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).

PA-S1.66

I am now officially two-thirds of the way done with my first year of PA school (hence the S1.66 in the title; only 19 weeks (4 weeks of break, and spring semester)) now stand between me and 2nd-year status.  Again, I find myself in this bizarre paradoxical situation (as I did in college) where, going into PA school, I felt like I would have 3 WHOLE years to enjoy myself, learn as much as possible, and meet amazing people.  At the same time, 3 LONG years to wait and wonder what day-to-day clinical practice will be like.  However, right now I am marveling at how incredibly quickly my program seems to be going.  In a little over 2 years, I will officially be a PA, and practicing medicine for a living.

That is still a while away, and at this point, I am still recovering from fall semester.  I have 1 glorious month off for break, and I could not be happier.  It has been quite a while since I have written (midterms in October), and I feel like this is really the first time I have to breathe.  Life has been go, go, go since the beginning of November, with an endless stream of exams, papers, and a fair amount of coffee added to that mix.  Considering the fact that I had 10 (yes, 10) classes this semester, I found myself having many moments to myself.  If being in grad. school teaches you anything, it's how to manage your time so effectively, that you have time left over for yourself.

Fall semester definitely brought a multitude of new experiences, as well.  In October, as part of my physical diagnosis class, I had to practice performing pelvic/genitourinary exams on standardized patients.  While I was initially nervous about this, I am so grateful to the people who so willingly gave us their time to let myself and my classmates practice our exams on them, rather than having to fumble through the exam the first time during an actual patient encounter.

I think the biggest adjustment for me this semester was becoming accustomed to the semester system, itself.  Going to the University of Denver, I was used to the quarter system, with all of my classes lasting only 10 weeks, and getting out for a 6 week winter break shortly before Thanksgiving.  This year, however, I was barely finished with midterms after 10 weeks, and final exams were still more than 6 weeks away.  Needless to say, I was exhausted by the time finals rolled around last week, and I had very little left to give to my classes, friends, and family.  Much to my surprise, after taking some very difficult finals that I felt less than prepared for, I received news of my final grades, and all I can say is that I was extremely happy, and felt a huge sense of relief after working for 15 weeks.  Next semester, there will be 2 less credit hours than fall, I will be rotating in clinic on Tuesdays, I will have had time to recuperate from essentially 6 months of straight classes.

For now, all I can do is marvel at how much I have learned in just 6 months (I find myself laughing periodically when I watch ER now, when the doctors put their stethoscopes in their ears backward, and loving the fact that I understand why they are giving certain drugs during a trauma), and relish in this blissful time to myself.

I hope everyone has a very happy holiday season, and a wonderful, healthy, and blessed new year! 

Reflections after a very difficult week...

I wrote this text in an email to a family member earlier today, and realized it conveyed my feelings about the past few weeks very well, so I've decided to share it with you all:

....I am sitting here on the Anschutz Medical Campus, preparing for my 3rd of 3 exams this week, and just thanking God that this week is over.  Now that the month of October is halfway over, fall has really made its presence known here in the Denver area, and everything is beautiful.  I am looking out the window during this short study break, and admiring how beautiful the medical campus has become.  The medical campus is situated on the old Fitzsimons Airforce Base, and is in the last stages of development (they are currently in the middle of building an addition to the Children's Hospital, and building the new VA hospital.  I just remember when I first visited this campus 3 years ago when I was planning on applying to PA school, the campus seemed so "new."  The concrete sidewalks connecting the buildings still looked like they had been freshly laid, and the trees and shrubs were little babies.  Now, the trees that were so little just a short time ago have really grown, and the leaves are changing the most gorgeous colors of red, deep purple, and yellow, and the entire campus is covered in crunchy, dry leaves that I just love to go out of my way to step on when I'm passing from class to class.  I only wish I had more time to appreciate how pretty this beautiful campus is, in spite of the intermittent noise of Flight for Life helicopters taking off, and ambulances coming in and out from the many hospitals here.

