End of Rotation #2

Sorry it has taken me so long to post.  I have no excuse, just didn't feel like typing I guess.  But, in case you were wondering where I was the whole month of August, it was here...

St. John's Urgent Care is located in the little town of Palatka, FL, 60 minutes east of Gainesville.  And this place had all the flavor of small-town-USA.  Most of my patients were missing at least 1 tooth.  At least 3 people in the office smoke, including the PA.  I think 3 of the girls at work had illegitimate children.  Felt like I was back in Montana :)

It's owned by two ER docs, so the place is treated a lot like an ER fast track.  The docs are rarely there, so the show is run by a staff of 4 PAs.  Kinda cool if you ask me.  Mostly did a lot of drug screenings, work/school physicals, worker's comp follow-ups, minor illnesses, and minor trauma (lacerations, sprains, breaks, etc). They have a lab (for blood work and UAs), X-ray, and EKG on site.  So, it was really nice to be able see a patient, run some tests, and be able to diagnose most of them right there.

I got to drain a ton of abscesses.  Helped close 2 lacerated fingers and flew solo on repairing a cut thumb.  I also got to read a ton of x-rays and EKGs.  My preceptor was really big on autonomy so he just let me go see all the patients I wanted to.  All-in-all, I got to experience quite a bit here.  I'll miss the staff.  They were quirky, but they were fun and so willing to help.

For the last week, I've been on the Psych Consult service here at the hospital on campus.  I don't like it.  I don't like psychiatry.  But, I'll fill y'all in on that at a later time. 

Surgical Rotation: Week 2

Holy cow this week went by fast!  I got to do and see so much.

Monday: I saw a few patients in clinic. I diagnosed an inguinal hernia, saw a patient for a follow up after his inguinal hernia repair, and diagnosed a patient with cholecystitis.

Tuesday: Was a looooooong day.  17.5 hours!  We're at the hospital from 5:30 until 11 at night.  Just as we were about to finish up our last surgery of the day, we got a page from the ER for a patient with acute appendicitis.  We ended up rushing him up to the OR.  I got to learn how to work the laparoscopic camera and put a stitch in at the end.  Near the end of that one, we got another page from the ER for a patient with acute abdominal pain because of a small bowel obstruction due to an incarcerated umbilical hernia.  He was blowing chunks all over the place so we got him up to the OR quickly as well.  And believe it or not, just as we were finishing that one up, we got another ER page for an emergency consult on somebody with a suspected bowel perforation.  But, by the time they were ready to take her up to the OR, it was 11PM and they sent us home.
But by the end of the day, I had seen a hernia repair, an anal fissurectomy, an anal dilation under anesthesia, a lipoma excision, a laparoscopic appendectomy, an exploratory laparotomy/umbilical hernia repair, and 3 colonoscopies.

Wednesday: Ugh.  This wasn't my favorite day.  I was assigned to present our small bowel patient that was placed in the ICU.  He was super acute and I wasn't even told about this really bad condition he might be developing, so I felt really stupid when getting questioned about him.
In addition, Wednesdays are usually reserved for Academics, but the residents were taking care of a lot of cases up in the OR.  So instead of the whole team meeting, Kyle and I got to sit in Dr. Edwards office and got quizzed for about 2 hours.  He wasn't mean, but I couldn't answer very many questions so I ended up feeling even dumber.
Tuesday beat me up physically.  Wednesday knocked me down mentally.

Thursday: I spent the day in clinic with Dr. Edwards seeing his consults and post-op follow ups.  Then, for lunch he took me out for sushi.  It was cool to be able to spend that much 1:1 time with my attending.  Not sure that anybody else in our class even sees their surgical attending let alone spends a whole day with him/her for face to face instruction.

Friday: There were only a couple cases scheduled for the OR today and Dr. Edwards didn't have anybody in clinic, so it was mostly a study day.  I did, however, get to scrub in on a laparoscopic cholecystectomy and they let me drive the camera for the whole procedure!  It was really cool and they told me I did a good job.

I'm kinda sad that I'm half-way done with this rotation.  I mean, the mornings are early.  The days are long.  But, I am really enjoying myself.  On top of that, Pensacola is really pretty.  I think I'll actually be kinda sad going back to Gainesville.

Week 1

Week 1 of clinicals = done.

So, in the last 5 days I have drained an abscess; scrubbed in on a laparoscopic cholecystectomy; put my first buried suture into a real live human being; observed a lap appy, right hemi-colectomy, and a couple hernia repairs; learned about medical coding/billing; and seen multiple patients in clinic.

