Blinded by the Light

I am more than happy to say that I'm finally in the LAST WEEK of my clinical rotations!  There is light at the end of the tunnel and it's glorious =)! I will finish my last rotation in family medicine this week and begin to really study for the ever dreaded board exam!

I have spent the last 17 weeks training in family practice (with a 'mini' rotation in Pain Management).  Overall, it's been a wonderful experience! I had the privilege of working with five really great physicians who are not only excellent clinicians, but also very kind and compassionate people.

Many people think that primary care providers deal mostly with colds, ear infections, physicals, etc. I was also under that impression, until I spent some time in their shoes! Especially in rural primary care, you can see anything from a simple cold and diabetes to new onset chest pain and chain saw lacerations! Literally, I saw a patient last week that cut his foot when the chain saw slipped off the wood, cutting right through his shoe. The best part was when he came back to have his stitches out and he was still wearing the shoe because the cut-out made it more comfortable =)! Hehehe... And just this week, we've gotten reports on patients with Zollinger-Ellison Syndrome (a not-so-common condition involving a gastrin secreting tumor) and mesenteric ischemia (a blockage in the vessels that supply the gut)! Whoa! Whoever said that primary care was boring was so wrong! 

I have loved getting to know the patients, seeing many of them two and three times. Hearing their stories of love, happiness, struggle and sorrow has been a humbling experience for me. It's amazing to hear what some people have been through who live right in my backyard. One of the patients was crushed by a tractor-trailer and had to have his hip reconstructed [as you could imagine] and replaced 4 different times, ultimately leaving him with one leg about 9 inches shorter than the other and a 9 inch platform on every shoe. After all he's been through, he told me that "he's just thankful to have both legs and to be able to walk." Just this past week, I met the cutest elderly British woman who was a World War II bride. We were doing a procedure on her with lidocaine and the doctor said, "you will feel a little pinch and then the burn of the lidocaine" and the patient says [with an adorable angry accent], "you better not lie to me!" hahaha... You gotta love the geriatric population! While it has been challenging to learn the wide variety of problems that present in family medicine, getting to know the patients has been more than rewarding. I will not be practicing in primary care to start my career, but I have a feeling that I will end up there someday =)!


In other great news, I'm excited to share that I have accepted an offer for my first job! In the fall, I will be finally getting paid working as a Physician Assistant in the Emergency Department! And... Congratulations to three of my best PA friends who have also recently secured their first jobs! We finally made it =)!

The Harrisburg Crew - When we really didn't know what we were doing in our white coats! My how far we've all come! =)

Officially my last post as Physician Assistant Student!
     ~ Lacie
  

More Than a Nutshell ~ A Blogging Explosion!

I know it's been quite a while since I've posted anything. A lot has happened since back in July, but I just haven't had time to make any updates and honestly... I'm really good at procrastinating, but not so good at catching up. All of these points should have been their own post, but I realllllly want to start blogging the present! Warning ~ you're about to experience a blogging explosion!  

1.  Finished R3 - Emergency Medicine

My ER rotation consisted of 6 weeks of 12 hour night shifts. The ER is challenging and exciting because you never know what's coming through those doors. The PA's at my ER location were responsible for running the Express Care center as well as working in the main ER. As the patients are triaged, they get placed on the board and the PA's and Doctors take their pick. The function of the PA was usually to care for the less acute patients while the doctor managed any critical cases. I'm a hands on person, so my favorite part was sewing up lacerations - fingers, faces, arms, legs, you name it... someone probably cut it. It wasn't a glorious task, but satisfying non-the-less! I also had the opportunity to be involved in the trauma alerts which was also very exciting and terrifying! My first trauma was an elderly man who fell from a tree stand and layed in the woods for 8 hours. While the PA held his lower leg, I got to reset the poor man's nasty [protruding bone] ankle fracture. Overall ~ such a great experience!          

My dislikes of the ER were the long, night shifts (in which I had to sleep all the daylight hours away) and the frequent flyers [drug seekers]. I could definitely do without either of those. 

      

2.  Finished R4 - Pediatrics 

I was sheltered and fed by the Ventre family for this rotation ~ and they were amazing hosts =)!

The first few days of this rotation were quite challenging and I gained a new respect for Pediatricians! I consider[ed] myself to be pretty good with kids. However, that all goes out the window when you have to put your otoscope (that tomahawk looking thing) into their ears and gag them with a wooden stick (unflavored). The newborns and infants were my favorite group - little movement, no talking, and for the most part no crying. The hardest part about this age (especially when sick) is reassuring the parents. Parents... people... go to the doctor for an antibiotic. No one is thrilled to hear that they just need to take the Tylenol they already have in their cupboard at home and wait it out.    

