2 years of knowledge

Wow.  Tomorrow, I will take my written comprehensive exam, a 200-question, 4-hour exam that will assess my knowledge and processing skills on 2 years worth of material.  It's so strange, because when I think about where I was in June of 2010, essentially fresh out of college, and starting from square 1 of medical training, it seems almost silly that 2 years of hard-earned knowledge, sleepless nights, endless trips to coffee shops, PILES of notes (I can only imagine the amount of trees that are no longer living, having been sacrificed for 10 page handouts for every lecture, x2 years, x40 classmates) can be whittled down to just 200 questions, and 4 hours.  It's amazing to think that I will be practicing medicine in a year.  Wow.  Just, wow.  Where have the past 2 years gone?  When I started with my lab group in the cadaver lab in June 2010, 3 years seemed so long.  Now, I'm wondering where it has gone.  I can't believe my clinical rotations start in just a little over a month.  Looking forward to my amazing schedule ahead, and leaving the classroom behind.  But first, my comprehensive exam tomorrow morning.  I'll see you all on the other side of the dark cloud :-)

Tomorrow's the big day!

Well, tomorrow is the big day....well, one of them, at least.  The start of comprehensive exams, required to enter 3rd year clinical rotations.  While I'm not terribly worried about them, the thought that this is the exam that I must overcome before I can enjoy the glory of 3rd year is weighing on my mind. And the fact that I'm fighting a nasty cold, care of my very adorable pediatric patients, doesn't quite help things either. 

While I'm a little nervous (who wouldn't be; I never really enjoy standardized patient encounters, anyway, knowing that 3-4 video cameras are recording my every move/sound, even though there's only myself and the patient-actor in the room), I know, and have known, that there is no real way to study for the comprehensive exams.  Everything we have done/learned for 2 years up to this point has prepared me for this week, and I know that I will do fine.  I just have to prove that I know what I demonstrate to know every day in clinic, and in other classes.  I just have to remind myself to remember to do the silly things we haven't done since 1st year, and the random physical exam maneuvers not commonly performed, except in specific circumstances....and to remember to properly drape the pt., and pull out the foot-rest on the exam table....having the pts. feet hanging uncomfortably off the table is never good form.  Wish me luck!  3rd year is so close, I can taste it!

Tiny humans....and minor freakouts

The last 7 weeks of my didactic curriculum (ever) include my rotation in general pediatrics.  Can I just say how much I love children?!  I knew this long before I ever started PA school, but after doing my last seven week rotation in palliative care, this rotation is a far cry from the end-of-life discussions I observed prior to this.  I walked into clinic on Tuesday morning, on the first bright, sunny day Denver has seen in a long while, coffee in hand, and found bright paintings on the walls of jungle and under-the-sea scenes.  "The Little Mermaid" was playing on a loop on the waiting room television (try getting "Under the Sea" out of your head after hearing it 9 times in one day; the calypso beat that Sebastian sings to is actually pretty catchy).  Immediately, I was welcomed by the doctor who started the practice, the office staff, and several other providers with whom I'll be working with this semester.  I was already having fun, and I hadn't even seen any patients yet.  Overall, my first day of this rotation was phenomenal, and I loved that all of the providers came in excited to see patients, and were so in love with their jobs.  I could get used to this.

The rest of the week was a drag, more so than is usual.  There are only 7 weeks left of the semester, including our week of the big comprehensive exam, and I had my first minor freakout session about the comprehensive exam.  There really is no good way to study for an exam that essentially tests everything we've learned in the past 2 years, before we're allowed to be let loose into the world of full-time clinical medicine.  However, I'm hoping that with the time I spend during spring break studying, I can use everything I know to prove that I'm SOOOO ready to leave the classroom. 

Back to studying for the 2 exams that stand between me and spring break (as much of a break as it will be with comprehensive studying).  Here are some photos from our recent IV lab (I got all sticks that I attempted successfully on my partner!)

Nice little blood splatter

Trying not to look at the giant needle

My turn....just threading the catheter into the vein :-)

And the letter that comes after O is.....

I'm pretty sure that in kindergarten, they stopped teaching the alphabet after the letter O.  I'm 100% convinced of this.  Why, you ask?  Because EKG interpretation is NOT my forte.  I really wish it was.  Sometimes, it just baffles me, because I'm a total physiology nerd, and how the body works just rolls off the back of my hand.  But how the electrophysiology of the heart actually translates into the rhythms that appear on a 12-lead?  I find myself always struggling to interpret anything more involved than the rate, rhythm, and whether there's ST-segment elevation or not.  Beyond that, it all looks like a bunch of squiggly lines that have varying degrees of points, depressions, and other things that seem as foreign to me as learning another language (full disclosure: learning foreign languages have never been easy for me, either).  So, needless to say, my weekend has been full of trying to desperately cram all of the rhythms into my brain for the exam that is coming up on Wednesday.  I have actually found the Dubin book to be very helpful, in addition to a few algorithms for interpretation that we've learned in class.  But, when all is said and done, I wouldn't trust myself to interpret an EKG.  I'll leave that up to the cardiology people.

