Well I finished my emergency medicine rotation last week and the final verdict is: the ER is not the place for me, and this decision really comes back to one of the many reasons why I chose to become a physician assistant rather then pursue medical school. One word: lifestyle. I decided I wanted a career where I could come home to Seth every night, I don't want to be on call all the time, I DID NOT want to go through 4 more years of school, and *gulp* here come's the 'k' word: kids. I don't foresee myself being a full time stay at home mom, but it really didn't make sense to me to go all the way through medical school and residency and then not really use all my training because I want to be at home with our kids more. So anyways, in the emergency room I wasn't even on a terrible shift (2pm-12am), but I never saw Seth except when I got home around 1am and went to sleep where he was already in bed. People in the ER complained (rightfully so) about the tough life/work balance, feeling as if they were neglecting their families, etc. So all I have to say is no thank you! I admire those who sacrifice their time to work in the emergency room, but I am selfish and want more time for me and Seth. :)
Other eventful things over the past couple weeks: Seth and I ran our half marathon last Saturday! In hindsight, the actual event wasn't difficult but the training was very difficult mentally. We trained for about 13 weeks, 4-5 days/week. I cannot think of a single training run where I thought 'YAAA! WOO! I get to go for a run today!" That definitely never happened. It was mentally difficult to force my butt to get out there, especially back in August and September when I had to run at 5:30-6am when it was 'only' 65-70 degrees out, because there was no way I'd survive in the 80s or 90s of the afternoon. And if I didn't run, all I thought about all day was the fact I needed to run. Not to mention the mental hurdles of adding distance along the way.
The half marathon was fun though. It's a pretty difficult route, basically weaving around every conceivable hill Roanoke has to offer. Good grief! It was amazing to see people of all ages, shapes, and sizes just running/jogging/walking along to reach this ridiculous goal of 13.1 miles. Kudos to marathoners, because at the end of the race I probably couldn't have ran another 100 feet let alone another 13.1 miles. But Seth and I both achieved our goals. I just wanted to stay under a 10min/mile pace and Seth wanted to be around an 8:50 min/mile pace. Now that this is all said and done, I don't really have any interest in doing another one or keeping up running. It was a bucket list item, and now I know I can do it, but I just genuinely don't love to run. I actually don't like working out at all. I like activities. I love mountain biking, kayaking, and hiking. I don't love going to the gym, but I do love being healthy and in shape so it is a necessary evil I suppose.
Also, my dad was here all week and rode my bike around the whole time the half marathon was happening to give Seth and I big yells and high 5's of encouragement along the way. :) That was the best. I can only hope my kids admire and love Seth and I as much as I love and admire my dad.
Wednesday, November 27, 2013
Tuesday, November 12, 2013
The World Sucks, and Medicine is Hard. Save Us Jesus.
I've had a few more days of experience in the ER and the burdens of the world have been weighing heavy on my heart. It is a rough environment, the ER, and as one of my professors put it "nobody comes to the ER on their best day." Here's a list of a few things I saw the past few days:
-A man severely addicted to alcohol and withdrawing (fyi: alcohol is the most dangerous substance to withdrawal from. Not cocaine, heroine, meth, or anything else you can think of, but alcohol)
-A woman who is 30 and has already been divorced twice.
-Numerous children with only one parent (those who are reading, don't get all offended by this. I was raised by a single parent, and my dad is a better parent by himself then most people are together, but one cannot deny that a solid, two parent home is the most ideal situation).
-A sexual assault victim needing a forensic exam.
-More foul and offensive language then I've heard in my entire life (not by patients I might add...)