Now that I am officially halfway through the semester, it feels like a huge relief knowing that there may actually be a light at the end of the tunnel of this, so far, very difficult semester.  I am doing very well in most of my classes, but I've also had the humbling experience this semester of failing an exam for the first time (actually, this just happened yesterday with my Pathology midterm).  However, I have resigned myself to just getting to the point of passing, and being happy with just that.  Having 10 classes at one time is crazy sometimes, but actually, quite manageable.  Even though most of the semester has been filled with the drudgery of classes day in and day out, I have had some interesting and clinically relevant experiences, such as learning how to perform a pelvic exam on a live person for the first time.  Although nerve-wracking at first, it felt for the first time that I am moving one step closer to actually practicing clinical medicine, which is a wonderful feeling.

As I have been moving through classes, some of them very clinically-based, I have also been slowly narrowing down my interests as far as fields of practice this semester, and have a very strong feeling that I would like to either pursue a career in Endocrine medicine, or Emergency Medicine, but, at this point, I am definitely leaning more toward Emergency Medicine, and have been for quite a while, even before I started the program.  I have always seemed to function best on a slightly elevated level of stress, and since there is always a level of high-anxiety/chaos in the ER, I feel like this would be a very good fit for me.

That seems to be all that is on my mind for now; back to studying for my Women's Health exam.

Finals start in T-minus....8 hours

As I head to bed for the evening, the evening before my first round of PA school finals, I am feeling sort of reflective tonight.  As difficult as this semester has been; as frustrating, maddening, and slow-going school seemed to go at times, I am in complete awe that I am here at the end of the semester already.  It's difficult to see how quickly time does pass when you live test to test, but looking toward the next 5 days of exams, I realize just how much I have learned in the last 10 weeks, and how much I stand to learn throughout the next two and half years.

The head and neck is a scary, scary region!

So, apparently I was a little too overzealous last time I wrote, and how excited I was about the head and neck.  REALLY overzealous!  I hate the head and neck...a lot.  It is the most exasperating, irritating, maddening, infuriating region of the entire body...although, still fascinating.  My head and neck exam is in 9 days, and it really feels like the pressure is starting to pile up.  We spent the last two days in Anatomy lecture going over the cranial nerves, the 12 nerves that start in the brain/associated structures.  For all non-science people, they are responsible for everything you see, smell, taste, hear, chewing, facial expressions, any sensation you feel on the skin of your face, crying, salivating, snot running from your nose (I just had to paint that picture), chewing, and the function of your entire digestive system.  So basically: they do a lot.  And each of the 12 nerves has multiple branches that travel through various regions of the skull, half of which (at least, in my mind) are imaginary, so sometimes it's pretty difficult to visualize where these nerves are going after they leave the brain, and attempting to draw them out on paper.  This is the first time all semester that I have truly felt overwhelmed at the amount of stuff that is contained in the body.  8 weeks into Anatomy, and I still have no idea how everything fits into our bodies.

Sometimes the most exciting things are the most tedious...

With only 2 and a half weeks left in the summer semester, my 11 day summer "vacation" seems so close, yet so completely out of reach.  Within that time, I still have: 1 Physical Diagnosis test, 2 Anatomy quizzes, 1 Head and Neck Anatomy exam (cadaver and written portions), 1 PD practicum exam, 1 simulated patient assessment note, 1 Clinical Reasoning final exam...I'm probably missing some stuff because, at this point, I can barely think ahead to tomorrow, let alone 2 weeks from now.  Anyway, there's a lot to be done, and it seems never-ending, daunting, and as if it will never end.

With the hell of the last 2 weeks behind me, in which there were 2 Anatomy exams covering 2 completely different units only 1 week apart, in addition to a paper and PD exam, this week was a nice breath of fresh air with no pressing need to study for the last 3 days.  Unfortunately, it was difficult to enjoy this brief time off from studying, because I was so exhausted from the last few weeks that all I wanted to do was sleep...and sleep some more.  I finally had a little time to myself, and all I could think about was sleeping, and even when I did sleep, I still felt tired.  PA school has finally started getting to me, and I am starting to feel that constant fatigue that happens when you combine too many lattes, late nights, stress, and zero personal time.  I seriously think that when I have my 11 days off from school, I will do nothing but sleep until noon, go to bed at 8, and watch movies/read books with the time I'm actually awake...it will be GLORIOUS!