Just kickin it in between surgeries

 I am really liking this rotation.  It really helps that I'm with a great team.  The days are long, but I've really enjoyed myself thus far.  While I still see myself in an area of medicine with more long term contact with my patients, I love the technical aspect and instant gratification of surgery.  There aren't many specialties where you get to fix somebody like you do in Gen Surg. 

Clinical Year: Day 1

Today I started clinicals.  My first rotation is surgery here...

at the Pensacola Naval Hospital.

I'm pretty lucky that I don't have to do this one alone.  My buddy Kyle Williams is on the same service with we so, we carpooled to work today at 8 AM.

When we showed up, we went through a very short "orientation" and were introduced to our preceptors.  I'll be working with an awesome attending physician, Dr. Chad Edwards, and his 4th year resident Dr. Marc Northern.  Kyle and I are very lucky in that there are no other medical students with us.  Just 3 other residents.  We will get to spend much of our time one-on-one with the chief resident and the attending, which is pretty rare in a teaching hospital...especially for PA students.

We spent much of the morning talking with Dr. Edwards about how he wants to teach us and what he expects from us as students.  While sitting in his office, Dr. Northern came and asked if I would like to do an incision and drainage on a leg abscess.  I jumped at the opportunity!  And so, on my first day of clinical year, I got to slice open somebody's leg with a scalpel, squeeze pus out, and pack the wound with gauze.  It. Was. Awesome!

Lastly, we went on rounds with the residents and attending.  There were only 3 patients so it didn't take long.  Dr. Edwards refuses to take longer than 30 mins rounding on his patients...no matter how many patients he has.  He says surgeons have short attention spans.  This will be much different when I get to Internal Medicine where rounds take 2 hours!

Tomorrow, I get to start bright and early.  I need to be at the hospital by 5:30 to round with the residents, then with the chief resident, in time for 7:30 scrub in :-/  Oh well, such is the life!

Last Week of Year 1

This is it folks.  The end of year one.  Gonna be a busy week...

This is what Summer A has been like.  This semester has just been a sort of catch-all semester for a hodgepodge of different topics, lectures, and reviews to get us ready for Clinical Year.  We also got to go back into the cadaver lab to learn how to do an arthrocentesis, insert a chest tube, and do an emergency cricothryoidotomy (cut an airway in the throat) on an actual human body.  It's been really nice to have some free time and not be so stressed out all the time. 

Speaking of Clinical Year, I got this too...

Here's the schedule for the next year of my life.  In just a couple of weeks, I'm off to Pensacola to start a month-long rotation in Surgery.  I'm actually pretty excited about it.  It will be a physically demanding rotation, but I love the technical aspect of surgery and can't wait to get my hands dirty (literally and figuratively).

P.S. - Summer has begun in full force here in FL.  Sooooo hot.

AAPA National Conference and White Coat Ceremony

Hey guys!  It's been a little while, but some exciting things have happened that I thought I should report on.

Firstly: IMPACT 2013 - AAPA's 41st Annual Physician Assistant Conference in Washington D.C.

IMPACT is where thousands of PAs and PA students gather for a week's worth of lectures, speeches, and workshops designed to keep us up to date on new information, procedures, and regulations.

13 from my class and 4 faculty were able to attend.  We had Memorial Day off anyway and faculty was nice enough to give us Tuesday off as well.  So, we flew up last Saturday morning and came back Tuesday night. There were 5 guys in our group.  We had booked a two bed room for the 3 nights, but the hotel overbooked, so we were stuck in this one, haha...

 It wasn't so bad.  I'm not opposed to sleeping on the floor.

I was able to attend quite a few lectures, but the highlight of the conference was definitely the National Medical Challenge Bowl.  There were 68 3-man teams representing PA schools from around the country.  I was lucky enough to represent the University of Florida.

 

We made it through the first cut that weeded out half of the 68 teams.  Pretty impressive since we beat programs from schools like Duke and Emory University.  We kinda got screwed on one question then lost the tie-breaker.  This picture was on the AAPA Facebook page the next day.

So, we lost, but it was all good.  We had fun doing it.

While there, I was also able to get out and see some of the sights.

 

Secondly: White Coat Ceremony.

After getting back to Gainesville, we only had 2 days of class since White Coat Ceremony was scheduled for Friday.  White Coat is a mini-graduation of sorts.  It marks our transition from the didactic portion of our training to clinical work.  I can't believe the year is almost over.  Even more so, I can't believe I'm about to be entrusted with the care of actual patients.  Things are getting real very quickly.