The list goes on and on. And in the midst of all this, I am thankful that I became a Christian years ago, because it makes coping with all of this a little easier. Christianity gets minimized by modern society to a lot of rules and is portrayed as hatred (and I do apologize for those people, but hateful people come in all forms and flavors of Christian, Atheist, Islamic, Hindu, etc, and those of us actually trying to find truth have a huge task of cleaning up the mess that our particular flavor makes, so please be patient and kind to everybody. Disclaimer ended). But what does it mean to be a Christian? Why can I cope with all the things I see in the ER easier then if I wasn't a Christian? It means to understand that people are broken, but that we don't have to heal ourselves or each other alone. What a huge task that would be!! It's difficult to fix something broken with something else that is broken. Everyone has there own struggles and ugliness, and broken people cannot fix other broken people. BUT!! There is a God who cares for and loves us, so much that even though people do the ugliest things to each other, He still wants to spend eternity with us, so his son, Jesus, who lived a perfect life, always kind, forgiving, and selfless, died taking all of our burdens onto himself. It means that I have hope that there can be healing and redemption of horrible situations, even as I'm inundated in one of the world's most desperate places, the emergency room.
And the alarming part of working in the ER is that almost every provider, whether physician, PA, nurse, etc., has made it very clear that they are not 'spiritual' as they like to say. They are not religious, and they like to make it known. So my question is, how on earth do they deal with working there? There is no higher being, no God, just people. Day after day with nothing but death, tragedy, and illness, where do they find hope? Medicine? Medicine is really a big guessing game. Using a story a patient tells, a physical exam, and maybe some labs we make our best guess at what is wrong and choose what we think might be the best treatment for it is. That fails often, and we don't have medicine for many many things. Science? How does science fix the woman's heart who's husband of 60 years just died? People? Whether we like to admit or not, even the nicest people do hurtful things and have their own burdens. How to we deal with the tragedy and weight of working in medicine?
So to wrap it up, my benediction, for the lack of better words, to my colleagues is this: If all you believe in is people (or science or medicine), I can only imagine how heavy the burden of a career in health care is going to be as we are the healers of the body, mind, and heart. Our job is to get involved and dig deep into people's lives, and what we often find is horrifying. People and this world are ugly, medicine fails, and there are severe limitations to scientific knowledge. I cope by knowing that Jesus heals and redeems all ailments, and that I am just privileged enough to get to help. I know that the burdens of this world are not mine, because thankfully, Jesus bore every burden when he died for us on the cross.
-A man severely addicted to alcohol and withdrawing (fyi: alcohol is the most dangerous substance to withdrawal from. Not cocaine, heroine, meth, or anything else you can think of, but alcohol)
-A woman who is 30 and has already been divorced twice.
-Numerous children with only one parent (those who are reading, don't get all offended by this. I was raised by a single parent, and my dad is a better parent by himself then most people are together, but one cannot deny that a solid, two parent home is the most ideal situation).
-A sexual assault victim needing a forensic exam.
-More foul and offensive language then I've heard in my entire life (not by patients I might add...)
The list goes on and on. And in the midst of all this, I am thankful that I became a Christian years ago, because it makes coping with all of this a little easier. Christianity gets minimized by modern society to a lot of rules and is portrayed as hatred (and I do apologize for those people, but hateful people come in all forms and flavors of Christian, Atheist, Islamic, Hindu, etc, and those of us actually trying to find truth have a huge task of cleaning up the mess that our particular flavor makes, so please be patient and kind to everybody. Disclaimer ended). But what does it mean to be a Christian? Why can I cope with all the things I see in the ER easier then if I wasn't a Christian? It means to understand that people are broken, but that we don't have to heal ourselves or each other alone. What a huge task that would be!! It's difficult to fix something broken with something else that is broken. Everyone has there own struggles and ugliness, and broken people cannot fix other broken people. BUT!! There is a God who cares for and loves us, so much that even though people do the ugliest things to each other, He still wants to spend eternity with us, so his son, Jesus, who lived a perfect life, always kind, forgiving, and selfless, died taking all of our burdens onto himself. It means that I have hope that there can be healing and redemption of horrible situations, even as I'm inundated in one of the world's most desperate places, the emergency room.