In Anatomy, we are finally covering my favorite area: the spine, head, and neck.  I love the head and neck, because so much goes on in terms of neurological functioning, and I honestly cannot think of anything more fascinating than the human nervous system...it's so delicate, yet so insanely complex.  To think that little nerve fibers control the entirety of our existence is mind-boggling, and, as I said, fascinating.  It's also very tedious.  The head and neck is the most complex area of the body, with endless arteries, veins, nervous structures, muscles, and bony landmarks.  I currently dislike the bony landmarks.  For this current unit, in a 25-page study guide for the exam, 8 pages are taken up by the bony landmarks of the skull alone.  Translated: there are hundreds of little holes, crevices, depressions, pointy things, not-so-pointy things, and imaginary places on the skull where nerves, arteries, veins, muscles, and other stuff go through, attach to, and go around to get to other places in the body.  There is truly nothing that kills your mood more than sitting and staring at a human skull, with a list of the landmarks you need to identify, and somehow get into your brain.  Finding them is not difficult; remembering what goes into/onto them is the challenging part.

In cadaver lab, as we have been encountering the spine, head, and neck, we have had some really interesting dissections, and some very tedious ones.  Earlier this week, we got to dissect the spinal column.  It was the most amazing lab EVER!!! Here's why: after removing the muscles of the back, we found the vertebral column, and after scraping away as much of the remaining muscle tissue on the vertebrae, I got to use an electric autopsy saw to remove the back of the spinal column from the ribcage to the tailbone, in order to visualize the spinal cord.  Using the autopsy saw was really cool, because it's designed to only cut through hard tissue, like bone, but spare soft tissue.  Theoretically, you can hold it up to your own hand while it's running, and it won't touch you.  However, I don't dare try it, just in case it malfunctioned for some reason :-P.  Anywho, after removing the spinal column, I saw the spinal cord.  It's actually relatively small in diameter (only about 1-2 cm thick) considering how important it is, but it was still the coolest thing I have seen this semester.  I was acting like a 9 year-old in a candy store the entire lab, because I was so fascinated and excited to see the spinal cord. 

Today's lab was not so exciting.  It was face dissection day.  I will spare you the details, but after we removed the dressing that kept the face covered for the last 7 weeks, we spent nearly 4 hours trying to remove the skin and find extremely delicate structures located in the face, and covered by very thick connective tissue.  Needless to say, it was very tiring, even when I wasn't dissecting, and by the time lab finished, we were all exhausted and very frustrated.  However, we get to open up the top of the skull and pull out the brain next week, so I am trying to stay positive, and get pumped up for the part of anatomy lab that I have been waiting for all summer.  It will be interesting to see what we find, not only in our cadaver, but everyone else as well; many of the cadavers died from strokes or brain bleeds, so it will be interesting to see if there is obvious evidence of brain death/damage when we open up the skull and pull out the brain.

That's all for now; sleep sounds so nice right now.

Balance is the key word

In PA school, everything is (supposedly) all about maintaining balance.  Being able to integrate and synthesize the massive amounts of knowledge being thrown at me, while having an outside life and remembering to care for myself at the same time is sometimes easier said than done.  However, I find that I actually have quite a large amount of time for myself and my personal interests, even though school is very difficult at times.

The first round of exams arrived and passed more than 2 weeks ago, and I am still here.  The first Anatomy exam was killer, but I was surprised to find out that I had done incredibly well, so I was very happy, but at the same time, there wasn't a whole lot of time to celebrate, as it was immediately on to new material.

After the hell of the upper extremity during the first unit, diving into the thorax, abdomen, and pelvis was really exciting...the "blood and guts" of anatomy is what really makes me go...it's just so fascinating.  It's where pathology is most evident, and my classmates have found some incredibly fascinating things in their cadavers.  There were several pacemakers found, evidence of central lines, surgical procedures (including several people who had multiple coronary bypass operations) and several cases of "organomegaly," or enlarged organs.  One cadaver had a heart that was nearly 5 times larger than normal, evidence of severe heart-failure. 

However, the thorax and abdomen presents its own set of problems, such as the fact that there is SO MUCH going on once you peel back the anterior abdominal wall.  There are so many different organ systems represented, and arteries traversing over veins, nerves, lymphatic drainage ducts, and other things.

