Last full week of Summer B

Holy cow.  Time has flown by.  Can you believe that this is my last full week of class?  Here's what's going on.

Anatomy
Last Friday, we finally got to do the face.  I forgot to mention that after our midterm, we switched up our small dissection groups and switched bodies.  So, I guess I wasn't as attached to this one, which made reflecting back the skin of her face a little less disturbing.  The head/face is what's going to kill me on the exam.  There are so many muscles and nerves and blood vessels there.  And not only do I have to know the names of the nerves, but what they innervate.
After we had done the face, the professors came in after-hours and took the top of the skulls off and cut the cranial nerves.  So, when we came in next and took off the towel covering our cadaver's face, the brain was just sitting there, waving hello.  It's a shame that we just don't have time for the brain in Anatomy.  All we got was a 1 hour neuroanatomy lecture with PA faculty and a 1 hour lab with some med students.
Anyway, now that are brains had been taken out and we had done the face, we got to saw the skull (and part of the neck) in half...right between the eyes.  Some of it could be done with the electric bone saw.  But the rest I had to do with a big hack-saw looking thing.  Interesting tidbit, burning bone smells just like burning hair.  With the heads cut in half, we could identify the sinuses of the skull; the nasal cavity with associated structures (turbinate bones, torus tubarius, etc); muscles of the tongue and mouth (genioglossus, geniohyoid, mylohyoid); and a great view inside the pharynx, larynx, trachea, esophagus, and C1 and C2 vertebrae.  Very cool stuff!
Today, half the group did the anterior upper leg and the other half did the upper arm.  Really not looking forward to lower leg and lower arm.  There are a ton of muscles there that always confuse me.

Med Com
Essentially, this class is done.  We took the final on Monday and turned in our last mock-interview write up today.  Here's where I stand...

Not bad, eh?  The class average on the final was a stinkin' 98%.  Only PA school can make you feel sub-par by missing 2 questions on a test. :)  All we have left now is our last mock-interview with an actor tomorrow.

Radiology
We did Skull and Spine radiology this week.  This was pretty cool stuff since it applied to 90% of the patients I took care of at the hospital.  And for you few Rehab people that read this blog--or anybody else for that matter--I will give a dollar (literally) to the first person to identify all 4 problems pointed out in this CT (contest restricted to non-PA students).  This guy was a goner.

I know there are more than a couple nurses that read this blog, so one of you better get it!

Anyway, that's what's been going on in my world.

Week 4

Almost through with week 4. Here's what's been happening.

Anatomy
Well, we had our first big exam of PA school on Tuesday.  It comes in two parts.  There's a written part.  Actually, it's on the computer.  It's 85 questions (multiple choice, true/false, and identification).  Then, we take a practical portion.  That's when you go into the lab and identify structures on the cadavers.  I had only missed one on the practice practical that we took on Monday, so I was a little bummed that I missed 3 on the actual test.  Oh well, I won't miss those again, that's for sure.

Anyway, here's how I did.

The bottom row is the overall grade which combines the written/computer portion and the lab/practical portion.  Being the competitive person I am, I wish I had done better.  But, I'm not arguing with a 90%.  Considering the incredibly intelligent people I'm in class with, I'm quite happy that I was able to get above the average.

Radiology
This week, we've been doing Abdominal radiology.  Every Friday, we do a radiology "lab" in the Harrell Center.  Remember, this is were we pair up and go over an automated Powerpoint presentation, then meet with a radiology resident and ask any questions.  And I misspoke last post.  Radiology is a 5 year residency plus a 1 year fellowship.  Crazy!  But now I see why.  Radiologists have to know quite a bit about all areas of medicine.  When they see something on an X-ray or CT, they have to not only understand the anatomy but also the possible pathology behind any findings (i.e. what type of mass would present at a specific place in the body and where that mass may have originated).  I was super impressed with Dr. Campbell.  The guy couldn't have been any older than me, but he had his stuff together.  Incredibly knowledgeable.  He said that because of how big Shand's Hospital is, he has about 300 films to look at right at the start of any given on-call shift.  Compound that over the 3 years he's been a resident and he has seen thousands of films.

In my opinion, the abdomen is harder to read than the chest was.  A trained eye can actually make something out of this amorphous blob in the abdomen.

Apparently, this film shows proximal small bowel distension with no gas distally, which is indicative of a mechanical bowel obstruction.  I don't see it.  Do you?  Sometimes the problem is very visible...but not all the time (to me at least).