Drinking from the fire hose

Ever since before I started applying to PA school, everyone I talked to said that during PA school, everything feels like you're trying to drink from a fire hose....getting completely doused in heavy, torrential flow of information, and struggling just to push back against the pressure.  Overall, I actually haven't found that to be true, but considering I'm in a 3-year program, it's most likely the pace of the program is a bit better than most.

However, I think this is the first time I've ever felt like that analogy is actually true.  I was out for almost 2 weeks recovering from a minor surgery, and I'm definitely struggling to catch up.  Even though all of my classes only take place once a week, 2 classes=2 weeks worth of material=Katie running around like a crazy person trying to get back into a routine.  Much like this:

HOLY CRAP! 

On the other hand, I truly feel that in spite of how overwhelmed I feel, every day is a day closer to clinic.  My schedule is almost complete for 3rd year, except for my required OB/GYN rotation.  Very excited to spend a year with patients, and (hopefully) figure out what specialty I'd like to focus my job search on.  It's only a slight comfort knowing that as a PA I can switch specialties throughout my career, but I'd still love some insight into where I'll start.  Every day I feel like I oscillate between wanting to do Endocrinology or Surgery, but I have an Endocrine rotation and 2 (hopefully 3 once my final elective is scheduled)  Surgery rotations next year, so I hope I can figure that out.

On a final note: think good thoughts....we have our IV lab in Emergency Medicine this week....EEEK!

"You're going to feel a little pinch"

We had our needles and injections lab last week, which was super fun!  Even for some of us who have already gotten plenty of experience giving injections in clinic, it was a great refresher on techniques, injection sites, and clinical pearls.

Knowing full well that we'd committed to being guinea pigs for our classmates when we started PA school, we chose partners, rolled up our sleeves, and exposed some nice arm flesh with plenty of sub-Q fat to practice injections on.  Here are some of the highlights from that day:

Ready to stick me with needles

Pretty wheal under my arm

   Otherwise, life has been pretty boring thus far.  Endless round of exams begins on Wednesday.                  

It's finally real!

On Monday, my classmates and I went to a meeting that we had anxiously awaited for practically the entirety of 2nd year, to this point: 3rd-year clinical discussions!  We got more information about the logistics of rotations (yada, yada, yada....I feel like I'm in the middle of a Seinfeld episode whilst typing that), and we finally got our "tentative" 3rd-year clinical schedules.  Knowing that some things will change, I was actually pretty pleased (thus far) with my rotations.  Since our program has a pediatric emphasis, I have at least rotations (general/ambulatory, inpatient, and pediatric subspecialty) in pediatrics, as well as the required internal medicine, family practice, ER, and OB/GYN rotations.  But since I'm seriously considering surgery for my future, I'm much more excited about my elective slots!  I already secured one elective in orthopedic surgery, and am waiting to hear the status on a requested general surgery elective.  Depending on how things go, my 3rd elective slot will either be filled by pediatric endocrinology (the only thing I love more than surgery), or another surgery slot. 

After working incredibly hard for nearly 2 years, I finally feel like I have some motivation to tough out the last 13 weeks ahead of me (and comprehensive exams....and ACLS/PALS certifications).  Although we have been doing clinical rotations all throughout our didactic training, I'm so excited to implement my knowledge full-time, and really delve into what makes me tick.

We're doing the first of many clinical labs tomorrow: needles and injections.  Pictures to follow!

Things I wish I knew before I started

It's been over 2 years since I learned that I was accepted to PA school, and would be beginning this incredible (albeit, extremely stressful, at times) journey that I am over 1/2 finished with.  At times, it seems so common place to get up in the morning, drag myself to class for another day, and stuff more into my brain than I thought would even fit just the day before.  But then again, I have my moments where I remember how worried I was that I'd never get to this point, and I was anxiously checking my email 8.3 times per day for any news about my acceptance status.  But every time someone asks me about any advice I have for the application process, or help out with an interview session with my program, I feel as though I have been transported back to my own interview, and how incredibly nervous I was feeling, worried that everything in my future relied on one decision that wasn't even my own to make.  Now, whenever a friend from college asks me about any tips they have for applying to PA school, I tell them I don't remember much, except for the things that I learned (unfortunately) from experience...the hard way, and will always recommend someone think about when they are applying to PA school:

1. Know (and be able to express in words) exactly why you want to be a PA.  I knew that I wanted to be a PA, but couldn't concisely express exactly what attributes of the profession appealed to me.  The 2nd time I applied, I knew exactly why, and they weren't the cookie-cutter answers many people probably give.  I knew what pieces of my personality were suited for becoming a PA, and the things of the profession that would satisfy each of the things I wanted and needed in my career.
2. Think long and hard about who you want to write your letters of recommendation.  They usually only permit 3 letters, and you want those 3 letters to be from people who can speak very well about your character, personality, work ethic, patience, etc., and not some generic form letter.  While getting a letter from someone with impressive titles, such as the head of a hospital department or a decorated college professor may seem like it is a good idea, if they can't talk about specific conversations you've had with them, or they don't know you outside of the classroom, steer clear of that person.  You really only want to do the application process once, and since you only have 3 letters to work with, choose people who have known you for a long time, with whom you have worked, or a doctor or PA that you've shadowed or volunteered/worked with, who can speak in detail and highly of your character and accomplishments.  Other than your first-hand account of your life and experiences, your letters of rec. allow the admissions committee to get another point of view of who you are, and if what your record shows is supported strongly by your letters of rec., it's much stronger than if your letters are generic and say something like "X is a good student who performed well....blah, blah, blah."
3. On that note, spend some time getting to know yourself....and know yourself well enough that you can both write and talk about yourself.  This seems like a stupid suggestion, but it comes in handy when you have to start writing essays.  The people who work in admissions read hundreds, if not thousands, or applications each cycle, which include at least one, if not more, essays to read.  You have to be able to stand out in 500 words or less.  Sit down and think about events/people/experiences/etc. that have changed the way you think, how you interact with people, etc., outside of school.  You have to be able to show that you can overcome adversity, stressful situations, and that you are passionate about things other than studying.  You've already gotten to the point where you have the grades and test scores that are impressive enough to apply to PA school....they want to know what ELSE you do!
4. Don't get caught up with thoughts of what you THINK they are looking for.  I feel into this trap the first time I applied: I was so worried about what I thought PA schools were looking for, rather than just being myself, and telling them about who I really was.  Whether or not the things you love to do (play an instrument, enjoy classic film, etc.) is something that is mainstream or not, just go with it, and if you think it's important for the admissions committee to know about you, then write about it.  When you're writing your essays or answering interview questions, talk about the things you love with so much passion and enthusiasm that you will make the people reading your application just as passionate about your activities and interests as you are.  It is all about building a picture of your character, and what makes you tick.
5. The most important thing that I tell people is to START EARLY!  If you plan on applying to more than one program, it is likely that you'll have to write a few essays, and you'll want to take plenty of time drafting your ideas, and working on edits (and having multiple people that you trust to edit them), and making sure that everything is absolutely the way you'd want the admissions committee to see them, and without spelling and grammar errors.  It will be much less stressful if you have some time to work on your applications, and submit them early, rather than starting late, rushing through your application and writing, and submitting in a hurry just prior to the deadline.  Applying is already super stressful, and taking enough time will help lessen that stress (if only by a little bit).

That's all for now....one more week of break to enjoy before tackling 15 more weeks of class, comprehensive exams, ACLS/PALS training, and then, on June 1, starting rotations!!!!  So close!

Do I really have to explain this one again?

I'm sure as pre-PA or PA students (or even practicing PAs) have had to explain what, exactly, is a PA to more family members, friends, and the general public than they can count.  Some days, I love explaining why I chose to become a mid-level provider, and how excited I am about having the flexibility that being a PA will provide, and all of the amazing contributions that PAs make to medicine.  Other days, I sometimes find myself rolling my eyes, and spitting back a cookie-cutter answer, or just feel carrying around a flier with the answers to everyone's questions ("No, I don't think it would be easier to just go to medical school;" "No, I am not selling myself short by being "just" a PA;" "Yes, we can prescribe medications, assistant in surgery, and treat our own patients;" "No, I cannot write you a prescription for vicodin;" etc....)

When I came across this video on Youtube, I found that someone (probably a frustrated PA student or PA-C) had already done just that, in a very humorous manner.  I think the monotone voices of the 2 characters make it even better.  All of my readers in the PA profession can probably relate very well to this video, and will laugh hysterically at the same time.

So blessed at the end of the year

As is customary for this time of the year (and because I finally have the time to reflect on everything that has happened of late), I have been thinking about all of the things in my life that I have been so blessed with during the past year:

• I am exactly 1/2 of a PA, with only one more semester left in the classroom!  I started feeling fairly early in the semester what past 2nd year PA students from our program have talked about before: the 2nd year slump.  Getting up, even for only 3 days a week, felt like such a huge chore, and every morning involved lots of coffee, blasting campy 80s music, and having a dance party/mental confidence booster in order to drag myself to yet another class.  However, clinic was something I looked forward to every week!  It was the one place where I could get away from the drama of being in class, and really hold my own.  I was blessed with 2 amazing rotations this semester, both of which I was treated with incredible independence and respect by my preceptors (especially during my second rotation in family practice).  I learned so much this semester in clinic, and gained huge confidence in my knowledge and abilities to accurately assess and treat my patients.  I even detected a heart murmur in an adult patient that had no history of a murmur in the past, which eventually led to a diagnosis of an aortic aneurysm.  I had so many moments like this where I have been able to synthesize everything I have learned in the classroom, and during past rotations, and I can't wait to start full time rotations in June.
• I have the love and support of my amazing family
• My sister came home!  After being gone for almost 4 months in London, she finally came home.  She even surprised us all by coming home 4 days earlier than expected, so we got to spend all week with her before Christmas.  
• I got to spend wonderful time with my mom and sister in the company of our amazing congregation for Christmas eve Mass, and I prayed the rosary using the beautiful Italian-made rosary that my sister brought back from St. Paul's cathedral for me!

I have been blessed by so many other things this year, including a phenomenal scholarship from my program, the opportunity to meet amazing people and have life-changing experiences in clinic and in my work experiences, and just happy to be surrounded by friends and family who love me.  I only hope that 2012 ends up being as wonderful as the tail-end of 2011 has been!  (That is, of course, if the world doesn't end :-)) 

Last-ditch effort to procrastinate

I should probably be sitting here, spending the next 1.5 hours studying for my last final exam of the semester, but I'd rather write, because there's nothing quite like supreme procrastination.