Round 2 of exams started today with Physical Diagnosis, which I did really well on, but there are still 2 Anatomy exams (thorax/abdomen, and then, after spending only 1 week on the lower extremity, another exam exactly 1 week after the upcoming one on the 19th), a patient-chart note, and a simulated patient interview on the last day of July.  The next two weeks are absolutely pure-hell, and I yearn for it to be August 1st already, and for this mess of exams to be behind me.  After this, it's 3 weeks in the head and neck, which I'm super excited for, especially when we dissect out the spine/spinal cord, brain, and peripheral nerves.  Since neurosurgery is one of the specialties that is high on my list, I am extremely interested in all things neuro.  As I said, 3 weeks in the head and neck, and the Anatomy exam associated with that, and 1 Physical Diagnosis comprehensive physical examination, where we are put in a room with standardized patients and graded on our physical exam techniques. 

My brief summer break seems so close, and yet, so far away.  Think good thoughts for me over the next two weeks.  I love and miss you all!

And it begins piling up...

It has been a little while since I've been able to post, but the work, true to form, is piling up.  I have only been in school for 2 full weeks (tomorrow begins the 3rd), and exam time is already looming.  There is so much content to be tested on, but unlike any academic endeavors any of us have experienced before, we actually have to remember what we learn...how else would we even know where to begin if one of our patients came in with "winged scapula" to deduct that this patient could have paralysis of the Dorsal scapula nerve, which supplies the Rhomboid muscles, allowing them to help hold the scapula flat against the thorax?  (You can tell that I was just trying to review the material as I typed).  The nice thing, though, is that everything is very intuitive, and all of the structures are grouped regionally, so rather than learning the ENTIRE muscular system at once, or the ENTIRE nervous system at once, we learn only the structures of the region we are studying.  That being said, this way of tackling Anatomy is also very difficult, and requires a great deal of skill when it comes to synthesizing the material, because we are dealing with all of the bony landmarks, muscles, joints, ligaments, nerves, arteries, veins, and lymphatic drainage of the upper extremity.

It is sometimes hard to remember that I also have 3 other classes that require attention, too, because Anatomy really takes up most of my time.  But, PA school is all about balance, and how to keep several things going at once.  I thought I was good at multi-tasking before this, but this is the biggest challenge to that thought ever.

At this moment in time, a lot of us, including myself, occasionally have to remind ourselves why we're here: to eventually become the great PAs we envisioned ourselves being, and attempt to make our way in the world.

Seeing what few others see...

Today was quite a day.  In addition to Anatomy lecture this morning at 8, and another class called "Intro. to Clinical Reasoning and Problem-Based Learning," we had our first Anatomy lab today at 1pm.  I can honestly say that I wasn't able to pay attention much to any of this morning's classes, because 1pm was looming in my mind.  I was so pre-occupied with the thought of being in my first cadaver lab, that I couldn't even focus.

I am not a squeamish person in the slightest (as my family can certainly attest to, considering I have often found it difficult to NOT discuss the nasty, but interesting things I learned about in school), but my emotions were swirling in my brain today, and I was so nervous about actually seeing the body for the first time today.  Even when we went up to the 5th floor of the education building (where the Gross Anatomy lab is housed) I started getting a little nervous.  But, considering the fact that I have 10 weeks of many long hours in the lab, I got over my nerves very quickly.  There is not a whole lot of time to contemplate being nervous, although there were moments of it throughout the afternoon.

The cadaver lab itself is beautiful.  Since the Anschutz Medical Campus is completely brand-new, all of the facilities (barring the old Army hospital, where President Eisenhower stayed when he had a heart attack) are pristine, and gorgeous.  The anatomy lab has big, bright windows that look out to the old army hospital, fondly known at "Building 500," and they let a lot of light in, which is nice, since a good chunk of the lovely summer weather will be going away during lab times.  There are 5 interconnecting lab areas, so we can freely walk about the long hallway of cadavers, and observe what others are seeing, and the techniques others are using.

Immediately upon walking into the lab this afternoon, my nose let me know right away that there was no other place on campus that this area could be except the Gross Anatomy lab.  Surprisingly though, I adapted quickly to the smell.

