pa school...done!

The two years are done- not like it was a breeze, but I admit being somewhat shocked that it’s done. The news has not “hit” me, or my inner me just yet- I am still waiting for the phone call, the notice in the mail, the certain something that says “No, you’re NOT done, you forgot X,Y or Z and you failed this, so sorry, no graduation for YOU!” I think it might hit me some time next week, when I am driving to get Nick in Vermont. Maybe then? I think I will probably need to stop, cry a good long time and then shake it off. 

I have not been the most stellar student- my class was filled with those. I was average. Smack Dab in the middle for most of everything. I think in the end, I was just that- and I am okay with that. I am not a chief, but am a very happy Indian.  Perhaps this is why I can look forward to being a good PA. I want happy, well taken care of patients. I am not a headline kind of person, but really happy to fly just under the radar, no waves.  

I actually really love patients. I am scared a huge big great deal about the next aspect of my life- lots of changes, but overall, the idea that I might make a difference in someones life, in a real way, is very exciting to me. (I add because my heart did indeed skip a beat or 3, that it’s as likely to be in a not-so-great way as I learn what it really means to practice the art of Medicine....)

I am excited about my job. It is in Asheville, at Mission Hospital in the ED. Scares me, yes indeed it does. But I am okay with it. I think my new boss might just be amazing. I only met her for a quick interview, but wow...she is one of those smart, savvy kind of women that make me darn excited to be working with her. My biggest fear is letting her down. I had several phone interviews, but when push came to shove, this is what I wanted, and I am really excited that I am heading there. Start day is June 11. 6 weeks from now. Very soon. Very very VERY soon. 

So, its done. The next post, which needs its own page and space is going to be about preceptors. Because, they are what made me ready for this next step.

A more personal post....

So, today marks the 29th of Feb. I am oh-so-happy to have this month gone and done with. It's been a doozy.  So, just because sometimes it's nice to mark what HAS happened, in order to see that things DO pass, I am going to write about them.

So, Arts surgery (and please, read this all the way because sometimes in the storm, the clouds are QUITE dark...and we all know that the sun does come up as soon as you look up to see it!) took place on a Monday.

 It was robotic, and turns out, damn good thing that A) Art decided to get it done despite the delay with the flood at the Cancer Center happening in January which led to him  not actually meeting the surgeon before scheduling and B) that they allowed this to happen. Turns out this puppy was not a slow kind of growing cancer, but one that was aggressive- more so than they thought.

Staging changed which was the news I got about 4 hours into the surgery. Dr. Miller said he thought that he had gotten all the margins, but nerve sparing could not happen. This can be devastating news for any man. Google it.

Because even if you prepare and talk it out, sitting there, talking to the MD really kind of puts it out there in black and white. It's no longer "a story" but an "Oh Shit" kind of moment. Because as any good PA student can tell you, those two years of school, you put a lot of crap on the back burner to deal with later. This was no longer later, but now. And it hit me- Hard.  Embarrassingly hard.

Art came out well, and was groggy, and Sa02s were a bit low (snoring does that to a person) but overall, seemed okay enough

So, I had been texting Stacy throughout the day, who was dealing with her own "stuff" and she kept me sane. Sadly, I elected to NOT buy the Hello Kitty purse that I texted numerous pictures to Stacy of from the Gift Shop, and I think I ate my own weight in Chocolate and Starbursts instead.

I ran my phone right out of battery. So, since I had NO gas, nor battery, I got into my car, thinking a nice drive to get a charge and a change of environment might be nice. I plugged in my phone and got the (expected) numerous VM's which I assumed were asking about Art. I saw one, however, that worried me, because it was from the person that boards her horse at our house. It was short and sweet.

"Call me when you get this okay?"

I got a text a few moments later, and it said the same- and I missed the bottom line of "the horses are okay" which was my biggest and greatest concern. So I called, and found out that the LAST thing I ever expected to happen had indeed happened.