Yet again, I feel like my writing has lapsed in favor of studying, and there's far too much to write about in one post.  I'm so happy to finally be at the end of a tough semester.  The material wasn't too difficult, or maybe I've just become accustomed to constantly being so busy, but regardless, it was a long semester, especially with my sister not state-side.  She comes home next Friday, and I'm so excited I cannot contain myself.

On the school front, I have found myself caring less and less about studying, and more and more about application of the material, which I think is pretty normal, given the fact that I'm a mere semester away from my full-time clinical experiences.  I had 2 phenomenal rotations this fall, and love that I'm finally at a point where I can go in and see a patient, take their history and do a physical, and come out pretty sure (or at least thinking down the right path) of what is most likely going on.  I really loved my 2nd go-round in pediatric endocrinology (and am planning on a 3rd time during one of my elective rotations next year), and I also ended up really loving my family practice rotation.  I'm so looking forward to only 15 more weeks of sitting in a classroom (EVER) and finally doing my rotations.  I'm so excited, especially for my prospective elective rotations, and I'm hoping I'll be able to figure out what I want to spend my life doing.  I'm still torn between pediatric endocrinology and a surgical sub-specialty, and I have both lined up (tentatively) as elective prospects during 3rd year.

Well, now that my exam is a mere 1 hour and 2 minutes away, I shall get back to last-minute cramming....so close to freedom, I can taste it! 

Finally coming together

The month of October was a pretty rough one.  It felt like an endless stream of exam (after exam, after exam, after exam), papers, and clinic.  But, in the middle of the stress of exams and piles of papers, a classmate very aptly reminded me that there's only 20 weeks left of our didactic careers....EVER!  Only 20 weeks of sitting day in and day out in a classroom, for 8 hours of lecture, until it's over, and we're released into the "real" world of 3rd year clinical rotations. 


Outside of the classroom, I am having more and more days where I feel fairly confident in my abilities to receive a chief complaint of a patient (say abdominal pain), go in, do an H & P, and from that, figure out with fair certainty what they have (or the top possibilities, pending lab work/imaging studies), and coming up with a broad treatment plan.  I am in a fantastic family practice rotation right now, and, being the fall-early winter season, I am starting to see lots of URIs and stomach flu.  But, this repetitiveness has helped me really cement my abilities to convey information to my patients, which is great.  It's the first rotation thus far that I've been able to act as the primary provider, and follow through on an entire visit. 

However, a mild freak-out period has just ensued, because there are ONLY 20 weeks left to somehow learn the rest of everything that I will need to know to treat patients before being let loose in clinic.  I hope that I can somehow retain the important stuff, and know enough at the end of May to not look to stupid in front of my preceptors.

I am so happy that the month of October is behind me, and November holds the promise of only 3 exams (feels like a wonderful break ahead), a 6-day Thanksgiving break, and having the time (if I choose to actually utilized it) to study for final exams, and not end up cramming during the first week of December.  Tomorrow is a self-declared snow day, since there's a rather large winter storm warning, and a pile of snow, ice, and very windy conditions expected for tomorrow.  The thought of making some mocha mint Dunkin' Donuts coffee, sitting at my desk, and studying for my exam on Thursday sounds better than dragging myself to campus for 4 hours of class.  Maybe I'll even put on some Christmas music (hey, Halloween has passed....I take it as license to start the Christmas preparations!)

Plugging along...

The past few weeks have been busy, with my sister leaving the country for London, and preparation for upcoming exams.

Sarah was so happy to leave the country, and see somewhere else different for a while.  I miss her so much, but I know she is very happy there, and we get to Skype every few days, which has helped.

I had my meeting with our clinical coordinator to discuss how I would like my 3rd year to pan out.  It went really well; in addition to my required family practice and general pediatric rotations, I have decided to focus my electives on surgery, and have at least 2 orthopedic surgery electives in the works, and a general surgery rotation that I'd like to do.

Other than that, everything is just settling into a routine.  Classes begin and end, and the amount of information being thrown at us about how to treat patients is never-ending.  However, once in a while, we do get gems thrown in there, like our suture workshop that took place last week:

"This little piggie went to market, this little piggie stayed home....this little piggie cried wee, wee, wee"....because they were cutting off his feet to use for suture workshops

I got practice in surgery this summer doing some sutures, and it was nice to drive home what I had learned, and really work on dexterity, and learning some other fun stuff.  I love my Emergency medicine class (suture workshop was part of EMed), and have always considered working in the Emergency room sometime in my life.   But for now, I am content with my pig feet.

That's all for now; gotta get back to studying for the 2 exams that are scheduled for Wednesday :-)

The (very) beginning of the end

Last Thursday, our 3rd-year clinical coordinator scheduled our first official meeting to discuss the specifics of 3rd YEAR!!!! (aka, the year of no more classes, no more scheduled exams, no more wanting to be in clinic, but you're really just camping out in the classroom).  It's the year that, from day 1, you look forward to, because it's when we actually get to apply the stuff we've desperately tried to cram into our brains for the past two years about how disease occurs, populations, clinical pearls, treatments, alternatives, things to beware, etc.  First year was exhausting, and at times, very disconcerting, and while 2nd year is already proving to be more enjoyable, I know it will quickly become much like the first, where I am aching to finish the didactic portion of the curriculum, and just see patients.