But, I did get a 100% on my quiz yesterday, so that's good.

Medical Communications
Wednesday was our last mock-patient interview with our classmates.  Next week, we have to do it with a standardized patient (an actor).  Here's my group afterwards.

Week 3

I'm now halfway through week 3.  I haven't been posting a whole ton because it's kinda just more of the same.

Anatomy
This week we've been digging into the abdomen...and no, I don't use "digging" figuratively.  Our lady was a little big and the internal abdomen is a pretty fatty cavity to begin with, so, needless to say, we've had to remove a lot of extra stuff.  We got a good look at the liver, the hepatic portal system, the gall bladder, stomach, spleen, small and large intestines, and all the associated vasculature.  We opened up the stomach and the first part of the small intestine (duodenum) to get a look at some of the structures inside.  Today we got to study the kidney.  This is by far one of the most complex and fascinating organs in the human body.  These guys are, on average, the size of a small potato but filter a liter of blood every minute!  Our professors are working this afternoon to hemi-sect our cadavers at the pelvis (cutting the pelvis in half and removing one leg) so we can get a better look at the structures down there.

Radiology
Radiology is actually part of our anatomy grade but is taught by PA school faculty and Radiologists from the hospital.  Since last week, we've been learning how to read one of these.

Apparently, this is one of the most difficult films to read in all of medicine.  Doctors do a 3 year residency plus a year long fellowship to be proficient in this field.  We got a lecture, a lab, and a couple Q&A sessions with Radiologists before we had to take a quiz yesterday.  I got a 90% but I am by nooooo means good at it.  What you see above is a normal chest film.  There is an insane amount of variation in an abnormal film.  Here are a few things you need to be aware of.  How's the exposure of the film?  Is the pt centered or is she rotated?  Did she take a deep breath?  How about the bones?  Any broken?  Is the diaphragm in the right spot or is it raised/depressed?  Is there any discoloration in the lungs?  What kind, blackness or whiteness?  Where is the discoloration? Whole left side?  Up top?  Down low?  Is there any mediastinal shift?  If so, toward what side?  If one side is showing up all white and the mediastinum is shifted toward that side, it's indicative of a collapsed lung.  If you note blackness where lung signs should be and the mediastinum is shifted away from the blackness, you have a tension pneumothorax.  Do you see a meniscus sign?  Pleural effusion.  Any Kerley B lines in the lateral aspects of the lungs?  CHF.  Notice any masses?  How about the hilar vessels?  Good size or enlarged? 
And on, and on.  There is so much to check and be aware of.  Luckily, our quiz wasn't super difficult and the doctor that spoke to us right beforehand was a-maz-ing.  She showed us one slide of a collapsed lung.  Go ahead, ask me why the lung was collapsed.  Because when the patient got in the car accident, he inhaled one of his teeth that had been knocked out and it plugged his right main bronchus.  True story.

Medical Communications
We don't have any more lectures for this class.  We just go to the simulation lab every Wednesday and practice interviewing a patient.  Today went really well.  A lot better than last week.  Tomorrow, we'll meet in our lab groups and go over gametape again with our faculty adviser.

See, just more of the same stuff. :)  Nothing exciting here.

Encouragement from my library desk

"We'll Get Through This!"

"We all love you!"

Thank you desk.  I needed that.

First mock patient interview

Today was our first videotaped mock patient interview.  This is how it works.  You dress up in business/professional attire and go to a place called the Harrell Center.

Holy optical illusion Batman! Both sides of this image are the same length.  Go ahead and check it yourself.

 This is a simulation lab for health care professions students.  They have a bunch of exam rooms that are set up just like a normal doctor's office.  Each room has a couple video cameras in it.  We got paired up with another classmate and had to take turns being the patient and PA.  As the patient, you had to come with a simple malady and a researched list of symptoms.  As the PA, it was your duty to obtain an HPI or History of Present Illness.

The HPI consists of eliciting from the patient the "sacred seven" or the 7 attributes of a symptom: Palliative/Provocative factors, Quality, Region, Severity, Timing, and Associated manifestations.  So, at the Harrell Center, your partner waits in the room and you, as the "PA" stand outside the room and wait for the man to come on the intercom and say something to the effect of "You may now begin the interview."  Then you enter the door and do your best to conduct a thorough HPI in the 10 mins that they give you.