Some lovely person decided that they should break into our house.

Yup.  Today.  Since I don't even own a KEY to our house, they thought kicking in the front door was a great idea.

So I have no more to say about that (Other than HUGE thanks to the observant folks that saw the door open and took their time to stay at the house, call the police and try and hold my very unholdable parts together and know to answer the phone when I called by saying "The animals are okay".)

That was a LONG DRIVE HOME! and despite the fact the day was rather warm, I was rather cold. I was tired (I had worked the previous night), and my eyes hurt a lot from crying.

Despite telling the RN"S to tell Art that they told me to go home and rest as I knew he would wonder and be concerned, they didn't actually do this, and he was beside himself with worry. So, despite my best intentions, and my desires to not tell him, him knowing that I would have been there if I could have been coupled with seeing my rather swollen and red eyes made that impossible. So, I left him after telling him (and helping him push his PCA a few times!) and told him I'd be back in the AM.

 I spent the night at a friends house, who knows me better than I think almost anyone does, and I just curled up in all my clothes and fell asleep.

Farrier in the AM, and little sleep, but got the horses done, barn done, and off I went back to get Art. My eyes, however, preferred to NOT be open, and they, come to realize, still hurt a lot.

Did you know that you can scratch your corneas by crying?  I am here to tell you that, yes, yes you can. And Yes, yes I did. Good enough to show up on staining. Across the visual fields. Special, huh? The ED at the U was VERY kind, and I did NOT steal the numbing drops, and best of all, got a hug from my preceptor who works in the ED.

I was a proper mess. I didn't like me. I was GROSS. I was a psych patient.  I was doing everything except saying I was allergic to Tylenol, Motrin, Sulfas and looking for some drug that worked called "DyLayDid???"  No, I just was "that" patient, that had hit her breaking point in an unfortunate place called the ED. But the RN's made it clear, I was NOT driving until someone checked out my eyes. So I obeyed.

But guess what? My kids are A-Maize-Ing. (intended...more on that soon). Nick and Jazz conspired, and between them, and not listening to me in the slightest (bless them), Nick flew home from Vermont the week before midterms. He arranged every thing himself, got food for the house, helped with the horses (this is huge!) and generally just made me smile, rented movies to watch on the computer (we do not own a DVD player and turned off cable a few months ago, and internet is thru the cell phones) and kicked my ass in Yatzee. Honestly, even now, the sheer kindness that my kids have just astounds me.

We found out the next day that my mom, who is on Coumadin fell and hit her head and broke her nose in several places. Thankfully, she is okay, but did have surgery the following week- normally I'd have been there in a New York minute but there was just no way. I have yet to miss a rotation day, and damn, since this was THE rotation, I was not going to start that now. I had my 4 days off (scheduled and I arranged shifts to allow for that) and I knew she was in good hands.

Several more annoying things happened, all connected in some way to each other to create a chain of "ughs".  But...

Today... I can laugh a bit at it all because-

Art is doing SO much better than anyone could have ever expected. Yes- margins were clear and nodes as well.
Nick not only kicked A** on midterms, but finally heard and is now a U of M student starting Summer 2012.
My mom sounds great and is doing well!
 I got A's on my last 4 rotations. I have heard back from the NY ED residency program, so that might be on track, and have a job interview at the UMHS, and remain hopeful that EPMG might offer a fellowship again in ED for PA's.
I had a great meeting with my program director that instead of being the dressing down I was convinced I thought it must be, instead turned out to be a huge moral booster, unexpected but oh-so-nice.

Finally, our sweet "White kitty" Lucas, who has been quite sick, remains alive, and holding on. We are not sure what his deal is, but he is quite sick. Hopefully he turns the corner- but I thought last Thursday that for sure he would not be alive today. He is. The vet remains totally baffled. But, he is thus far still here.

There are a lot of great ED stories to share, and moments that make me SO happy I am on this path, but Adios February. I am more than ready for  March, despite turning 50!

