The actual graduation day....

Here are a few pics of the day.  Jas and the kids came up (quite a feat with 2 under the age of 3...!) and Lauren and Brad came, too. Very nice to have the support.  And the white coat....

Gary F and I- while he LOOKS serious, it's just an act....
Proud of him!

And the proof that I was some sort of something somewhere 

Finally!

Lots of initials huh?

Brit and Mike

Ana was super well behaved

 And now, onto other things!

What I will miss about Michigan (My Farm)

This was going to be just about missing Michigan-

 but what has become very clear to me is what I will miss is 

my farm, 

my flowers, 

my chickens. 

My house? not so much miss the physical,

 but will miss what I know.

What I know

...what I find important to me is what I know. 

What I can depend on, what brings me joy 

is stability.

 I realize that is very NOT 2012

 that we are supposed to be open to the moment, 

the power of change

No denying change is powerful

No metaphors missed here. 

but, clearly (to me)

 I appreciate the knowledge of knowing

that tomorrow, the sun will rise.

That is what I feel about this land

I know it as well as I know myself 

(which may be in question to me at times, 

so it could be argued-quite fairly-

 that I know my land better than I know myself)

 The garden has not been tended the past several years
Many reasons-

but each year, the flowers continue to rise, and surprise me each year.

I love this view

and as scary as it is, watching Reason gallop up the drive from the lower pasture, 

I love this view, too

But I will miss this land. I will miss the earth. 

I will miss being in a place that seems to know me, and gives me beautiful gifts each year,

even when I have had to abandon it

It's true- I am finally done and a PA-C

This will hopefully be a series of posts. because, well, so many things are happening, and while connected, are really separate. I have had a very hard time separating out the good and the change, from the sadness that has enveloped me at times. I am okay- but please excuse a few weepy moments and emotional tirades.  Hopefully, I can separate it all out.

So, that PANCE test? Eh um ugly times. I figured out 1/2 way thru section 4 that the test was not about knowing the right answer, but knowing what the wrong answers had to be. Very few were clear cut (to me) and often were more "oh, um, well it CAN'T be that, but COULD be this, but probably not...." logic type answers. I wasted a lot of energy on the way I looked at the questions. Bottom line, I passed and got a big old sign to put in my -ahem- office. Maybe I'll care some day? I don't know. I wish I had enjoyed the journey a bit more. I usually do, so PA school certainly threw mud in the face of that.

The end result is I have a job- the one I really wanted- and now that I have it, am scared to death. But hopefully the newness will overwhelm me, and I will get back to loving learning about health/sickness and pathophys and not be so internally stressed that I make the learning awful for me. My internal voice is not so kind!

I have zero idea of my schedule. None. I know I will work some nights, so I will set about finding someone to watch the farm for me when I work nights. I think it will be okay. If I get lucky and get back to backs, I will probably stay in AVL so I can rest as much as possible. I figure that I will work 4 days a week, and eventually maybe 3? I hope. Financially, however, times are- not fun... so I may end up having to work a lot more than I'd hoped for a bit. Again, it's all good and I feel really glad that I am at such a great place, in a great town, and seemingly great people.

I've gotten a few blast emails and they are funny! Seems like everyone has a great sense of humor and I am very excited to get to know them all better. Hopefully they will not be put off by how little I know!

 It's a strange thing- but I am going to emphasis rest for myself pretty soon. This is not a normal state for me- I am usually gogogo. If I do not rest soon, I may regret it.  I think I may out and out crash into a muddled heap someplace if I don't force myself to take a few days out and just not pack, or do anything. Not an attractive sight, I assure you- grown woman in a muddled heap! I've seen it in my minds eye a few times!

Other than that, I am pushing on, trying to figure out what have "value" to me as I pack. I want a very clean house now- I feel strongly about that, so a lot of extra "stuff" is not coming. Thank goodness for Kindle and online resources.  I took a load down last week, and the overlap of my moving in and Jazz and her family moving out allowed for me to really think about what mattered. My room down there has my favorite paintings on the walls, and it makes me really happy to see them. They are beautiful. Of course, of horses.  I do love the sheep picture above that I found in Burlington but did not know the results of the boards, and again, being financially responsible I did not get them.  Maybe later in the summer??

Okay- 2 more important posts to go!

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.)