About an hour afterwards, they upload your video to your account on their website so you can watch it and determine how big a fool you just made of yourself.

I kinda had a leg up on my classmates though, because I did something similar every week at the MTC.  We would have to "teach" investigators and then watch game-tape.

Here I am afterward with my awesome classmate Fallon.

I look like a freakin giant

She did a great job playing the PA, and I was an awesome patient (I had amoebic dysentery...i.e. abdominal cramps and diarrhea).

I think I did a pretty good job being the PA.  Granted, we had a lot of time to practice before-hand, but it's still easy to forget things when you're put on the spot like that.

Heart, lungs and posterior mediastinum

Before I tell you about today, let me just say that I am disappointed in Google/the internet.  There are basically no good pictures of human lungs out there.  Most of what's out there are poor CG images of lungs.  And I thought the internet had everything.

Anyway, this is one of the better pictures I found...and it's not even that realistic.

Today we got to actually cut out and remove the lungs from our cadavers.  (We did the heart yesterday).  It is difficult to really understand the beauty and efficiency of these extremely complex organs until you see them up close and personal.
In many ways, the human body is pretty resilient.  I mean, it's a downright miracle that all of what we are (physically) came from 2 "half-cells" coming together into one cell and differentiating a trillion times into tissues and organs.  Then, the fact that all of these highly specialized organs and systems work together so perfectly (or at least so functionally) is mind-boggling.  Even in very sick people, the body has redundancy systems that compensate for deficiencies.
Yet, at the same time, it's humbling to realize how fragile it all can be.  Our little lady had a collapsed left lung.  Instead of being full, firm, and healthy, it's this little, shriveled, wrinkly thing.  Another cadaver had suffered lung cancer.  His lung was dang near unrecognizable for what it was.  And it is alarming that with a few well placed swipes of a scalpel, our lady's heart and lungs were taken from her body.
But to hold these organs in your hands, to open them up, to see with your own eyes just how amazing they are, is something I wish everybody could experience.  It sure gives you appreciation for what God has created.

Moving on.

So, we got to take out the lungs and examine the trachea, primary and secondary bronchial branches, and where all the major blood vessels enter.  Once the lungs and heart were removed, we could (with a little work) see many of the blood vessels (azygos, accessory, and hemiazygos veins; the neuro-vascular bundles of the intercostal (between the ribs) spaces, the descending aorta with its many branches, as well as the thoracic duct of the lymphatic system and the sympathetic trunk of the nervous system.  There are about a hundred other structures I have to know, but I won't bore you with them.  Today completed our look at the thorax.  Tomorrow we'll move below the diaphragm and into the abdomen.

I also wanted to say that I am really appreciating a lot more the already prosected cadavers we worked with at BYU.  I can't tell you how much of the inside of our bodies is just fat and connective tissue.  Most of our lab time is spent clearing this crap out of the way so that we can see actual structures.  I don't know how many hours were spent by students and professors at BYU to get a cadaver cleaned and ready for the lab, but it must have been a ton.

Lastly, I got this email as I was sitting in class today.

EVMS was the only school that I hadn't heard back from yet.  For some reason, their program starts in January whereas everybody else starts in either Summer or Fall, which I think is silly.  That's why their email came so late.  I just thought it was funny, because there I was, sitting in class at what I think is the best Physician Assistant school in the nation, and in pops this rejection letter.  Oh well, their loss, not mine. :)

My Class

Don't know if I'm allowed to do this, but here's my class.

Today's cool stuff

Amazing things I got to do today in Anatomy.

1) Cut through ribs and retract rib cage/sternum to expose the pleural cavity.

2) Hold a human heart in my hands...Like so

Actually, it was more like this...

I wish I could take actual pictures of me in the lab, but they don't allow that for obvious reasons.

3) Saw a partially collapsed lung.

4) Saw and felt a cancerous lung.  Instead of a nice spongy texture, it was like a balloon full of mud.  Moral of the story...don't smoke.  Ever.  It's gross and it will kill you.

All in all, it was a pretty cool day.

July the 4th

Ah the 4th of July.  Typically one of my favorite holidays.  This year was a bit different.  Being in a new place far away from friends and family makes it a little more difficult to get into the spirit of things.  And honestly, no place does Independence Day like Provo.  That place knows how to be patriotic.

Gainesville actually did their celebration last night.  Maybe it was so people didn't have to go to work the next day.  Who knows.