Another flower added

Last night I worked with my next amazing PA. EPMG has a roster of impressive, bright PA's that bring a lot to the table, including their absolute willingness to teach, impart wisdom, pearls and other delights that bring me to a new level of excitement about becoming a PA. I was lucky to get this rotation, and I am thrilled being there. I count down the days, not because I am looking towards the end, but because I am sad that it is going to end.

My first two patients were easy ones. I made the DX, and it was quite simple. Reassured them they were not going to die, and off they went, hopefully relieved. Since the rest of the ED was hopping, I felt a bit like a good luck charm. Ah, the joys of being naive. ;-)

My third was a young woman who was placed in a hall bed. Ah...not a good thing for anyone. Complaints of N/V, general exhaustion. Her history reveled that she had missed her last period. Further questioning also indicated that her mom had died less than a year ago, from HIV. No smoking, drugs, ETOH herself-mom contracted HIV from a boyfriend a few years ago and the disease progressed rapidly.

She was living in her moms house, taking care of her brother who was younger than she was. Simple math showed that her brother was a minor when her mom died, herself just barely into adulthood. Dad was long gone. She had no other relatives that were involved in care of herself or her brother. She had insurance, and worked at a nearby fast food restaurant supporting them both. She was an example of an upstanding citizen.

And indeed, she was 6 weeks pregnant. I sat next to her, and told her the news. I asked her if she considered this a good thing, and she nodded yes. The supervising PA ordered the rest of the tests, and all came back fine. She was given prenatal vitamins and we spoke a bit about good prenatal care, and the importance of this. Her boyfriend was steady, a good guy, looking for work. When I gave her the results of the ultrasound, her bottom lip trembled slightly, but the joy on her face was not able to be disguised.

She was scared, but happy. She clearly realized that this was major, life altering event. A beautiful girl by anyones standards, she somehow emanated that internal strength and courage that some just have and can draw on at the right life moments. She was drawing on it, and it was doing her well.

When it came time to discharge her, still in her hall bed, I hugged her and told her that I knew her mom was watching. She said that she thought her mom probably knew and wanted it to happen. She said her mom was a great woman, a wonderful mom, and she missed her a lot. I got her email address, probably the first and only time I will ever do so with a patient.

Another patient that I will never forget, another flower added to my lifes bouquet.

Some PA school truths.

1)I am behind. I am ALWAYS behind. I have not logged every patient that I have seen...not even CLOSE. I lost a lot of info, and E*Value was not able to retrieve it. Oh well. I am behind.

2) Kevin has finally turned off the ability to log patients that we saw 6 months ago. This should worry me. It does not. I am relieved. Can't do anything about it now, can I? How many sore throats can I log?

3)seriously- sore throats are just that. Sore, Some need meds, some don't. Clinical judgement. And I fall onto the SNAP side of things (Safety Net Antibiotic Protocol) because I'd rather not give  antibiotics if I can avoid it...stewardship and all that jazz.

4) I am almost DONE!  This is a good thing. Both for me and the program. I have pissed them off, esp the newest staff member. I am not one to piss people off very much, but clearly I have pissed them off because I have tried to find my own rotations.  This has not gone over well at all. Lead balloon like not well.

5) BUT! This is how I found my most current rotation. My preceptorship is in Howell at the ED there. When I told one of the PA's that I am working with now that I was going to be there, she said it was going to be excellent. Kevin said that it would be excellent. So I am feeling excellent. All good.

6) Seriously- I am glad that PA school is almost done. I don't feel ready to go out and do my thing, but thats probably SOP. So- onward into more learning.

7)(Lucky #7)  I am applying for jobs. I also am somewhat hopeful that I might be able to get a fellowship at St. Joes.  I have also sent in an application for the Rural ED residency in NY (Which was my intention from the very beginning). They have not emailed me back despite several emails to them. Don't think this bodes well, but....  next post? What I want to do.

