Friday, July 29, 2011

2 weeks

Today marks the two week mark until the end of my clinical rotations.  After that, I have two more weeks until I graduate.  Thus, I am four weeks from graduating after 2 1/2 years of work that has changed the way I think, changed the way I function, and changed the landscape of my home and family.  This is perhaps cheesy, but examining myself before PA school and comparing that individual to the present is an interesting mental exercise.

2 1/2 years ago I could not have told you what BUN, Creatinine, or GFR are.  But this past week I spent a good amount of time managing a patient with wild abnormals for all of these and, essentially, turning kidney failure around.  Now, granted, I have not repaired any kidneys and I have certainly not changed the course of kidney disease significantly.  But I helped a patient stay out of the hospital, which was her biggest wish.  And the idea that I could ever have the skills, the resources, or the will and daring to attempt to manage something like kidney failure in the outpatient setting would never have even crossed my mind.  I had oversight - my preceptors were there the entire time and ready to keep me from killing the patient.  But I put the knowledge that my instructors instilled in me to work and made the right choices so that they didn't have to jump in and take over and instead they stood by and watched as the patient's condition improved, much to my surprise.  Despite knowing the right information and making good decisions, I still wasn't sure the treatments I prescribed would have the effects necessary to achieve the desired result - thus I was pleasantly surprised and gratified that things are looking up.

Even comparing myself now to a year ago - I had just finished my didactic year, my brain full of facts and protocols and ready to begin my real training.  But when I set foot in my first rotation, my eyes were big as saucers and I had no idea what I had gotten myself into.  My first consult in the ER was more a rote memory of how to perform an H&P than it was the application of learned skills.  That I happened upon the right diagnosis at the time was more luck than knowledge, and even now I always say, "it's better to be lucky than good," when I have a success.  The point is that I marvel at the change.  It is cliche to say that I've progressed by leaps and bounds, but it describes the situation well. 

I am grateful to God for my successes and give Him the credit.  And I still pray that, even though I helped turn kidney failure around, my hands will be blessed and the patient will have a good weekend and be waiting to greet me at the door to the clinic on Monday morning rather than lying in a hospital bed having been admitted while I wasn't watching.

What have I gotten myself into?

Saturday, July 16, 2011

Up in the air

I think I've discussed this in the past and if I haven't then I have certainly thought it - the uncertainty in life is killer for someone like me. 

First I struggled with the uncertainty surrounding going to PA school.  I put in a decent amount of effort the first year that I applied and interviewed with my program and waited as patiently as possible.  When I received the, "We regret to inform you..." letter the uncertainty nearly overwhelmed me.  Should I even be pursuing this?  Am I supposed to go to PA school? I made up some ground by gaining more experience and applied again.  Once again, the uncertainty ate at me.  Will they call?  For this program, if you get a phone call you're in... if you get a letter you're out.  Now we know that the call came.  Praise God.

Then there was a lot of waiting and uncertainty about how well the didactic year would go.  Am I up for this challenge?  I prepared myself mentally as well as possible and put in as much effort as I felt I could and the Lord blessed didactic year. 

Following that I was uncertain about clinical year.  You get the drift.  What will come through the door next?  Am I up to doing surgical consults in the ER on the first day of my surgical rotation?  And so on.  And here I am, almost done with clinical year. 

The next level of uncertainty lies ahead of me.  Where am I going to work?  How will I be paying our bills in 6 weeks?  What about our student loans?  Things are looking up for us - there are definitely job prospects, yet nothing is set in stone.  So there is a lot of room for uncertainty here. 

In the end the take home point that I hope to pass along to my children and anyone who might take a moment to hear it is that there will always be uncertainty.  Moving through life will present us with much uncertainty at every turn.  The Bible tells us to be wary of saying, "I will do this or that tomorrow."  This is the way God has made the world.  And looking back, I see better why we need to trust Him to get us through each uncertain obstacle.  He is good.  Romans 3 tells us that "All things work together for those who love God and are the called according to His purposes."  Looking back on the last 2 1/2 years I can see in a very real way how God works to bring all things together - how He blesses us. 

My hope is that someday I will be able to relax and have faith during times of uncertainty to avoid overstressing myself and those around me.  Maybe someday I'll grow up to that level...  Only time will tell. 

Monday, July 11, 2011


The past few weeks have presented me and my family with the opportunity to work through the rigors of PA school while undergoing family tragedy.  There have been a number of aspects to this struggle, as most of you have experienced with your own personal tragedies.  We are by no means unique in this, but I am relating the story to share the experience with others so that they might better understand or at least commiserate with PA students and students of other medical professions.  Again I apologize for being purposefully vague, but the details belong to us.

It began about three weeks ago when a routine doctor visit yielded bad news.  News that we had dreaded, yet it came nonetheless.  I was thankful for compassionate preceptors who allowed me some time to deal with the bad news, but the next day I was back at work trying to make good decisions and be precise through a muddied mind, distracted (gladly so) by grief.  I was grateful that I had a supportive environment and a can-do family, otherwise I would have been unable to bear the weight of everything going on.

The second chapter (or the last half of the first) came today - another phone call striking me in my emotional gut, leaving me distracted and unable to think about anything but my family for quite a while.  But today, right after the phone call, I entered a patient room and the nice lady sitting there immediately started crying.  It seems our life tragedies had coincided on this day.  The difficulty I had was that my mind wanted to be elsewhere, my emotions were flowing in the equivalent of a re-entry tachy-arrhythmia - feeding upon themselves and blunting my empathy.  I was able to push it aside for our hour-long (though it was only intended to be a 1/2 hour) appointment and we even made some progress... for the patient.  Following that patient, I saw a lady I have been treating for depression and we worked through her struggles.  At the end of this day, my mind is numb, I lack much emotion and despite the weight of what is going on around me, I feel less than engaged, not as present as I should be. 

Thus today I had a valuable experience - balancing the emotional needs of my patients with the emotional needs of my family have become truly competing demands and I have worked through the first in what I am sure will be a long series of such episodes.  I can't say I have achieved success - it is too early to tell.  But I have survived the day, my family is resting at apparent peace, and my patients ambled back through the waiting room with many a thank you, appearing content with meds in the pharmacy and consults/referrals ordered. 

God is good, even in times of great trial.  May we never forget it.