How I am learning to change the world on my Infectious Disease rotation.

First let me begin with some school logistics, because it is pertinent to a point I’d like to get across today. I just started my elective rotation in infectious disease. One of my favorite classes in undergrad was microbiology, and I did research with the bacteria Pseudomonas. I remember that period of my education. I LOVED learning. One of my favorite parts of the day was going to that class, studying for it, going to do my research, or reading articles to prepare my research. I chose an infectious disease rotation because of this, but sadly Monday morning on my first day I wasn’t excited at all to go in.

PA school is a learning lover killer. It’s where people who love to learn go to intellectually die. It basically takes 4 years of medical school, does some condensing, but then essentially shoves it into 2 years and then you’re expected to go off into the world after that time and take care of people. It’s horrible. The classic analogy is trying to take a drink from a fire hydrant. Anyways…lately I have thought and said, “I am really just tired of learning.” Last month I was on OB/Gyn (Women’s Health), and although I didn’t mind it, I only ‘minded it.’ That’s the point.

I just finished my first week on infectious disease and all I can say is that my love for learning has been reawakened. We are all wired to love different things, and I have been wired with a special affection for microbes. I could eat, drink, live all things bacteria, viruses, and fungi. I don’t know why, but I just love ‘em! And I am excited to come home and study about them regardless that I just spent a long day at the hospital!

Microbes are so fascinating; but they are not the sole cause of this love for learning re-awakening. So what has evoked this? My attending physician overseeing me and the residents. This man takes so much extra time to talk me through every single patient, asks questions to help me process through their signs and symptoms, tests to be ordered, a diagnosis, and treatment plan. It would be much faster and easier if he just told me what they have, why, and what we’re going to do for them. When we go see patients, he introduces me to every single one. I feel like I matter, that I am contributing, and that my education is important to him. He includes me in discussions with other physicians and asks what I think. He will do menial tasks like get me a pair of gloves or showing me how to do a basic trick on the electronic medical record software. He also takes so much time with each of the patients, explaining to them what is going on, asks them about their families, asks them about their lives, and is just so sincerely kind to them.

In the basic gist: he cares about people, a lot. He respects and serves people, in big tasks like taking care of their life threatening infections to showing me a trick on the computer to make the resident’s lives easier. After an afternoon with him I have learned so much, not only because he has a wealth of information to share but because I feel included and that what I am contributing is important.

Some of you reading this may feel like your job or what you do with your time isn’t important and that it makes no difference, but I am telling you that it does. We have small interactions with lots of people on a daily basis, and doing something as simple as fetching a pair of rubber gloves from a cardboard box stuck to the wall for the PA student is hugely impactful on the quality of her education. We can all be impactful in big ways with small things, and it all starts with just caring about each other.

How to Travel When You're Broke

A few people have asked how we can travel being so broke. Ok, we aren’t super broke. The bills get paid, and we have a little left over sometimes for little luxuries like movies and dinner out, but we save our pennies for trips, and here’s how we afford them:

1)   Airbnb.com. One of the biggest expenses of traveling is lodging, and this has been our life saver. This is how we stayed in the Outer Banks, NYC, and Boston. Basically people with extra space in their house rent it out for super cheap. Our place in the Outer Banks was a legitimate bed and breakfast, but our place in NYC was literally a bedroom and bathroom in the apartment of 2 guys who just needed the extra income to pay rent, and our place in Boston was a floor of a house a single lady rents that we split with 3 of my classmates who also attended the AAPA conference in Boston. There’s all kinds of options on there, and we highly recommend it. It's safe, you make a profile so hosts can screen you, the hosts have profiles and reviews (we don't stay places with <5-10ish reviews), etc. Also, we don't travel to sit in our room. We travel to see wherever we're going! So our standards is somewhere clean and safe to sleep and shower.

