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.

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!