And the alarming part of working in the ER is that almost every provider, whether physician, PA, nurse, etc., has made it very clear that they are not 'spiritual' as they like to say. They are not religious, and they like to make it known. So my question is, how on earth do they deal with working there? There is no higher being, no God, just people. Day after day with nothing but death, tragedy, and illness, where do they find hope? Medicine? Medicine is really a big guessing game. Using a story a patient tells, a physical exam, and maybe some labs we make our best guess at what is wrong and choose what we think might be the best treatment for it is. That fails often, and we don't have medicine for many many things. Science? How does science fix the woman's heart who's husband of 60 years just died? People? Whether we like to admit or not, even the nicest people do hurtful things and have their own burdens. How to we deal with the tragedy and weight of working in medicine?
So to wrap it up, my benediction, for the lack of better words, to my colleagues is this: If all you believe in is people (or science or medicine), I can only imagine how heavy the burden of a career in health care is going to be as we are the healers of the body, mind, and heart. Our job is to get involved and dig deep into people's lives, and what we often find is horrifying. People and this world are ugly, medicine fails, and there are severe limitations to scientific knowledge. I cope by knowing that Jesus heals and redeems all ailments, and that I am just privileged enough to get to help. I know that the burdens of this world are not mine, because thankfully, Jesus bore every burden when he died for us on the cross.
Thursday, November 7, 2013
A Night in the Trauma Bay
Last night (Wednesday) I got to the the ER around 8PM and left at 5:30AM Thursday. It was actually a pretty quiet night. In the 9.5 hours I was there, I only logged 8 patients, none of which was a true huge trauma. Earlier Wednesday morning a stabbing victim came in, but I was not there yet (DANG!). So! That's good for the city of Roanoke but makes for an uneventful night for us. Thank heavens one of my classmates was with me and my preceptor is very friendly, otherwise it would have been a long long evening.
There was one really interesting case though. They had Boerhaave Syndrome.
Basically what happens in Boerhaave Syndrome is there is an increase pressure in the esophagus from over eating, eating too quickly, or severe vomiting, which then causes your esophagus to rupture, and all the food or vomit that was in your esophagus is now in your chest cavity. As my professor says in his heavy southern-rural-Virginian accent: "This is B-A-D not good. That is some BADNESS." This is a problem, because you chest cavity is sterile and has now been contaminated. Treatment? Crack open the chest cavity, clean it out to get as sterile as possible, fix the tear in the esophagus, and put them back together. If untreated, there is almost a 100% mortality rate because you get a massive infection all around your heart and lungs.
So to put this in perspective for this patient, the poor thing was eating dinner, they all of a sudden got terrible chest pain and felt like they had aspirated a piece of meat (which means they felt like it had gone into their trachea or bronchi towards their lungs) and couldn't get it out. After seeing the CT scan, that piece of meat was floating around in their chest cavity. So what should have been a pleasant evening at home eating dinner turned into calling the cardiothoracic surgeon and having their chest wall broken open to retrieve that piece of meat. The ER doc on that night said the patient would most likely fully recover and be home in a week. How amazing is that!! Also, I might add this patient was in zero distress. They basically just sat there for a few hours with some oxygen in their nose waiting to go into surgery. Also amazing.
So! That was the most interesting thing I saw all night. One other thing I learned:
People having serious heart issues don't look like they do in TV shows. Granted we didn't get anyone having a full on heart attack, but we had a few people who could be well on their way to that shortly. While learning about MIs (myocardial infarctions...or heart attacks), I really imagined people in a large amount of distress, quickly crashing needing immediate life saving intervention. Sure, I bet those people exist, but the few people we saw last night who could have a full on MI at any moment were in absolutely ZERO distress, not too concerned, just casually talking, with their only complaint "My chest just hurts a little and my arm feels a little funny."
SO! As we are going out and about living out our lives, I think being educated on the signs and symptoms of a heart attack are important. What if you saw somebody in the grocery store having one? Would you be able to recognize it and know to call 911? The Cleveland Clinic has a great link about recognizing a heart attack I would recommend reading. http://my.clevelandclinic.org/heart/disorders/cad/mi_symptoms.aspx
To summarize, it was a pretty quiet night, but an exploding esophagus is pretty interesting at least!