(MY IDEAL LIFE...In Tryon, working at St. Lukes.  ED department. It's out there now.)

Online blogs, podcasts, and other really neat things to have at your disposal.

I am blogging this, because there are a few places that are my GO TO places on the web.

So, First- Podcasts....

A Gobbet 'o pus  Mark Crislip  who would be the first to say the world needs a more of Mark Crislip...  Mark is an ID doc, and he podcasts about 2 times a week. Great quick listening. The beginning ones have a lot of sound effects that he has removed from the most current ones. I liked the sound effects for the first 100 or so. Now, I appreciate just listening. He also has an app that I use a lot, as well as a QuackCast that I have not explored yet. Sure to be soon.

Emcrit- just spectacular. Always has a bevy of show notes that I refer to. This is geared to the ED /Critical care MD but I still find it great to listen to. Usually about 20 min long. Great Manny Rivers MD of Henry Ford Fame and his sepsis talk. Saved my butt a few times!

ERcast- another one that just is easy to listen to- lots of everyday, important info'


OOPS! Never finished this post...will do so later!  But for now, enjoy what I have listed thus far!

Babies...

This is not going to be an "in order" post, because I am really behind (and yes, I was taught do NOT start anything with an apology but I am starting this with one because clearly I didn't listen.)

I am with Dr. Mason. I was told (perhaps warned??) that I was going to love him.  I do. It is one of the best rotations I have had, just because his patients adore him, he gives them every second they need, and he gives us every second WE need. How many people can do that? A lot to look up to and learn from.

First day? A lovely OP vaginal birth. Since it was my first birth that I was not...um...being the center stage of, it was interesting. And beautiful. And the baby was perfect. Hard birth (OP means, at least from what I a can tell thus far is that is it going to be hard, and pushing a face up baby is often REALLY hard.) But she did it with a lot of coaching.  I am pretty sure I was more happy than she was at that point in time.

Monday brings a lot of scheduled births that are from high risk moms. Several were from clinic patients that we saw on Friday. I am very glad I get to see those births. I am really excited and I must say that being a part of bring life into the world is just...amazing.

There is a lot more to write, and I think I will be writing a bit more "personal" stuff soon, because a lot of personal stuff is happening. Not all of it's good (ah- a very atypical Annika Sentence!) so deserves a bit more explanation. But that will come next...

The LOL Surgical consult

Call nights are long- often filled with incredibly boring periods, peppered by intense moments of trauma codes. This night was no different,  we had more ER consults than trauma codes. A good thing for the people involved, but for us, at hour 19, well, a bit of trauma does the exhausted body good-caffeine? Ha! No need with a healthy dose of adrenaline- stabbing, gunshot or 3, housefire with a pregnant woman- that'll getcha going.

I got a consult on an older AA woman. She had an abscess- but it was not specified where. I have learned that getting in on the bread and butter cases, the ones that the interns and residents don't want, are the ones that I want. I can DO them- and learn from them. 

I did my H & P. the history revealed no major medical issues. No surgeries or injuries save a broken tooth or so. 3 kids, all normal vaginal deliveries. +FM of the typical DM, CAD, HTN- but thus far, she had none of the above. Did not smoke, drink, do drugs.  No waving red flags.  Okay! I can DO this! So, her issuse seemed to be just isolated- painful and isolated.

This poor, tiny 78 year old woman had an abscess on her mons pubis. Big one. Denied waxing, was not sexually active.  She was married, but her "man" had been living with another woman for the past 20 years. She was a-okay with this. No one else in her life-lived alone.  She did call her husband when I was interviewing her to ask him what other meds she took- Vit e was pretty much it.

The PE revealed she had the worst...um...well, yeast infection that I had ever seen, and honestly, guys, hope never see again. It was..."impressive". Put that in your admission note and that'll catch someone's attention. As I said, she  denied DM, however, just as I was beginning to ask all the questions, leading at least my differential that such an infection tends to come from in a woman who denied ever being sick, the RN pops her head in "Her BGL is 511". As I was being told this, she was grabbing her Big Oreo Pack out of her purse to munch on. I told her that Oreos are probably off the menu for a bit.