The 2-4 year old group was my biggest challenge! It wasn't uncommon to open the door and have a child screaming just at the site of me... not a good start. Time to pull out the tricks! Drawing faces on tongue depressors, tongue depressor puppets, filling their hands with tongue depressors... Hahaha! Come on... I didn't have much to work with. The worst part was when the tricks didn't work and I had to resort to plan B - the me/parent/grandparent hold down. I hated to do it and in the beginning I pulled the "I won't force it now, you know... since the doctor is going to check him/her too." And then... one day my preceptor said to me "who is responsible for examining this child and making a diagnosis?" Ugh... "I am," I said. Then she says, "you must do what it takes to complete the exam." From then on, I did what it took and even received several compliments from parents (and a few hugs from kiddos!) <--- which made it all worth it!  

3.  Anniversary Trip to the Finger Lakes

Scott and I celebrated our 2nd Anniversary in October! We both love the beauty of fall, especially during prime leaf peeping season. 

We started our trip in Corning, NY at the glass museum and then headed to Watkin's Glen to hike the park.

 

Then we did our own wine tour of Lake Seneca! We started off stopping very frequently - like every 5 miles - but quickly realized we wouldn't be legal to drive the rest of the trip at that rate. 

 

We stayed the night at a really cute bed & breakfast called The Chapman House in Geneva, NY. We hadn't made a reservation, so we were lucky to find such a great place that would allow us to stay one night - and with Ellie too! The owners were so nice and made a delicious Egg's Benedict breakfast! 

Can't you just picture Scott bathing in this old, claw-foot tub? Haha... Just kidding! There was also a walk-in shower at the other end.  

One of our favorites was Three Bothers Winery. There were 3 Wineries and a Brewery on the same property and each had their own theme. Bagg Dare was a Cajun Bayou theme ~ too funny not to love! 

 

Ellie loved the trip too! She's such a great traveler and loved all the stops/hikes/meeting new people! 

We clearly had a great time ~ and will be drinking a lot of wine over the next year...

4.  Gettysburg Day Trip

It's been such a long time since I've been to Gettysburg and it was another fall trip that was on my bucket list. And Scott loves history, especially local history, so he was definitely up for a battlefield tour! We also talked my parents in to joining us...

 Of course you can't visit Gettysburg without a little reenactment...

5.  Finished R5 - Internal Medicine

I think I learned the most [textbook information] on this rotation, but if I had to rate it... it would have been my least favorite so far. We had lecture/teaching sessions several times a day through the Penn State Hershey program, so I definitely learned a ton in that regard. I was located at the VA and I just didn't enjoy caring for the particular diseases that I saw day after day - COPD, pneumonia, cellulitis/diabetic complications, alcohol withdrawal, etc. I also put in some long hours at this rotation. I would go in early (6:30ish) to round on my patients individually and start my notes, and then after my other team members did the same we would discuss the patients and then round as a team. The afternoons consisted of finishing notes, lectures, and taking new admissions on our "on call" days. So I would typically head home around 5 or 7 depending on the day... which left me just enough time to eat and cram in some school work before bed. It wasn't a bad rotation - it just lacked excitement and personal interest. I'm sure my dislike for the rotation also had a lot to do with my impatience and readiness to finally move home! 

6.  I moved back home [finally]!

It was a loooooong 7 months... filled with enough anxiety, nerves, awkward moments, and stress to kill a herd of elephants! I was really going strong at the beginning, but towards the end... it was pure survival -- light at the end of the tunnel mode. Lucky for me, I have a great group of friends going through the same thing which helped to keep me going. And my support from home couldn't have been any better! Lots of encouragement from family, especially from my parents and Scott's parents. Scott and Ellie held down the house very well -- and spent countless hours listening about my days and sometimes just sitting on the other end of the phone. There's something to be said about just living in the same house ~ you don't even need to talk all the time, just being there is enough. Needless to say, I'm so grateful to be home for the remainder of my rotations and I look forward to starting a semi-normal life! =) 

Despite the overwhelmingly stressful aspect, it has also been a very humbling experience. I've surprised myself so far with how much I know, and I've also realized the amount that I have left to learn. It truly is a life-long learning career. Hmmmm... who signed me up for this?! It will all be worth it in the end....   

Next Up... 

3 month Family Practice Rotation --> Graduation in May --> National Certification Exam -->
Real Life

~ Lacie

General Surgery

I've had a wonderful experience in my surgery rotation so far and have been very fortunate to work with yet another group of amazing people! Everyone has been so welcoming, patient (even though I'm sure they're swearing at me in their head...Ha), and willing to teach me anything. While I would have never imagined myself doing surgery before this, I can honestly say that I've really enjoyed my time here and will be disappointed to leave! I have a feeling that I'm going to love so many specialties and have a hard time deciding when all this is said and done with!