There was one really interesting case though. They had Boerhaave Syndrome.
Basically what happens in Boerhaave Syndrome is there is an increase pressure in the esophagus from over eating, eating too quickly, or severe vomiting, which then causes your esophagus to rupture, and all the food or vomit that was in your esophagus is now in your chest cavity. As my professor says in his heavy southern-rural-Virginian accent: "This is B-A-D not good. That is some BADNESS." This is a problem, because you chest cavity is sterile and has now been contaminated. Treatment? Crack open the chest cavity, clean it out to get as sterile as possible, fix the tear in the esophagus, and put them back together. If untreated, there is almost a 100% mortality rate because you get a massive infection all around your heart and lungs.
So to put this in perspective for this patient, the poor thing was eating dinner, they all of a sudden got terrible chest pain and felt like they had aspirated a piece of meat (which means they felt like it had gone into their trachea or bronchi towards their lungs) and couldn't get it out. After seeing the CT scan, that piece of meat was floating around in their chest cavity. So what should have been a pleasant evening at home eating dinner turned into calling the cardiothoracic surgeon and having their chest wall broken open to retrieve that piece of meat. The ER doc on that night said the patient would most likely fully recover and be home in a week. How amazing is that!! Also, I might add this patient was in zero distress. They basically just sat there for a few hours with some oxygen in their nose waiting to go into surgery. Also amazing.
So! That was the most interesting thing I saw all night. One other thing I learned:
People having serious heart issues don't look like they do in TV shows. Granted we didn't get anyone having a full on heart attack, but we had a few people who could be well on their way to that shortly. While learning about MIs (myocardial infarctions...or heart attacks), I really imagined people in a large amount of distress, quickly crashing needing immediate life saving intervention. Sure, I bet those people exist, but the few people we saw last night who could have a full on MI at any moment were in absolutely ZERO distress, not too concerned, just casually talking, with their only complaint "My chest just hurts a little and my arm feels a little funny."
SO! As we are going out and about living out our lives, I think being educated on the signs and symptoms of a heart attack are important. What if you saw somebody in the grocery store having one? Would you be able to recognize it and know to call 911? The Cleveland Clinic has a great link about recognizing a heart attack I would recommend reading. http://my.clevelandclinic.org/heart/disorders/cad/mi_symptoms.aspx
To summarize, it was a pretty quiet night, but an exploding esophagus is pretty interesting at least!
Monday, November 4, 2013
What's for dinner? Veggie Casserole!
Veggie Casserole
4 cups cooked brown rice (use beef broth instead of water)
1 bag frozen cauliflower
1 bag frozen broccoli
1 bag frozen whatever veggie you want! (I get a corn, green bean, and pea mix.)
Cheddar cheese
Make the rice using beef broth, mix rice and all veggies into a large casserole dish, shred some cheese on top, and cook until cheese is melted and dish is hot.
This is really more of a side, but I like to just eat a big bowl of it. It also makes for great left overs for lunch or dinner the next day.
Comments on the level of healthiness of this dish:
1) Brown rice is better then processed white rice
2) Use low sodium beef broth
3) Thou shalt not eat canned vegetables.
4) Nix the cheese if need be. It's still a nice hot, filling dish!
5) Watching carbs? Use less rice, or substitute quinoa. I just personally like rice better, and it's cheaper.
6) Notice this doesn't have any meat in it. I love meat, but our perception of the actual amount of protein we need is way out of proportion. We (as in Seth and I...mostly I) have found that, in general, we just feel better by eating less meat. About a year ago we made the decision to only eat organic meat, and it is EXPENSIVE, so rather then compromise on the quality of the meat, we just eat less of it. As a result, I really feel a difference now that we're eating less meat and only organic. Not to mention if I eat a large portion of red meat or non-organic, I typically don't feel that great. I am a proponent of organic produce too, but I also realize that the cost associated with that so we just do what we can.
Enjoy!