We proceeded to our designated humidor, sort of a large, stainless-steel tray with a lid that folds down.  We opened the lid, and the black body bag with our cadaver was inside.  After unzipping the body bag, we figured out that we had a female cadaver, and the tag on the table said the date of death was July of 2009.  The hands, feet, and face are covered by gauze bandages for now, which definitely helped with the emotional disconnect that had to happen before I was ok to dive in and cut.  

During the entire lab session today, I kept thinking about how amazing we are as a species, and being able to see it first-hand really reinforces that.  Even though I felt a little emotional when lab was all over tonight, when I was actually doing the dissection, I was completely fascinated by the structures, and actually being able to see what I've been learning about and studying throughout my life as a student...it's pretty amazing.

As you can tell, today was a day for Anatomy, and nothing much else happened today.  I have to study and read ahead for lecture tomorrow and Thursday, and prepare for what we will be dissecting on Thursday, when we will encounter the upper extremity.

Tomorrow is the big day!

The first day of classes is finally here!  It's been almost 6 months since I found out I had been accepted, and those 6 months have been the longest of my life in many respects.  They have been long months of anxiously waiting for school to start, of worrying about whether I could handle the challenges being in PA school would present, of being so excited to finally be living out my dream...just 6 very long months. 

Now that it is here, I have gotten over MOST of my insecurities, and am totally ready to dive into the insane workload of the summer semester.  I have 4 classes, but undoubtedly, the one that will dominate my life this summer is Human Anatomy.  Lecture is scheduled 4 days a week, Monday-Thursday from 8-10am, with the corresponding lab scheduled 2 days a week, Tuesday and Thursday from 1-5pm.  That being said, I will certainly be spending more that 8 hours a week in the Anatomy lab, considering there is so much material to learn, and not nearly enough time in that 8 hours per week to finish the required dissections, and actually retain what the heck we are seeing inside.  Just the amount of books I have had to purchase for Anatomy alone (8 in total) bears some idea of the kind of workload I am about to undertake.  None the less, I am so excited, a true testament to how much I love medicine, and the great extent to which my life is dominated by it.  I willingly commit my time to reading books that many wouldn't touch, unless threatened, and I actually find everything I read fascinating.

That being said, any of you out there reading can probably already foresee the future, when, at the end of the summer, I will be blogging about how much I cannot stand Anatomy, and how happy I will be to be done with that class forever.  But, being fresh-faced and not tainted by late nights, too much coffee, too-little sleep, and long hours in the cadaver lab, I can still stand here and honestly say how much I love Anatomy.

That is all for now, since I actually have to set the alarm and return to the academic schedule.  At least I have a pot of coffee ready to brew the minute that alarm goes off at 5:45 tomorrow morning.

Hi, my name is Katie, and I'm a Physician Assistant (Associate?)

I, like many PA students and currently practicing members in the profession, closely follow news associated with said profession.  The PA profession, still being relatively young, is a tight-knit one, and whenever an issue arises within the field, it is widely talked about on the PA blogs and news sites.  Upon logging onto my Facebook page this morning, my news feed displayed the news from one of the PA blog pages I follow, and a very interesting article was linked, which I enclose below.  It speaks of the suggestion that a change of title be employed, and that "Physician Assistant" be changed to "Physician Associate," to clear up any ambiguities there are within the general public about what we actually do, and what responsibilities we have.

I, for one, am 100% in favor of the seemingly simple name change, that has the potential to drastically change how people outside of the medical profession see us.  Even though I haven't even started school yet, I have lost count of the hundreds of times that I have had to explain exactly what PAs do, often because the word "assistant" throws many people off; most people assume that Physician Assistants are on the same level as Medical Assistants, which couldn't be further from the truth.  The word "assistant" really isn't quite accurate anymore, seeing as how PAs have a very distinct set of responsibilities and duties when it comes to patient care.  Since we are trained under the medical model, the same model that doctors are educated under, we can perform many of the duties as doctors, such as physical exams, ordering/interpreting tests, prescribing medications, and assisting in surgery.  Medical assistants, on the other hand, take vitals and ready the patient for the PA/Dr. to perform their duties.

