The little things...

Today I want to post about the little things that make the grind of PA school a little bit better.  This is meant to be something of a celebration as we are now 190 days out from graduation and being done with all challenges associated with school (and after those 190 days, I get to enjoy all the challenges that come with actual work, but that's for another post). 

First, and foremost, my wife has made it all endurable.  She has helped me in every way from taking care of the kids with often minimal input from me to packing me a lunch almost every day for the past 1.5 years.  She deserves high praise and all my love for her endurance and her efforts, and the fact that yesterday she had to take a "rain check" valentine from me for something really special next year when the finances are more stable.  

But today, the biggest "little thing" is that they gave me an office.  It isn't much to look at, but the benefits one receives from having a quiet place to eat lunch or do a chart review are marvelous for one's psyche. 

Digging deep...

This week I had a chance to go back to the school office and chat with one of our faculty members about how everything is going and share some stories about lessons learned over the past six months.  It was a good time, mostly filled with laughter at all of my shenanigans.

One episode that I haven't shared yet occurred during my orthopedic surgery rotation and drew a raucous laugh from my former instructor.  It was an early morning, before 0700 and we were preparing to perform a total knee replacement on an elderly woman.  Just the previous week I had been verbally cautioned against scrubbing in too soon because it made me useless in prepping/positioning the patient.  This morning, I was determined not to make that mistake, so I waited in the hall outside the OR with my attending and his Nurse Practitioner.  They were hurriedly doing their last minute tasks and I didn't have anything to do.  The NP told me to get scrubbed and I began to meander through the task not wanting to get done too soon (in the end, I was simply woefully unmindful of the situation).  As soon as the attending stood up and started getting ready I snapped to scrubbing my hands and getting ready, but it was already too late.  They finished scrubbing moments ahead of me and the attending stepped into the room one step ahead of me.  And here is where I made the mistake: I didn't realize that stepping into the OR behind the attending was tantamount to being 20 minutes late to surgery - ie it was a total disgrace to me and I should be ashamed of myself.  The attending took the opportunity to inform me of my failure in front of all of the OR staff.  I was behind him, so he couldn't see the look on my face or the sweat beading on my brow, but the rest of the OR staff could.  There were a few snickers and chuckles (well deserved), but in the end I got gloved and gowned and did my job at the side of the operating table.  I was adequately shamed and I never repeated that particular error.

As I talked with my former instructor, this story brought much delight.  But we talked about other things going on - about psychiatry, about the struggles that PA school has brought with family, money, and time.  After I left I kept feeling that gut feeling that anyone who has played competitive sports has felt.  That feeling that says, "Time to dig a little deeper... It's fourth quarter, we're holding on to the lead just barely, and the other team has just put in a fresh set of players."  It's that feeling of exhaustion, pride, diligence all mixed together but looking at a finish line that is a full lap in the distance...  It's time to dig deep so that I can finish strong.  I have fewer than 200 days left, just six months.  I am fully 4/5 of the way through PA school and though things have been tough, we are doing quite well.  My prayer is that God will finish what He has started well, and I have no doubt that He will be faithful to do so.  But I know, through this feeling, that without Him I would be struggling very much.

Confessions

As difficult as it is to admit this, there are times at the psych ward that scare me.  I am not one to be easily put-off.  In fact, I deal with most incidents that might make one frightened well (though, if you ask some people I scared easily when I was a teenager).  Whatever the case may be, some of the patients on the psych ward give me the creeps, the heebee-jeebees, and otherwise make the hairs on the back of my neck stand up. 

The reason: we have some patients who are not your run-of-the-mill mentally ill folk.  We have a couple of hard core patients who have gone above-and-beyond - they are psychotic criminals.  These are the guys who hear voices in their heads ("nice" or "happy" voices some say) that tell them to do things like kill their entire family.  Now, admittedly, none of them have killed anyone.  But they have caused serious, permanent disfigurement of others as well as themselves.  And these guys are the ones who make me look over my shoulder every time I unlock the ward door at night.  They are the ones who cause me to sit with facing all entrances into the room, and they are the ones who make me extremely uncomfortable when we are in the same room together and they are between me and the door. 

Perhaps these guys are the reason I don't like psychiatry much.  I can't really pin it down.  But the other confession of the day is that I am having some trouble enjoying this rotation like I have enjoyed other rotations.  I am working shorter hours, I am home before the sun sets, and I get a one hour lunch break.  This is by far the least medically intense rotation I have had, but it is also the most mentally taxing in some ways.  Never before have I been required to NOT wear a tie for fear that I will be strangled with it.  At any rate, I certainly enjoy the medical side of what we do for our patients - and we do quite a bit.  One aspect that I have identified is that psychiatry has few objective measurements by which we can measure progress.  Much of what we know is subjective reporting and there are few examinations we can do to obtain any objective idea of how the patient is doing.  I suppose I prefer the objective measurement of a patient coming to the clinic or ER ill, receiving treatment, and leaving well. 

And once again I come back to the truth that there is yet much I need to learn - not all medicine is objective.  There is a lot that comes down to judgment of the provider and I know this in an academic sense.  Nowhere is this more important, in my fledgling opinion, than with psychiatry.  I welcome the challenge and hope that by the end of my time here I can gain at least a little bit of insight into this judgment.