4 cups cooked brown rice (use beef broth instead of water)
1 bag frozen cauliflower
1 bag frozen broccoli
1 bag frozen whatever veggie you want! (I get a corn, green bean, and pea mix.)
Cheddar cheese
Make the rice using beef broth, mix rice and all veggies into a large casserole dish, shred some cheese on top, and cook until cheese is melted and dish is hot.
This is really more of a side, but I like to just eat a big bowl of it. It also makes for great left overs for lunch or dinner the next day.
Comments on the level of healthiness of this dish:
1) Brown rice is better then processed white rice
2) Use low sodium beef broth
3) Thou shalt not eat canned vegetables.
4) Nix the cheese if need be. It's still a nice hot, filling dish!
5) Watching carbs? Use less rice, or substitute quinoa. I just personally like rice better, and it's cheaper.
6) Notice this doesn't have any meat in it. I love meat, but our perception of the actual amount of protein we need is way out of proportion. We (as in Seth and I...mostly I) have found that, in general, we just feel better by eating less meat. About a year ago we made the decision to only eat organic meat, and it is EXPENSIVE, so rather then compromise on the quality of the meat, we just eat less of it. As a result, I really feel a difference now that we're eating less meat and only organic. Not to mention if I eat a large portion of red meat or non-organic, I typically don't feel that great. I am a proponent of organic produce too, but I also realize that the cost associated with that so we just do what we can.
Enjoy!
Sunday, November 3, 2013
the Beginning
Hi Everyone!
I've decided to start blogging as a way to process my experiences out on rotations, share funny newly married (can we still say that at 3 years?) stories, and life in general. :)
3 things to share about today:
1) CLINICAL YEAR HAS ARRIVED. I started my first rotation this past Friday. To summarize, physician assistant school is two years with the first year spent in the classroom and the second year out on rotations, 12 rotations each a month long. My first one is the emergency room. I was incredibly nervous for this first day. When do I get to eat!? Where do I go? Put my stuff? I've been studying my butt off for the past year with almost 40 hrs/week of classes and labs to prepare for the ominous clinical year, but am I really ready? I'm happy to report that every uncertainty went away once I started seeing patients. This is exactly where I'm meant to be in life, and although I didn't know every answer, I have been thoroughly trained on how to find out the answer. I loved talking to patients. I loved being able to answer questions. I loved DOING things!!! Draining abscesses, splinting, physical exams, I loved it all! Although I did not love the timing of the shift (2pm-12am), the hour drive to the ER, and surprisingly the incredibly vulgar, ubiquitous vulgar language among the staff, I am so thankful for this little bit of affirmation that this is just where I'm supposed to be. Ideally in future posts I'll elaborate more on interesting cases I see and experiences with colleagues, but first I need to feel out what is appropriate to share.
2) RUNNING. Seth and I have been training for a half marathon. I am not a runner. I don't even particularly like running. I have never ran in my life. I don't know what got into me this past August, but one day I just decided to find a half marathon schedule on Pinterest and stick to it. And all I have to say is almost 10 weeks later, I went from barely being able to run 2 miles to today, where I ran 11 miles and felt strong and healthy. It hasn't been easy. I haven't even really liked it that much. But the key is just put on those sneakers and get out there every day and accept that some days you'll feel like $1,000,000 bucks and other days you will feel like garbage. But I never knew these little legs could take me so far, but they have! And yours can too, but the key is you gotta just keep showing up and get out there. I PROMISE it gets easier. It's so nice when finally your lungs get conditioned and all you think about is if your legs will get tired, but it does take time. Patience. :) Also, the first rule of running/jogging/walking: thou shalt not compare your mile to anybody else's mile. A mile is a mile. Be proud of yourself no matter what, because the hardest part is just putting on your shoes and getting going.