2)   Eating is a big part of our travel experience. We do splurge on at least one great meal a day. But we don’t eat out breakfast, lunch, and dinner every single day. Typically we just buy a bag of bagels and some fruit for breakfast to eat wherever we’re staying, have snacks to carry with us during the day, split lunch, and have an awesome dinner. Also, alcohol is expensive people. Sure, on one nice dinner I’ll get a glass of wine or if there’s some interesting local beer, Seth will get something. But if you’re going to booze it up, just stay home. Being drunk in NYC is the same as being drunk at home, and you may as well save yourself the expense of going all the way to NYC.

3)   Honesty, we don’t spend a lot of money when we go places. We really just like to walk around and eat good food. In NYC, we made lists of places we wanted to see on different parts of Manhattan, walked all day to see them, and spent on eating (splurged on ice-skating in Central Park on Christmas Day. WORTH IT). In the Outer Banks, the beach is free, the National Seashore (so amazing) is free,  the lost colony of Jamestown is free, I think it was $10 to go up in the Bodie Island lighthouse, but other then that what did we do? We walked around and ate. Boston was the same. The things to do in Boston is see all the historical sites and walk the Freedom Trail. So I guess it depends on what you want to do. Museums cost money, so usually we forgo those unless there are discounted/free days. We do our research ahead of time of the places to see and don’t go on guided tours that cost money. We don’t like to shop, and we take advantage of free entertainment at our restaurant choices. I guess I would have liked to see a show on Broadway in NYC or go scuba diving in the Outer Banks, but for our budget, we still had awesome trips without those things.

4)   Other big expense of traveling: actual transportation. We drove to the Outer Banks (only 5.5ish hours). To save on parking and gas, we drove to DC and took a bus to NYC (way more convenient anyways). We, by some miracle, got round trip tickets from Charlotte, NC to Boston for $120/each. But a major saver is when we arrive places, we walk. A LOT. MILES. EVERYWHERE. Subway tickets, gas, taxis, etc., add up quickly, and also you just see more when you walk. You'll discover places you normally wouldn't have and you really experience a place how locals do by just walking around, and that's what we like. Anyways, it helps to have your lodging in a strategic location to allow for this.

Hope this is helpful for somebody! Our trips are by no means luxurious, but we are seeing and doing lots!

Mother's Day Woes

 I should be studying platelets and the coagulation cascade (how our body forms clots) right now. This seems to be the bread and butter of cardiothoracic surgery; maintaining a perfect balance of not causing your patient to bleed spontaneously but also keep them from forming clots and causing strokes, pulmonary emboli, etc. post operation. But I got up at 4:45 this morning, worked 10 hours today, cleaned, and ran 3 miles. So I’d rather write something else. It’s about to get personal up in here.

Mother’s Day. It’s coming up this Sunday. Holidays like this are meant to be celebrated, but with them comes lots of baggage and awkwardness. Me for example: I don’t have a mom. Many people know this. Without going into too many details, basically since I was 11-12ish I haven’t had one. Starting around age 11, mom was in and out with lots of ugliness in between ultimately resulting in my dad officially a single parent by the time I was 15. Some people (insensitive ones might I add) say “well it’s not like you were a baby when she left.” Right. She was only the most abusive and then completely absent during very pivotal times of growth and development into a young adult. That’s much better. Thanks @$$hole (sorry, but sometimes dingleberry just doesn’t cut it for a noun).

 So anyways. back to Mother’s Day. I always have mixed feelings about this holiday. I am not upset or angry at my mom for what happened anymore. But it’s just so dang sad! It weighs heavy on my heart that she is missing out on my sister and I’s life. It makes me sad that my poor dad had to go through the loss of a marriage and also carry the great task of dealing with 2 pre-teen/teenage girls on his own. It also makes me wonder what the future holds for me as I become a mom one day and the fact I just don’t really know what that looks like.