A buddy from school invited me to bike it up to campus with his wife and him to take in the festivities.  We made it up there in time to catch a few songs from the Gainesville Community Band before the fireworks began.

It was a descent show.  Not Stadium of Fire but not bad either.  It was hard to get into it though.  The fireworks brought back a lot of memories of people and places and things I was missing out on this year.








So, because I kinda celebrated yesterday, I spent most of the day on campus in the Anatomy lab going over the Brachial Plexus and the Axillary artery with it's important branches.  There were actually quite a few of us up there, so I didn't feel like such a loser.  After lab, we sat around and reviewed some terminology for one of our quizzes tomorrow.  It's nice to finally be making friends again.  Then I came home and did my readings.  By 9 I had had enough of studying and was craving ice cream for some reason.  So, I walked on down to Cold Stone and bought a highly overpriced but delicious cup of ice cream.  Cheesecake Fantasy.  Mmmm, cheesecake.

It turns out my roommate has had a whole load of firecrackers stashed in his room since last year.  So we spent 15 mins or so throwing firecrackers off our balcony and in front of our neighbors' doors.  Real adult of us, I know.  But hey, it made us laugh pretty hard.

Possibly the world's best hamburger

As a warning, this is one of those random, non-PA School posts.  Deal with it :)



Step 1: Mix ground beef with secret blend of spices

Step 2: Mix crumbled bleu cheese, some sour cream, a splash of vinegar, a dash of hot sauce, and a sprinkle of garlic powder

Step 3: Fry bacon

Step 3: Slice and toast onion hamburger bun

Step 4: Cook burgers

Step 5: Place burger on bun, dress with bleu cheese dressing, top with bacon and French's Fried Onions

Step 6: Eat the most delicious thing that you will ever eat

Day 1

Well, I'm done with my first day of P.A. school.  How was it?  Let me tell you.

It was great!

We had anatomy lecture for an hour starting at 8.  We learned about the vertebral column (including ribs).

Then, we went to anatomy lab.  THAT was an interesting experience.  I was fortunate enough at BYU to be able to learn anatomy on cadavers as an undergrad.  Many of my classmates (probably most of them) did not.  But the cadavers I learned on were already prosected (skin, fat, and connective tissue already dissected away).  So, there was some disconnect between them as cadavers and them as people.  Today was a whole different story.  Lucy (that's the name I gave our cadaver) died of breast cancer at the age of 76.  We open the bag and there is this whole person lying on the table.  Luckily, for the first day,  we were dissecting the upper back so our cadavers were face down.  I'm not sure how well it would have gone over to see the person's face on the very first day.

A couple of things I learned today...

1. Preserved human skin does not feel like live human skin.  It feels very thick and tough...like leather...but thicker.
2. Scalpels are really, really sharp.  (Don't worry, I didn't cut myself).
3. There is a crap-load of stuff underneath the skin before you ever get to muscle (fat, connective tissue, fascia)...especially on larger individuals.  So, if you ever plan on donating your body to a med school, please shed a few pounds first.
4. The human body is simultaneously awe-inspiring and disgusting.

After lab, we changed clothes, ate lunch, and then went back to class for Medical Communications.  Dr. Rice (program director) gave us an introduction into taking a patient history.  We'll get more on that tomorrow.  The lecture was short today, so we sat around until it was time to go down to the computer testing center to have a small orientation there.  Then, we were done.

I rode my bike to school today and then rode it back home.  Let me tell you, I will NOT be riding my bike home tomorrow.  Going to school is great.  It's fairly cool in the mornings.  In the afternoon though, the heat and humidity are brutal!  The buses here have bike racks on them, so I'll ride the bus home tomorrow.

After I got home, I spent a couple hours consolidating all my schedules, readings, assignments, and tests into a Google Calendar.  That's one sort of frustrating thing about the program.  There are so many different documents in so many different places that it's hard to know where to find everything.  There isn't once central website that everybody uses to post class materials.  So, I had to get everything onto one document so as to not forget when things are due.

From 6:30-9:00, I went to a study group.  Now I'm home.  I still have some stuff to read for tomorrow, but it shouldn't be too bad.

And there you have it.  My first day.  I am going to try and take pictures throughout the semester...but probably not everyday.  I'm not sure how much I'll be posting from here on out.  My goal is once a week unless I did something extra cool on any given day.  I'm kinda liking this blogging thing though, so who knows, maybe I'll post more frequently than that.