3) MARRIAGE. I wish we didn't have cable. It's just so easy to turn on the TV. I love Chopped and HGTV, but I'm finding that quality time with Seth spent in front of the TV leaves me feeling incredibly unsatisfied. We had an awesome afternoon on the porch. It was really sunny, and we were reading (with intermittent guitar playing from Seth). Still not interacting as much, but there is just something about TV that makes you feel so unengaged and unfulfilled about the time you spent together. Goal for the week: keep the TV off more. Ultimately I wish we didn't have cable at all (and our lives pre-cable just seemed so much better), but of course it is college football season, and Seth loves his Oregon Ducks.
So this is the beginning of my blog. I don't know what will come of it, if anything, but I imagine as clinical year progresses I will have some interesting experiences to process through, and if anything, Seth does something really hilarious at least every other day that is always worth sharing. I've also been trying to learn to really cook this past year with some great successes and huge failures, so those things may be worth sharing too. Who knows!
Happy Sunday!
I've decided to start blogging as a way to process my experiences out on rotations, share funny newly married (can we still say that at 3 years?) stories, and life in general. :)
3 things to share about today:
1) CLINICAL YEAR HAS ARRIVED. I started my first rotation this past Friday. To summarize, physician assistant school is two years with the first year spent in the classroom and the second year out on rotations, 12 rotations each a month long. My first one is the emergency room. I was incredibly nervous for this first day. When do I get to eat!? Where do I go? Put my stuff? I've been studying my butt off for the past year with almost 40 hrs/week of classes and labs to prepare for the ominous clinical year, but am I really ready? I'm happy to report that every uncertainty went away once I started seeing patients. This is exactly where I'm meant to be in life, and although I didn't know every answer, I have been thoroughly trained on how to find out the answer. I loved talking to patients. I loved being able to answer questions. I loved DOING things!!! Draining abscesses, splinting, physical exams, I loved it all! Although I did not love the timing of the shift (2pm-12am), the hour drive to the ER, and surprisingly the incredibly vulgar, ubiquitous vulgar language among the staff, I am so thankful for this little bit of affirmation that this is just where I'm supposed to be. Ideally in future posts I'll elaborate more on interesting cases I see and experiences with colleagues, but first I need to feel out what is appropriate to share.
2) RUNNING. Seth and I have been training for a half marathon. I am not a runner. I don't even particularly like running. I have never ran in my life. I don't know what got into me this past August, but one day I just decided to find a half marathon schedule on Pinterest and stick to it. And all I have to say is almost 10 weeks later, I went from barely being able to run 2 miles to today, where I ran 11 miles and felt strong and healthy. It hasn't been easy. I haven't even really liked it that much. But the key is just put on those sneakers and get out there every day and accept that some days you'll feel like $1,000,000 bucks and other days you will feel like garbage. But I never knew these little legs could take me so far, but they have! And yours can too, but the key is you gotta just keep showing up and get out there. I PROMISE it gets easier. It's so nice when finally your lungs get conditioned and all you think about is if your legs will get tired, but it does take time. Patience. :) Also, the first rule of running/jogging/walking: thou shalt not compare your mile to anybody else's mile. A mile is a mile. Be proud of yourself no matter what, because the hardest part is just putting on your shoes and getting going.
3) MARRIAGE. I wish we didn't have cable. It's just so easy to turn on the TV. I love Chopped and HGTV, but I'm finding that quality time with Seth spent in front of the TV leaves me feeling incredibly unsatisfied. We had an awesome afternoon on the porch. It was really sunny, and we were reading (with intermittent guitar playing from Seth). Still not interacting as much, but there is just something about TV that makes you feel so unengaged and unfulfilled about the time you spent together. Goal for the week: keep the TV off more. Ultimately I wish we didn't have cable at all (and our lives pre-cable just seemed so much better), but of course it is college football season, and Seth loves his Oregon Ducks.
So this is the beginning of my blog. I don't know what will come of it, if anything, but I imagine as clinical year progresses I will have some interesting experiences to process through, and if anything, Seth does something really hilarious at least every other day that is always worth sharing. I've also been trying to learn to really cook this past year with some great successes and huge failures, so those things may be worth sharing too. Who knows!
Happy Sunday!
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