That being said, hearing about scheduling of our 3rd year rotations was so exciting, and a little overwhelming.  I'm part of the regular track, so I'll have my standard inpatient/ambulatory peds, internal medicine, family practice, OB/GYN, Emergency med, and some electives thrown in there (which I'm hoping will be surgery-related).  I have been thinking more and more that surgery is definitely in my future somewhere, but I just don't know exactly how that will eventually play out.

Each month during our second year, we will have meetings regarding 3rd year information, as we get closer to finding out our schedules, and where we will be going for our required rotations.  I am just anxious to get out there and start using what I have learned, although, with only 2 weeks down in 2nd year, I still have quite a long way to go before I know any more than I did during my first year about practicing medicine.  I just wish the light at the end of the proverbial tunnel was a little brighter, because I'm already getting a little tired and worn out.   June, please hurry!

I also know that, starting next Friday, this semester will undoubtedly become much more difficult for me emotionally, because my sister will be leaving the country to study abroad in London for the semester.  Whenever I have a God-awful, horrible day that makes me seriously question my decision to become a PA, or even enter medicine in general, she seems to have a sixth-sense about it, and knows just when I need motivation the most.  Not having her around will be hard as the semester drudges on, even though I know she will be having the time of her life in London.  Excited for her, but scared for how I will hold up while she's gone.  As said before, June: hurry the hell up!!!!

The difference between herpangina and herpes simplex I...

The first official day of classes as a second-year student started out by diving head-first into the water, so to speak.  I had become accustomed to starting with note-taking and actively learning during college, where, as a biology major, there was no such thing as "syllabus day," as some of my marketing major friends fondly knew the first days of each semester as.  So, I expected no less with PA school.

Second year classes are such an amazing difference from first-year classes!  Because of our 3-year program format, we have essentially 2 years of didactic work before full-time clinic, and the 2nd year is composed primarily of the clinically oriented classes, that deal exclusively with the clinical presentation, pearls, and treatment options for pathologies in different specialties.  Today was jam-packed with Pediatric Clinical Medicine, Dermatology, Pharmacology, and Professional and Clinical Practice (where we discuss the nitty-gritty details about being in clinic, like coding, charting, referrals, dictations, etc.).  We had a fascinating lecture on oral health issues in peds. patients (I'm really going to love this class), and it's so nice to finally be at that place where the focus is entirely on the true clinical stuff.  We discussed the clinical differences between herpangina and herpes simplex I infection, among other pathologies that commonly affect the oral cavity.  Derm. was equally as fascinating, where we discussed the biochemistry and pathologic process involved in the development of acne vulgaris.  Pharm. was....pharm, and then it was time to go back home.  Excited to start clinic again next Tuesday, with endocrinology at Children's Hospital for the first 7 weeks.  Endocrinology is still high on my radar as far as possible career paths, so it will be interesting to have some more experience this fall.

Ok, on to reviewing everything from today; I already know that there's no way that procrastination will lead to anything good with this year, and the work-load ahead of me...

And it's back to work

It's hard to believe that 14 weeks away from classes is already at an end, and that I will be returning to class in just 5 short days.  I've never been a big fan of summer, because, being the nerd that I am, I always loved learning over having an extended period of relaxation.  Therefore, I never thought I'd be saying this, but this truly has been one of the most amazing, life-changing summers!  I had my 2 incredible rotations (pediatric endocrinology and orthopedic surgery), did 2 sessions of a summer science camp for HS students, and had some much-needed time to sleep, read books without -ology in the title, and catch up with my family and friends.

This year is one that I'm both dreading and absolutely looking forward to at the same time.  It is so exciting that for the next 9 months, my classes will all be clinically oriented (Adult, pediatric, emergency medicine, psychiatry, dermatology, orthopedics (yay!), and some others mixed in there).  Aka, no more basic science classes....everything will be clinically applicable.  However, after having such an AMAZING summer in rotations, I have had a taste of how great life is going to be on rotations/working after graduation, the thought of going back to sit in a classroom for 9 more, long months seems like cruelty.  Give everyone a taste of how much fun practicing actual medicine is, and then make them sit in a classroom again.

But, the nice thing is that I'll still have clinical time once a week for the entire year.  I'm actually looking forward to my fall rotations: for the first 7 weeks of the semester, I'll be in an orthopedic rehab. clinic (yay, more ortho and musculoskeletal patients!!), and for the second 7 weeks, I'm in an urgent care/family practice office.  It will be a great combo. of patients, and I hope to really nail down my exam skills and refine my clinical thinking.  Since I've already had a family practice rotation, I feel much more comfortable with this upcoming rotation, as I know the questions and exams I should be doing, and how my thinking should proceed.

I will try to keep my posts coming fairly regularly, but considering that I will be losing my free-time in T-5 days, who knows how often I'll be able to do so.  There may be a few mega posts covering large chunks of time....

