life marker of friends starting to move away from each other, and to start their own life microcosm. In reality, everyone lives in their own life microcosm. They will just start to overlap less.

Buddhism doesn't tell people to ignore their emotions. If I'm melancholy about this, that's not a bad thing. It's necessary to acknowledge what is upsetting me, as to not let is fester and grow into something more and possibly debilitating. Buddhism just tries to prepare you for these events. They are going to come, but life continues. There is no reason to think this makes life worse. It shouldn't make me fearful of life without this close friendship. Live in the moment of now, not the past or hypothetical future.

Written Directly from the Belly of the Beast

I haven't been updating much and for that I apologize. This really should be the time I update because I've been having the most negative experiences lately. I think people prefer reading about the horror stories of medical training, rather than the good. Since I'm currently on a horrible rotation where I'm kept for hours without having anything to do I might as well update. So, let's start from he very beginning. (a very good place to start)

 

A little while ago I had my pediatrics rotation in an ER. I hadn't been looking forward to this for two reasons.  1)  I don't have a knack for peds.  2)  I already kind of knew the preceptor and I didn't anticipate us meshing well.

 

Let me first say that I don't dislike children. However, it seems that if you do not have a strong love and appreciation for children, which increases exponentially the younger they are, then you are not a "kid person." This is a little unfair. It's kind of like the opposite for geriatric patients. The assumed default feeling towards geriatrics is a negative one, but if you don't hold this bias then you're automatically a "old people person." Whatever, if people want to see me as a hater of children and lover of old people then so be it. In my eyes though they're all the same. I don't necessarily like one group more than the other purely based off age. I prefer puppies above all of them.

 

The children themselves were easy. Children don't give long histories, and generally don't have complicated histories. They don't go on and on about vague symptoms that have gone on for months. Their parents on the other hand are a different story. I swear I think people become dumber when they have children. People were bringing in kids cause they have a temp of 99 for less than a day (temps start at 100.4, no exceptions), or because they vomited once 6 hours ago but have successfully eaten since. It was so odd. My family would never bring kids to a doctor for these things, even if it was their first kid. My grandmother laughed at the things people brought kids in for. Or you would have parents bringing there kids in too late. Why didn't you bring the kid in when the temp was 104? What was it about 106 that finally made you bring them in. Oh it was the fact that WERE NO LONGER RESPONSIVE?! But it's true what they say. Parents are worse than the kids. Overall I didn't dislike peds. I feel fairly competent in the ER setting with children, and wouldn't run away from them like many other ER providers.  Can they tolerate fluids? Does their fever respond to motrin? These are the big questions.

 

My preceptor wasn't as bad as I expected, but don't let that fool you. I'm still not a fan of his. As far as providing patient care he was fabulous. I learned a lot from him and he was a great teacher. However, his personal demeanor left much to be desired. This man thought he was the greatest doctor of all time. He constantly talked about all the shit he did in his mother country. How he single handily ran an entire hospital his first year after med school. Along with this he was also very quick to criticize everyone else. You were a moron if you didn't something wrong, and he would let you and everyone else know it. He had zero patience for ineptitude.

 

He especially had a special type of contempt for PAs. If they did something he didn't like it was much worse than if a physician did something he didn't agree with. For instance, one physician did an entire septic workup on a child that in reality didn't even have a fever. He very discreetly went up to that physician and gave his input and didn't make a big show about it. However, if a PA came up to him at 11:50PM and asked if he was done seeing patients he WENT OFF on them.  His shift ended at 12AM and he would condescendingly ask, "If I wasn't hear then what would you do with that patient? You would see them. You can see them now even if I am here. I have 10 minutes left. I'm not seeing more patients." This occured with a PA that had worked with him one time before. He went on and on speaking audibly to himself about how outrageous that the PA tried to get out of doing work.

 

He would also complain about how the PAs never saw any peds patient when he was there. He said they should be seeing all the injury patients that don't require his expertise.  He however didn't care of the the EM docs didn't see peds patients. You see in his eyes, PAs are suppose to do all the work the docs don't want to do. Docs have the privledge of choosing who they want to see. In short, this guy was an ass.

 

In addition to this he was also nasty to the nurses and techs. One story that stands out was when I went to see a patient and they complained that the bed wasn't made. I looked at the sheet and indeed the sheet looked soiled. In my head I thought it was just a permanent stain, but I left to tell someone it needed to be changed. When my preceotor asked why I wasn't seeing the patient I told him that the sheet needed to be changed, and he started going on a tirade. He searched out the tech who was suppose to change the sheet. She had been told by the nurse that it was changed. I witnessed this. The nurse indeed said she had changed the sheet, and I believe she did. However, the preceptor continued giving it to the tech. He went as far as to say, "I don't change the sheets in my own home? Do you really expect me to change them here?!" Wow. That was just about the rudest thing I ever heard.

 

This preceptor also could not stop talking about his kids. He pushed his kids so hard that it made me pitty them. He expected only 110% from them. It was very much like that WSJ article on "Chinese Mothers." I do believe there is something to that philosophy, but you don't need to tell me everything there is to know about your kids. Save it. I didn't ask. He was also very defensive when a doc asked me about the high school I went to becuase it's consider very prestigous where I'm from. My preceptor could not handle the fact that my high school was considered better than his kid's. As if it somehow reflected poorly on his kids. I defused that situation by saying, "My school's minimum student performance was just higher than other schools. It by no means means that kids at other schools can't out perform kids from my school. You just couldn't coast by as easily at mine." He excepted that explanation.