When I explain to others that PAs have such a wide scope of duties, many question my decision to attend PA school, and not go for medical school.  Again, this one silly word causes many of the people that know me to assume that I am settling for an "assistant" job, rather than "suck it up" and become a Dr.  But it is purely a lifestyle choice, one that allows me to have the kind of life that I want, and treat my patients in a way that I envision medical care to be. 

Even though a name change, if it is to happen, is far from occurring, I have hopes that it would cut down the confusion and more accurately reflect the rich history and wonderful scope of the profession I have chosen to dedicate my life to.

For the full article, click the link:
http://physician-assistant.advanceweb.com/editorial/content/editorial.aspx?cc=219643

45 days and counting...

It has been quite awhile since I've posted, and during that time, quite a lot has happened.  As the start of PA school inches closer, the number of items on my to-do list has increased exponentially.  Just when I think I'm making headway on the massive list, I get another email with upcoming dates to remember, or I think of things that must be done before I move into my new apt. and start school.  Setting up my utilities, cable, internet, and making appts. to have immunizations and TB tests done are only a small part of what I accomplished only today.

Even though my list is long, I am continually reminded what this list signifies; it represents what I have to accomplish in order to be as ready as possible for the start of PA school...and I am really excited! 

Included in the last "new student" newsletter from the CU PA program was the list of textbooks and supplies I will need for the summer semester...and if I thought my own list was long, this one threw me right out of the ballpark.  This summer will consist of 4 classes: Human Anatomy with cadaver lab, Introduction to Clinical Reasoning, Physical Diagnosis, and The Psychosocial Aspects of Healthcare.  Between the 4 classes, I had to order a total of 8 books, which were not evenly distributed.  Human Anatomy will definitely be the most time-consuming and heavy of my classes, if I am judging by the book list alone: "Clinically Oriented Anatomy," "Cross-sectional Human Anatomy," "Grant's Dissector," "Netter's Atlas of Human Anatomy," and "Netter's Human Anatomy Coloring Book."  Even though I have taken Anatomy twice before, and am familiar with much of the human anatomy, there is a lot to be forgotten as soon as the class is over, and since this time is for real (as in, I have to actually remember this stuff in order to treat my patients) I am thoroughly committed to learning it and having it stick...I hope.

My other books were for Introduction to Clinical Reasoning and my Physical Diagnosis class.  Throughout my book and supply ordering process, I experienced the biggest geek-out moments of my life.  In addition to the textbooks for these classes (which I will get to briefly), I had to order my medical equipment.  As someone who has been dreaming about practicing medicine since I was 4, this was one of the greatest moments of my life.  I ordered my diagnostic kit, which includes an ophthalmoscope and otoscope, my blood pressure equipment, and my very own stethoscope, with burgundy tubing.  I can't believe I am going to own a stethoscope!  YAY!

The same geeking out ensued when I received my physical diagnosis and clinical reasoning books in the mail, which consisted of Pediatric and Adult symptom guides, a medical terminology guide, and a 1000+ page behemoth detailing the various steps and components of a complete physical exam.  I got so excited upon opening the package, that I'm sure my mother was wondering what type of stimulants I was on :-).  But it really is hard to put into words how exciting it is to know that I will actually learn and remember what these books contain in a few short months/years: the knowledge pertaining to the practice of medicine.

I don't know how it feels when brain cells die....

...but I'm pretty sure what I'm feeling now must come close.  It has been 8 months since I have last been in school, and I have, for the most part, embraced my time off, and the ability to give my brain a rest after college.  However, there comes a point for me, when having time off to watch movies, read books, bake, cook, and sleep in becomes WAY too much.  Plainly stated: I AM SO BORED!  I think my brain cells are starting to die (not literally because of boredom, as several thousand brain cells die every day, but figuratively speaking). 

Although many students currently in the PA program have said to study anything before the program starts is as close to committing a sin as you can possibly get, but I have decided that I need some sort of intellectual stimulation before all of my brain cells die entirely, and there are none left for the actual program.

I have yet to decide what I am going to do in order to satisfy my need to learn and do something intellectual, but I have contemplated volunteering at the museum, or tutoring, or (Heaven forbid) simply pulling out one of my old college textbooks and reviewing some of the stuff I have learned.  I love learning, especially science, and that may just be the way that I get rid of this monumental brain cell-slowly-dying feeling.