So many firsts

I didn't realize when I started PA school that there would be as many "firsts" as I have had.  Every time I start a new rotation, I feel like it's the first day of school all over again.  The slight sense of nervousness and anxiety, going into a different practice environment, with a different preceptor, and seeing a different patient population.

"Firsts" aren't necessarily bad, though.  Most of my firsts have been exciting and fun: first time assisting in surgery, first time removing stitches, first time seeing a rare endocrine disorder, first time doing a steroid injection, etc.  I still always get a little nervous, but mostly excited when the opportunity to do or experience something for the first time arises, because I know it brings me one step closer to finishing school, and practicing medicine.

Nothing else exciting to report; 2 more blissful weeks of vacation left before starting classes again, and more clinical time.  I am happy that this will be the last "first" day of didactic work EVER in my career, but after experiencing such a phenomenal summer, and realizing 2 of the best clinical experiences ever, it will be difficult to return to the classroom for another year, before diving back into clinic in earnest.

Orthopedic surgery, round 1 run-down

Seeing as this is the end of my first orthopedic surgery rotation, it seems fitting that I do a run-down of the past 2 weeks:

Number of weeks in rotation: 2

Number of patients seen: well over 100 (I lost count on day 2)

Number of surgeries: 15

Number of new sutures learned: 1 (the horizontal mattress stitch is pretty awesome if you don't wan't a huge scar when they come out!)

Number of solo intra-joint injections performed: 1!!!  (By far, the most exciting part of my day today!!!)

I wish I could say that being so stubborn and set in my ways will change after such an incredible, eye-opening experience, but due to the fact that I am so stubborn, I don't think that will happen.  But, I can definitely say that this has, by far, been the best 2 weeks of my training thus far!  I was so lucky to have such a fantastic teacher in my preceptor, who took the time that I needed to learn, and gain something from each experience.

I must say that learning about orthopedics in lecture and actually experiencing it first-hand is so different; I always thought that I could never imagine seeking a career in orthopedic surgery, because sitting in lecture, learning about how bone growth happens, and the types of bone pathologies on paper can become very tedious and boring.

However, in the clinic, when I was actually able to see the effects of these pathologies, and how they affect patients' lives, and the evidence of everything as seen on x-rays, MRI and CT imaging studies, in addition to the very hands-on nature of their assessment and treatment, my opinion totally changed.  I loved the balance between seeing patients in clinic, and the ability to scrub into surgery, and have the procedural component included in there.

I am pretty sure that after this experience, I don't know how any other rotations will be able to live up to this one, and how challenging and fun it has been.  I have been so surprised by how the things I have been so enthralled by in the classroom have turned out to not interest me as much in clinic, and the things that I never would have considered beforehand based on my classroom experiences have me thinking about the possibility of long-term career goals.  I can honestly say that this has been the best summer I can remember in my entire life, with the combination of fantastic clinical experiences, wonderful (and much-needed) time off from the world of academia, and the chance to explore my place in medicine.

Beyond the broken bones

Considering my life is currently dominated by all things orthopedic surgery, I felt it appropriate to change the picture on my blog, to that of a post-op. x-ray of someone with total knee replacements, a surgery that is not uncommon in ortho.

For those of you who, at times, know me better than I know myself, you know that I am an EXTREMELY stubborn person, and, sometimes to a fault, I am very set in my opinions, and my feelings on what I like, and what I dislike (or think I dislike).

Such was the case coming into my required surgical rotation for the summer.  Months ago, back in January, we all had to fill out an inquiry form for our surgical rotations, indicating our preferences for surgical specialties (general, GI, urologic, trauma, orthopedic, etc.).  I just remember that, when I did fill out the form, I ranked every other specialty above orthopedic surgery; the idea of ripping apart joints, using tools seemingly better suited for a carpentry shop, and operating on bones really freaked me out.

So, much to my dismay, when we received our assignments for the summer, I saw that not only was I placed in Greeley, but in orthopedic surgery...what, was this the universe showing its hatred toward me?!?!  In the weeks leading up to the one I just completed, I tried fervently to find positive things about my assignment ("well, this should make it easy for me to realize I don't like surgery;" "I'll reinforce what I don't like, which will inevitably help me know what I do like when it's time for me to pick a specialty," etc.)  Seriously, there was no one dreading a rotation more on the planet than me, last Sunday night, as I went to bed before my first day in the ortho. clinic.

I must admit, my first day of the rotation was a little uneventful, since it was a clinic day.  My preceptor operates 2 days out of the week, and sees new consults, pre- and post-operative patients the other 3 days in clinic.  A lot of range of motion testing, special tests, and trying (and failing most of the time) to interpret x-ray and MRI studies to determine what caused pain, swelling, redness, limited motion, etc.  All throughout clinic on Monday, I was thinking about (and dreading) Tuesday, because I knew that would be my first day in surgery, and when I finally had to encounter all of the creepy things that made me think I hated orthopedic surgery.  I was terrified that at the moment I heard the revving of the jigsaw used to remove small pieces of bone, I'd pass out cold on the OR floor.