But in the midst of all this yuckiness, there are lots of wonderful mom/female figures in my life. First of all, my Gram. Grandma Gloria is actually my maternal grandmother, but she has always and is a huge part of my life regardless that my mom is no longer part of my life. My mom’s entire side is actually fairly dysfunctional, but my Gram is the kindest, gentlest woman on this planet and always rescuing everybody. She truly is the matriarch that holds the universe together. Not to mention, how many 81 year olds do you know still fish, pick berries, and camp in the wilderness of Alaska? Then there is wonderful Holly, Dad’s fiancé. Holly has been around for, what seems like, forever, and her and Dad made the transition of joining our families very gracefully. She is everything I could ever want for my dad, and everything I would want for a step-mom. There’s also Elizabeth, my mother-in-law, who since Seth and I started dating back in high school has welcomed me into their family as one of her and Rob’s own. So am I sad about my mom? Yes, but quite frankly, my dad is a better mom then some moms are and I have so many wonderful women in my life.

So this Mother’s Day, lets celebrate all kinds of motherly love we receive from all kinds of people. <3

Guts Everywhere! Surgery and Life Beyond.

This month I’ve been on my surgery rotation in beautiful Banner Elk, NC. This is THE coveted surgery rotation of my program, and I have been anxiously awaiting it since clinical year started.

The PA students get to be first assist in the operating room. Aka: It’s me right across from the surgeon doing the actual procedure and the two surgical tech nurses there to rescue me from doing something stupid or take over to assist when things get crazy. Just this week I have had my hands full of yards of live human intestines, held a gallbladder, navigated an abdomen with a laparoscopic camera, drained an abscess the size of my fist in a location I won’t describe, done a partial mastectomy (removal of breast tissue), gotten to close (or suture) many of the wounds, and many other things.

A typical day starts around 6:30AM when I go see all the patients who have been admitted to the hospital who are recovering from their surgery, then I go to the operating room and get the first patient ready with the nurses, surgery starts at 8, after the surgery I follow the patient to the recovery room where they wake up from anesthesia and are either stabilized to go home or get admitted, and then repeat with the next case. After all the surgeries are done, we go to the clinic and see people who might need surgery (consults) or see people a few weeks after they had surgeries (follow ups). Then after that I go round on all the admitted patients again and then I go home around 6PM. And then I’m on call, which I’ve been called in twice this week after hours, but luckily I haven’t had to work past midnight any night.

This has been a good rotation too, because I’m learning about how to manage patients who are in the hospital. I think in bigger hospitals the surgeon just literally operates and then hands off the patients to a ‘hospitalist’ who then manages them as an inpatient (somebody who has to stay in the hospital over night). When do they need IV fluid? What kind? How much? Do they need antibiotics? When is it appropriate to order x-rays or CT scans? What do you do with that information? How does a patient’s care change based on their age? What do I do with all these labs? What are all these instruments!? Learning SO MUCH!

I am loving every second of this. As my friend Brittany, who is a general surgery PA, says, “I love seeing people’s insides!” It really is fascinating. Surgery is so task oriented and satisfying. When something is wrong, we operate and fix it (for the most part). The day also flies by. The operating room is like a time vortex. You start a surgery and next thing you know you’re with the patient in the recovery room and 3 hours had gone by when it felt like 20 minutes. I have always known I would absolutely love this rotation and have been waiting for it since clinical year started. And how glamorous and, as my professors say, ‘sexy’ is it to say you work in surgery?

 I would LOVE to work in surgery after school is over, however these hours are atrocious. No matter how much I love my job, I will love being at home with Seth more.  His next few years might be crazy though as he pursues graduate school himself and works so maybe I should do surgery for awhile? Who knows. I want to love my job. That’s kind of been the point of going through all this schooling, so I can do what I love. But on the other hand, I am not defined by my career. It will be interesting come July/August when I start applying to jobs and see what opportunities come about and decisions to be made. Until then, I am enjoying myself, feel so lucky to be here, and just trying to make it through one last month of this away rotation marathon. 

Feeling dumb in internal medicine and Anchorage living

It’s been awhile since I’ve written. Mostly because I’m too busy spending time with my family every second I can, trying to study, or sleeping.