 

While I missed having family there, it was great being surrounded by so many amazing friends.  Besides, it was too short a ceremony to expect family to travel so far.  Graduation will be much more of a milestone. 

Summer Utah Trip

There are not enough words to describe how nice it was to see my girls again, so I'll use pictures.

Abby puked all over the place not 5 minutes after this picture was taken.

Orem Library

Daddy-Daughter date

Daddy-Daughter date

Dimetrodon (incidentally, not a true dinosaur)

BYU Museum of Paleontology

Striking a pose.

End of Spring

Wow.  The semester is over.  It went so quickly I can hardly believe it.  Here's a rundown of all we did...

10 Sections of Medicine
14 Exams
26 Quizzes
12 Clinical Procedure labs (including suturing, venipuncture, skin biopsies, lumbar punctures, and casting)
5 Patient visits
5 Histories and Physicals
4 Timed SOAP notes
4 EKG interpretations
1 Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) exam
1 Admission order
1 Suture practicum
and an Advanced Cardiac Life Support certification

Yes, they pack all of that into 17 weeks.

Maybe it's because it went by so quickly, but I didn't realize how much ground we actually covered until I typed it all out.  It's crazy!

Now, almost 2 weeks of hard-earned freedom.  Tomorrow morning I jump a flight to UT.  Something I have been counting down the days to for months!  Chances are you won't hear from me until I get back to Florida.  Hopefully I'll have lots of good stories and pictures from my time with the girls.

Until then...

Catching Up

Hello all?

It's been a bit since I've updated y'all on what's happening down here in the Sunshine State. 

The last time I posted was on my birthday.  That night, I was so nicely surprised by my amazing friends.  I thought I was just being treated to dinner by a couple of them, but when we showed up to the restaurant, there were a dozen people there waiting for me.  I didn't even know where we were going.  But they surprised me with sushi, a cake, and gifts.  It was a great birthday!

Mmmmm Sushi

Maria, Austin, Stephanie, Brendan, Me, Cally, Kristy, Tina, Christina

This semester, I've also been playing 4 on 4 flag football with some guys from class.  We were just playing in the Rec League so there wasn't a championship or anything, but I think we came away only losing 2 games.

David, Austin, Me, BJ, Jeff, Danny

 Florida has been the source of a lot of new experiences for me.  One of which was jury duty.  I lived in Utah for 8 years and never got called up for jury duty.  I haven't even lived here a year and I got a summons.  I don't know, I was actually kinda excited about it.  Never done it before and wanted the experience.  So, I got excused from school, went to the courthouse, and made it through the 1st round of prescreening.  Then they separated us into groups and sent us to courtrooms to go through the selection process.  Well, the group I was in was further divided in two.  My group sat in the audience while the other group was grilled by the prosecuting and defense attorneys.  Then they sent us out to lunch.  When I got back for my selection process, they decided to send me home because I had to be in a mandatory class on the date the trial was scheduled for.  I was kinda bummed for two reasons. 1) I didn't get selected for a jury and was robbed of my Twelve Angry Men experience and 2) I wasted an entire day just to find out that I wasn't selected.

Oh yeah, and I've been doing lots of this too...

But it hasn't been all book work.  I've gotten to do a lot of fun hands-on stuff too.  Check it out...

And this...

I also got to see a locally produced play with my good friend Mayra.  It was a quirky modern comedic take on the classic tale of Robin Hood.

And lastly....the moment I had been waiting for all year...drumroll please....Clinical year schedule!

So, Gainesville is my home base, but it looks like I'll be spending quite a bit of time out of town.  My first month rotation will be surgery at the Naval base in Pensacola.  That's really far away in the panhandle.  I think it's even in a different time zone.  Then the 2nd month I'll be commuting 50 minutes to an Urgent Care clinic.  I'll spend the month of December in Jacksonville.  In March, I have another hour commute each day to another primary care clinic.  

But the really good news, is that during those months where it says "Elect," I will probably have rotations in Utah!  I'm super lucky that the Asst Director of my program used to be on faculty at the University of Utah's PA school.  She's been using her connections to try and find me rotations there.  So far, she's found a Pediatric Cardiologist in Orem that I could precept with...which would be amazing.  I can't wait to be close to my girls again.  I miss them a ton!

Well, there you have it.  You're all caught up on the last month or so of my life.  A lot has been happening and I am so close to being done with the semester.  Just 2 more exams and an ACLS course and I'm 1 step closer to being a PA!