I didn't sleep a whole lot on Monday night...too nervous to calm down and sleep.  I got to the hospital at 6:30 am for the scheduled 7:30 am start of the first surgery.  I found my way down to the OR, and into the locker room, where I changed from my street clothes into the requisite blue scrubs, my super comfortable tennis shoes, surgical cap, and 2 pairs of shoe covers.  I then entered the OR hallway, and found the main desk, and looked at the scheduling board to see what was up for the day.  My preceptor had 6 procedures scheduled for the day, including a few arthroscopic procedures, and a total knee replacement.  I met up with him in pre-op. to visit the first patient on the schedule with him, and to touch base on what the day was going to look like.  At this point, I could hear my heartbeat inside my ear, and I was shaking beyond belief (and I had no coffee that morning, for fear that I'd get into a long surgery without the opportunity to leave to visit the ladies room).  Once the pre-op visit was done and the patient was under anesthesia and ready to go, I left to go with my preceptor to look at the x-rays, and "scrub in."

Scrubbing in is quite a bizarre practice for anyone not in medicine, and even some of us in medicine.  The ways in which we must move in order to get our gown, gloves, goggles, and other protective gear on without contaminating ourselves, the sterile surgical field, surgical tray, and the other sterile people in the room is quite mind-boggling.  It sort of looks like an awkward, 90s-style club dance, in which you back into the room after scrubbing your hands and forearms, with the scrub nurse coming at you with your gown while you wriggle your arms through the sleeves, and someone comes up behind you to close the velcro enclosure at the neck.  Then the scrub nurse holds your right hand glove out in front of you, and with still partially damp hands, you have to somehow dive your entire hand into the glove, and make sure all of your fingers find the appropriate home.  The process repeats for the left hand, and then for another pair of gloves placed on top.  Then, to tie the gown around the waist, you give one part of the sash on the gown to the scrub nurse, while you grab the other side, and twirl around (what is fondly known as the "surgical pirouette") until you meet on the other side, and you tie the 2 strings securely in a bow.

Seriously, between the process used to get scrubbed in and sterile (by the way, there is probably nothing that makes you feel more stupid as a student than scrubbing in for the first time...there is no way around it...you will look like an idiot, but everyone in medicine has had this rite of passage), and knowing that I was about to see someone's bones, I was proverbially sweating bullets at this point.  And the surgery hadn't even begun yet.  Oy.  I was toast.  But, I figured, as a student that was scrubbing into surgery for the first time ever, my precepting surgeon would probably just have me standing somewhere obscurely in the OR, observing.  Nope.  "Katie, stand right next the table right here; you'll get a better view that way."  So much for obscurity.

Once the surgery had started, and he was down to the bone, my surgeon told me to take my gloved finger and place it into the surgical field, while he flexed the joint.  Apprehensively, I did so, totally freaked out.  But, once he started flexing the joint, I realized just how amazing it was that I was touching someone's actual bone, while it moved!!!  This tiny joint in the foot, that had helped this person move, was the one I was touching right now in surgery!  SO COOL!

Yep, and all of you naysayers out there can probably predict how the rest of the story goes: a few screws and stitches later, and I was hooked!  Seriously, I fell head-over-heels in love with orthopedic surgery!  And that was just with the morning surgery!  A few arthroscopic procedures and a very quick ingestion of lunch later, I was getting ready for the afternoon's total knee replacement.

As a student, I had heard up until now that there is pretty much nothing more violent that we, as healthcare providers, can do ON PURPOSE, than total joint replacements.  I knew that when my surgeon told me that I would need to don the surgical haz-mat suit for this one, complete with booties, gown, and a helmet with it's own personal cooling system, I knew the rumors weren't lying.

Once in there, I was told to again, stand right next to my preceptor, but this time, I was going to get the opportunity to not only observe, but serve as the 2nd assist!  He wasted no time in deconstructing the joint (if you have a morbid curiosity, just look up "total knee replacement" on youtube; there's a plethora of live surgical videos that go through the surgery in detail).  For all of you not in medicine, in a period of just over 2 hours, the knee joint is completely deconstructed, the patella is removed and retracted to the side, small pieces of the tibia and femur, most likely severely affected by arthritic change, are removed using a surgical jigsaw, the artificial end pieces (aka the new knee) are fitted, cemented in, and everything is sewn back and stitched up.  Seriously, when I say violent, it's pretty fitting, although mostly bloodless.

Being a part of the total knee replacement was pretty much the most amazing thing I've done up until now.  I was there to witness, first hand, as a surgeon completely tore apart someone's knee, again, on purpose, and used his skills and a bunch of surgical titanium to build a new knee that would not be riddled with the same arthritic issues as this patient's actual knee had been.  It was SO MUCH FUN!!!!  Again, if you have a strong stomach, watch it on Youtube; it's pretty cool!

After the total knee, there was just one more surgery, and 15.5 hours after I had arrived that morning, I left the hospital for my bed, blissfully knowing I could sleep in a bit the next morning, since the day only involved rounding on the post-op. patients, and checking on their progress.

Wednesday involved rounding, and Thursday was another busy day of seeing patients in clinic.  Surgery, like Diabetes Camp, feels like total immersion.  Orthopedic surgery is a world unto itself, with an entire breadth of terminology, physical exams, pathologies, and techniques, and surgical tools (including to my amusement, an ugly looking tool called a "mother-in-law," most likely named by someone who thought his mother-in-law was scary) to know and master.  Since this is only a 2-week rotation, I cannot possibly learn everything, but I have been fervently studying every night after clinic, in the hopes that some of what I see in clinic and surgery will stay with me.