There are a several things I've had the pleasure of doing in surgery... making incisions, retracting, holding the lap cameras, suctioning, cyst excision, wound closure, and a few others. As a student, it's a lot of "hold this" and "look here", but scrubbing in and being part of a surgery is so exciting! Being able to see the internal anatomy and getting to feel it with your own hands is absolutely AMAZING! One of my favorites is to see bowel peristalsis during an open abdominal surgery ~ so cool! The human body never ceases to amaze me! My first suturing experience was rather interesting, as I had to stitch up my preceptor's hand after a slip with the scalpel. Of all the times he could have cut his hand for the first time... of course I had to be there =)! His hand still seems to be functioning, so I guess that counts as a success?!

Most of being a student is trying to NOT look like a complete idiot, a daily goal of mine in which some days I succeed and others I do not! Ha... There have been so many times when I've thought "I wonder if I look as stupid as I feel" ~ which I've come to find out is a general consensus among many of my classmates. Throughout PA school, you basically lose every part of yourself in an attempt to become a (somewhat... Ha) competent medical provider in two years. During this time, we give up our normal lives and devote everything to our studies... we no longer eat or exercise like we should, little time for family/friends, we're mentally broken and numb to every ridiculous assignment (i.e. read 80 pages and only 2/18 quiz questions is actually from the reading), stress becomes the norm, sleep is a reward, and not mention the level of irritation you develop against the rest of the world. Thank goodness for supportive families and PA friends to suffer alongside! =) I have been blessed with a wonderful support system and amazing experiences so far... almost 2 rotations down, 5 more to go!  

In an attempt to maintain my sanity, I try to find time for laughter! If you don't work in medicine or haven't been a student of medicine, you may not find these quite as funny... When I need a good laugh, I visit this site and typically laugh until I cry! Enjoy...

whatshouldwecallmedschool:

HOLDING RETRACTORS

WHEN A PROFESSOR TELLS US TO HAVE FUN OVER THE WEEKEND...

I’m like:

WHEN MY PRECEPTOR SENDS ME HOME EARLY FOR THE DAY

I’m like:

WHEN A NON-MED FRIEND OR FAMILY ASKS ME TO HANG OUT DURING SURGERY ROTATION

I’m just like:

(the original video for this little clip is even more amusing... http://www.youtube.com/watch?v=Nh7UgAprdpM&feature=related) 



CHECKING OUT THE WAITING ROOM AT THE DERM CLINIC
(frankly, I think this applies to most waiting rooms... LOL)

TRYING TO SCRUB OUT OF MY SURGICAL GEAR FOR THE FIRST TIME

I was like:

Bahahahaha.... I could go on forever ~ love that website! 2 weeks left and next up is Emergency Medicine...

~ Lacie

6 Weeks of Dermatology... Complete!

Where has the time gone?! I finished my first rotation in Dermatology last week and while I have not enjoyed being 4 hours from my home and loved ones, I LOVED Derm!

The staff at Hermitage Dermatology were amazing! Everyone was very welcoming and willing teach me whatever they could. I honestly dreaded moving so far from home, but everyone there made it a wonderful, worthwhile experience. Thank you! 

Most people believe that Dermatology is a boring specialty and that all you do is look at rashes. I can't lie... there were a lot of rashes!  But to our patients, that rash was keeping them from living the life they wanted. Imagine if your skin was constantly itchy and burning, and then imagine what that must feel like on a day like today (97 degrees here in Hermitage!). If you've ever had an itch like this, you know that it can drive you crazy! Not only is it irritating and painful, but some of these conditions can be unsightly and keep people from wearing comfortable clothing or even going out in public. The treatments these patients receive are life changing, and to me... that's not boring at all! Not everyone was a first time fix, but I loved seeing smiling patients come back in for their follow-up! 

In addition to the common "rashes" such as contact dermatitis, eczema, psoriasis, and acne, I also saw rarer conditions of Pemphigus Vulgaris (a blistering disorder) and Lupus. And then there was a lot of fungus, some scabies (eeee!) and sooooo many more... but I would bore you with a huge list of medical mumbo-jumbo and the teacher in me would feel the need to explain everything... ha! Needless to say I went home daily thinking I had a new skin condition and with the feeling of "itch"! lol... 

I also saw a lot of cosmetics throughout my rotation, including Botox injections and fillers. Who knew that a bottle of Botox in your armpits could keep you from sweating like a madwoman?! Sign me up =)!

The days moved quickly and it was a nice mixture of medical conditions, cosmetics, and procedures. Anyways... I survived the first rotation and added Dermatology to my list of possible specialties =).

Next up is General Surgery and somehow, I was lucky enough to have this rotation in Hermitage as well... Stay tuned to see how that goes and hopefully I can snag a few pictures of wound care to share... just kidding! I really spared you the gross details of some Derm procedures (like the cyst I&D)! haha

After my mom spent 1/2 a day in my baking apartment, she bought me another air conditioner... so I plan to stay cool this weekend. Thanks mom!! You're a life saver, as always!

Stay cool everyone!

~ Lacie