I’ll begin with my internal medicine rotation. So what is internal medicine anyways? Basically an ‘internist’ is a physician who does extra training to become an expert at one particular body system. A cardiologist is an internist, along with an infectious disease doctor, or a gastroenterologist. This month I’m at an office that does metabolic (mainly diabetes and lipids (aka: cholesterol)) management and all things endocrine (thyroid, sex hormones (estrogen and testosterone), adrenal glands (these produce adrenaline and another hormone called aldosterone that helps us retain salt), etc). That was a lot of parentheses, so I hope it makes sense. But as you can imagine, it’s pretty intense and covers A LOT of stuff. My preceptor is SO smart and has had many years of schooling to become a diabetes expert/lipidologist/endocrinologist. And he has a biochemistry background to boot.

So what does this mean for me? This means I feel like a total moron all day, pretty much every day. I spent the first few days just frantically writing things down and reading, reading, and more reading (on week 3 and mostly still doing this). The office is very fast paced, there isn’t a lot of time for questions and discussing each patient, so it’s either sink or swim. I feel like I’ve known the answer to 1% of the questions my preceptor has asked me, and even half of those I blank on because I’m so nervous and just trying to process everything I’m learning. I get anxiety about this every morning, because I am really learning sooo much but just not demonstrating that very well! Every morning when I head into the office, I just try to put on my game face and put on my big-girl-PA-student pants.

So anyways, I think my preceptor thinks I’m not very smart (maybe not, but probably). BUT! Every day I just try to show up with a good attitude, be proactive and helpful, and demonstrate that I want to learn and be there. I’m not the smartest student they’ll ever have, but gosh dang it I will be the most enthusiastic and hardest working one! Like I said, I am learning so much, and that’s what’s really important so I just need to get over it. This is just the first rotation I’ve had where I really feel like I knew nothing going in. It has been an amazing, albeit difficult, month of growth intellectually and mentally. I feel SO lucky to have the opportunity to rotate there, and I feel like everything I’ve learned will be so valuable anywhere I end up working. Also, I’ve found Type 1 diabetes so fascinating. I think I’ll write another blog post just on that sometime. Another side note: there’s a PA in the office that graduated from Marietta College!!! My beloved alma mater in Alaska! Pio nation for life! WOO WOO!  

Lastly, on living in Anchorage. I’ve spent the month living with my big sis, Racheal. We aren’t from here, so this was a first for me although she’s lived up here a long time. Anchorage’s surroundings are so beautiful. The city is right up against the huge, amazing Chugach Mountains but also on the ocean. Something else about Anchorage too is that it has an AMAZING trail system. You can get from one end of town to the other without ever crossing a road. HOWEVER! After looking around for a few weeks, I will say all the buildings in Anchorage are hideous, and the town itself is not very attractive. The 1970s/1980s were not known for their great architecture. Yuck! Otherwise, this seems like a great place to live. Lots of good food and outdoor activities, and that’s about all I need.

This has been such a special month for many reasons. I’ll never get another opportunity to spend this kind of time with Rach (Seth has been in Roanoke and Nic, my brother-in-law, is currently deployed). It’s always wonderful to see my family and my heart is full getting to spend precious time with them. However, home really is where the heart is, and my heart is in Roanoke right now. This time up here has flown by so fast, and I’m thankful for every second of it, but I miss Seth and belong wherever he is. It’s amazing how you can feel so out of place somewhere you love so much and spent most of your life when you’re without the one you love.

So I have another week left here, and then back to Roanoke for 5 days until I leave for North Carolina for another month of being away. Seth and I are doing just fine, but by this weekend it will have worn on me so I don’t know how next month will feel. This is month 2/3 of away rotations, and the last one is the coveted surgery rotation that I’ve been looking forward to. Hopefully it’ll keep me busy. Until then, onward with one more week of diabetes, cholesterol, and endocrine management!