Next week is another busy week of clinic patients, rounding, and most importantly, SURGERY on Tuesday and Wednesday.  Seriously, if you had talked with me just a week ago, you're probably totally flabbergasted that I'm actually excited for more surgery.  It's kind of addicting, actually...like chocolate, only better.

I am already anticipating scheduling more stints in orthopedic surgery throughout my clinical rotations, including, hopefully, another, longer rotation with this same surgeon.  I have learned so much, and am so grateful to have such a patient teacher, and overall, so far, amazing experience.

Stay tuned for all of the nitty gritty details of orthopedic surgery, week 2.  If it's anything like this past week has been, I'm sure I'll have plenty of fodder for another interesting post.

High-low, high-low, it's off to camp we go...

Wow, it's been WAY too long since I've posted...since like, the end of fall semester of 1st year.  I can definitely say that a ton has happened...enough to deserve more than one blog posting.  Here's just a peek at what I've been up to:

1. I'm officially a 2nd-year PA student (aka, PA-S2).  I must say, I had so much fun changing my email signature from saying PA-S1 to -S2, and being able to have the -S2 on my security badges for the hospitals.  It represents 1 extremely long, arduous year, full of tears, frustration, feeling overwhelmed almost as often as I brush my teeth, completed.  It also represents moments of satisfaction, especially those during my clinical rotations, when I am reminded of WHY I put up with the frustration and feelings of being extremely overwhelmed: I will have the health care needs of my patients in my hands, and will have the knowledge and tools to help them.

Students from previous classes have always said that this summer between 1st and 2nd year is the most glorious summer you'll ever experience in the CU PA program, because it actually somewhat resembles a normal summer.  So far, that has proven to be true.  We finished classes in May, and other than the 2, 2-week clinical rotations that we've had to complete, all of the other time until August 29th is ours.  It's such a great feeling being able to sleep in, and not have to freak out about a nap-time that inadvertently went WAY longer than 30 minutes, as you'd set your alarm for more study time.  I know, that with just over a month until August 29th, I really need to enjoy the time I have remaining, because 2nd year will be just as unforgiving as the first.

Now, onto those clinical rotations.  After spending countless hours in the classroom, there's such immense satisfaction that comes from being in the clinical realm, and having the opportunity to "practice what they preach."  I am surprised at how much more comfortable I feel seeing patients now, as my first time in clinic was nerve-wracking, and an experience in overcoming the feeling of being an idiot.

This summer, I was scheduled for my required surgical rotation (more on that in the next post), and an elective.  For my elective, I chose Pediatric Endocrinology, and was split between the outpatient clinic at the Children's Hospital, and the 2nd part of the rotation was going to Camp Colorado, Diabetes Camp 2011.  My week at TCH was so much fun, as endocrinology is one of my favorite areas of medicine, and the practice environment at Children's is just so much fun, and definitely favorable to students.  All of the providers jumped at the opportunity to have me see the interesting patients that they were treating, and eventually throw me and have me see some on my own.

Diabetes Camp, on the other hand, felt like a foreign language emersion program.  Camp Colorado is one of the many camps that the American Diabetes Association puts on around the country every year, so that kids living with Type I Diabetes have the opportunity to thrive in an environment with other kids dealing with Type I, and to just be kids, doing camp things.  Often times, normal summer camps just don't have the capacity or knowledge to deal with the day-to-day requirements of a camper with diabetes, and therefore, a lot of these kids wouldn't otherwise be able to experience summer camp.

Camp Eagle Lake was absolutely gorgeous!!!  I still can't believe I got credit for my clinical rotations for this!

Beautiful view of Eagle Lake, just after an afternoon rainstorm :)

Beach-front lifeguard chair

Like I said, the week that I spent at Diabetes Camp truly felt like a total immersion program in a foreign language.  I learned more about blood glucose testing, blood sugar highs, blood sugar lows, insulin types (rapid-acting, intermediate-acting, long-acting, Lantus, Humalog, Novolog, etc.), insulin pump therapy, and giving injections than I could have ever learned in the clinic setting, where, when these kids do their follow-up appointments, things are going pretty well for them on the day of their appt.  I also saw first-hand the effects of too much exercise, not enough exercise, crazy teenage hormones, altitude, and 5 pita grilled cheese sandwiches on blood sugar levels.  Let me just say, it was one crazy week, but I learned so much about diabetes management, and will most definitely be returning next summer for another round!  

I was so incredibly humbled by the 268 campers there, and especially by their parents; I was completely exhausted after just 6 days of 24/7 diabetes management for my 7 campers...this exhaustion doesn't even scratch the surface of what the parents of these campers must feel every day, worrying about their child's blood sugar levels, getting up at 2am to test them, and give them a snack if their sugar is too low, and bolus them with insulin if it's too high.  However, I was extremely lucky to have a med-staff partner who not only has done camp before as a staff member, but she has been living with Type I for the past 8 years, and taught me so much, and very willingly answered all of the random questions I had for her!

After briefly recovering from my endeavor in endocrinology, it was off to my required surgical rotation in Orthopedic Surgery, in lovely Greeley, CO (stay tuned).