 

I use this guy as a life lesson. I hope to never turn into him. I'm pretty sure that won't happen, since I already never talk about my accomplishments, and down play any praise I receive. Horray Catholic guilt.

 

Next post: Surgery

Pointing the finger

Parents come in with child. Child had closed a door on his hand and lost the tip of his finger. When the plastic surgeon came in he was under the impression that they had brought the tip of the finger in with them. They explained that the tip of the finger was found, but at home. So the surgeon explained this means the kid will have a bit of a stubby finger.

Later in the day the parents call the ER and say they have the finger and want to know what to do with it. I would have told them to stick it up their ass.

Rough Sex

I was hanging around the fast track ED station when a PA comes from behind me asking my preceptor, "Can I borrow Greg for a male genital examination?" He allowed it and I was taken away like a library book.

We got the door of the examination room and the PA asked the patient behind the curtain if he had changed. He said that he needed just one more moment.

"What's the patient here for?"
"Some scrotal pain and a possible mass."
"Think it's epididymitis?"
"Could be the beginning of an abscess."
"I didn't even know you could get an abscess there..." And we walked in.

The patient sat there with the opening of his gown in the front, his shirt off, and boxers on. He had been specifically told to take everything off from the waist down with the opening on the gown to the back. I have learned to just expect these things.

(I'm going to be perfectly honest though and say he had a rockin body. So I wasn't complaining about the show. Go ahead and tell me that it's inappropriate to even think like that. But give me a break, I'm HUMAN.)

I looked on as the PA put her gloves on and the patient positioned himself flat on the table. She told him to show her what was going on, and he tried lowering his underwear as little as possible. The PA eventually just told him to take it off.

The PA started examining his scrotum and testes with her hand, while asking him where it hurt and how it felt. He then took that opportunity to tell us the whole story leading up to this.

"I was sitting at home and my shawty was on my lap. She started dry humping me a little, you know just for fun. I guess she was grinding her butt into me too hard. It didn't hurt when she was sitting on me, but did later on."

Personally the only part of this story that shocked me was that someone actually used the word "shawty" outside of a Bring It On franchise film. But what do I know I'm just a sheltered, suburban white boy.

The PA finished her examination and told the patient she needed a urine sample. She explained he could put his boxers back on, flip the opening of the gown to the back, and use the bathroom. I knew this went right over his head when he said, "Okay, I can go now," looking at us as if he was going to piss right in front of us. I told him the bathroom was across the hall.

This 40-something mother of 3 teenage daughters looked mortified as we walked back to the station.

"That was more information than I ever needed to know. All he needed to say was that he had rough sex."
"You mean rough foreplay."

Change of Heart

Woopsies! It has been a little while since my last post.

So the last time we spoke I had just finished Emergency Medicine. I have since also completed my Geriatrics rotation. This was my first medical inpatient rotation. I really enjoyed this rotation and part of that has to do with the 4 day weekends. But I also enjoyed it because it showed me an area of medicine that I was interested in pursuing.

Notice I say "was." I'm still interested in Hospitalist medicine but it's definitely a lot more stressful than I thought it would be. You are responsible for EVERY SINGLE PROBLEM THEY'VE EVER HAD! That's a shit ton of things to be held accountable for. Now it's not that I don't want to help these patients. But when you have failed to control your blood sugar, hypertension, high cholesterol and never stopped smoking... well I just don't think it's fair how much liability is put on me. If you're not willing to take care of yourself, then why should that be put on me?

I also got a lot of experience in the ICU. This was particularly helpful because my elective rotation was going to be in critical care. I got a good sense of what you see in the ICU. It's normally either very old people that should be in hospice, very complicated patients that I mentioned before, or rarely acutely sick people that make full recoveries. The reason I was interested in critical care was because of those few acutely ill people that have the potential to have good recoveries. So I still maintain interest for critical care, just not as exclusively. I enjoy the complicated inter-system workings of the field, but it rarely even matters that I understand why things are going wrong. Getting a patient to "stable" isn't nearly as satisfying as I thought it would be. Because of this exposure to critical care I decided that I didn't need a rotation dedicated to critical care to know what it's all about.

During didactic year class I was always very interested in Urology, but the only elective we had was in Uro-oncology. That was a little too specific for my interest, but nonetheless a very important and relevant aspect of Urology. While in geriatrics we had a couple of urologists lecture to us and it reminded my past interest. It was also quite obvious that Urologists love what they do. They don't seem as burnt out and they seem to get gratification from what they do. One urologist also pointed out that this is becoming a very PA in demand field. Urologist are finding great ways to utilize PAs and other PAs are telling me it's a great PA field.

All this being said I still have no idea what PAs do in urology. I don't know what kind of patients they see in clinic, what their role is like in surgery or what kind of procedures they get to do on their own. So I decided this is what an elective rotation is suppose to be used for. I have an area of medicine that I'm interested in but don't have a clue what day-to-day is like. My clinical coordinator gave me a little grief saying I'm always changing my mind on my elective but said it was an easy enough change. In my defense I only asked her once about her thoughts on me doing CT-Surg. I've never actually changed my elective before.

This rotation isn't Uro-oncology though. She told me that we have a general urology rotation at our affiliated hospital. She also said they are BEGGING her for students, which often means they are looking to hire. I would DIE to get a job at this hospital since it's TWO blocks from the apartment I'm moving to this upcoming summer. I won't deny that this also plays a role into my decision.

I'm currently doing pediatrics. I've only been there for 2 days and I already have a cold. I guess that's what happens when you are holding a kid down that's getting an IV and they're spitting into your mouth.

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.