At least I had one answer to one of her problems.

Clearly, however, the other issue was going to be done in the OR. Poor thing. She had a red, hot, fluctuant mass, about 6cmX10cm.  It did not go thru to bone from what we were able to assess in the ED.

 Here is where it gets funny.

She had never been in the hospital. She wanted to take EVERYTHING home- the empty IV bags, the chucks, her phone was out-she was snapping pictures everywhere. I have one of her-she wanted to have one of both of us on my phone too so I'd never forget her. (Not like I could forget her...).

She was so cheerful, so optimistic, and upbeat. She was sitting up in the OR when we got in, talking to everyone a mile a minute. I am sure she was nervous, but none the less, a truly bright spot in the rotation for everyone who touched her that night.

Later, I found out she had been putting Icy-Hot on her "'fected part". I came into her room for her post op check and she had it out to apply it to the open drainage area.  I can only imagine the pain that would have been. I had asked her on initial interview if she had done anything to make it feel better, I guess I needed to ask if she did anything to make it feel better that failed. That I would consider a fail to be sure. She then admitted to putting cabbage compresses on her "'fected part" too. Her post op went smoothly- her BGL were labile as would be expected, but medicine did their magic and they were eventually controlled.

And now, in all the ways that so many of the rotations went in Detroit, her story is so much deeper, sadder and still astounding to me.

Frankly, Sad.

Remember that phone? All those pictures? She had a chronicle of her life in pictures on her phone. If anyone ever got her phone, the things that they would see. She could hardly see her phone, but she took pictures still. When she was showing them to me, about 1/2 way back was a picture of a man in a casket.

 I was taken aback...what in Gods name did she have that for?  I asked of course (I always ask...just my nature). She knew him- he was her neighbor. He had been shot, in front of her, outside her apt. And yes, she had pictures of him on the sidewalk, dead. She knew who shot him.  While telling me about this, she covered her mouth, asked if she was going to Hell because she had lied to the "Po-lease" because she knew that if she admitted she knew, she might be next. You don't live that long on the east side of D-Town if you're a dummy. She clearly is no dummy.  If there is a God, this woman is certainly not going to Hell. She has been there- but her cheerfulness and joy in the world was bigger and greater than what surrounded her.

She said she had pictures of all the people she had seen at funerals. All her friends kids who had died. All the people in her building who had been shot and killed over the years.

She told me that she slept in front of the window now, watching to see if anyone was coming. I am a white girl from the country and I have one thought about guns besides ban 'em. I want FAR away from them- esp if someone I don't know is carrying them.  Her thought was that if she saw who was coming, she could get away. She was scared but it is what she knew. Me? I'da picked a door. A solid door.

I don't remember her name, I have her picture still. I hope she is okay. She was discharged home after 2 days stay to get her glucose under control. I hope she followed up- and I hope that somehow she has found some peace and quiet in her life.  Yes, I asked SW if they could somehow help, but no- nothing to do. She was A&OX3. Frankly, she was a great example of survivor, strong, beautiful, an optimist in the light of all that is so difficult about D-Town.

This happened well over 2 months ago. I am ending my stint of being in Detroit for rotations. Overall, I have gained such an appreciation of the deep recesses of humanity that exist downtown. Yes, it's a terrible place, but under the layer of grime and filth, there really is something very special about the city. The grit, the simple acts of survival that profoundly effected my rotations there. Certainly I learned something about medicine or at least I hope so, but I also learned a lot about people. I actually do believe that the city can be brought back.

There are a lot more stories- more blog posts to come. It's a lot of driving to get to and from- easy 2 1/2-3 hrs a day. I won't miss that! Makes for no time to write anything. A2 next month....