It's been one of those weeks...

These were my daily goals for Thursday:
1. Have my computer/electronic medical records system working. I was kicked off of the system at 8:30 the night before. I guess that was my sign to go home. Fortunately, it was working the next morning.
2. Talk to the clinical nurse psychiatrist about a patient whose needs exceeds that of a primary care provider. This was also my first "will not see again" patient. I've started THE LIST.
3. Not end the day with a mentally unstable patient, unlike the previous two days. Yeah, one of those weeks.

On an up note, my goals for tomorrow include:
1. Road march 6 miles through Transmountain Road. More details later.
2. Finish about 9 patient notes that had to be put off due to other events this week.
3. Go grocery shopping at the commissary when it is actually open. Open!
4. Prepare my lesson for Sunday school on Sunday. Yep, I'm subbing. It's actually from Preach My Gosple, chapter 2.
5. Enjoy my Bluebelle Groom's Cake ice cream (chocolate ice cream with strawberry swirl, chocolate cake pieces, chocolate covered strawberries, something like that.) I have been thinking about this ice cream for well over a month! It's my reward for setting a new personal record on my physical fitness test -- which I completed when it was 35 ndegrees outside. I think I will remember to bring gloves when it's that cold next time. Maybe keep the long pants on for the run too.

For those who were wondering...

Here's an update on my current job status...

Pediatrics job in Santa Ana: Group just posted their ad yesterday, I sent in my CV, job interview on Monday!! Downside: lots of driving...

Loma Linda: I was turned down for an interview for not having enough experience, which I was expecting anyways. I figured when they said "preferred" that would still give me a green light and I didn't have anything to lose.

Montclair: Family practice and derm, just found out from Mom today. Haven't heard back yet. Doctor is looking for a long-term partner I believe, especially one wanting more of the business responsibility, so....not quite sure how to feel on that one...

Washington (rural) pediatrics clinic: Still in the back of my mind. I figure if I don't have a successful interview next week, I may take a roadtrip later this month for an interview. Benefits do look nice, and it's pediatrics in a high-spanish area, we'll see...

There may be some other random job issues coming up in the next couple weeks. Stay tuned,

The Scythe Has Fallen...

The Scythe of the Grim Reaper of Unemployment, that is... Yes, my job is the latest casualty of the healthcare crisis. It was quite an unexpected blow to me. As I was clocking out for the day on Monday, my supervising physician pulls me aside and explains that due to current financial issues (less private-insurance patients, lack of reimbursement from Medicaid patients) the clinic could no longer afford to keep me. The news floored me. I was unemployed as of that very evening.

My emotions are still a bit raw. It is mainly the grief of loss, the unexpected shock, the stress of meeting my financial obligations (I have two loan payments due in a couple of weeks, and seven months left of my lease) and the sudden disruption of a life that had been progressing very smoothly. Today I reflected on Elizabeth Kubler-Ross's 5 stages of death/dying/loss and noted that I had a short moment of denial (the "is this just a bad dream?" thought I had on Monday night), and now passing through the sadness stage and gradually easing into acceptance with the whole thing. I have tried to self-medicate by watching the first season of "Flight of the Conchords." I really could use a laugh. And maybe some chocolate milk... Nevertheless, I feel no anger, no bitterness,* or need to "bargain." The grief is still real, and I have had shed more tears the past couple days than I would like to admit, but I want to arouse my optimistic nature as well. Things will work out. I don't want this to be mistaken as a false happiness to suppress discouragement, but it is as the adage says, "Life is 10% of what happens to you and 90% how you react to it." I also reflected recently on a saying that Joseph B. Wirthlin said, quoting his mother, "Come what may, and love it." So, am I going to love being unemployed? Well, I may not like its effects and stresses, but I can still find joy in today. I have more opportunities waiting for me. More free time, that hopefully I will be able to put to good use including serving others. Anyone need help moving out? Some cookies or empanadas made? Or, hey, maybe I could even go out on a date on a weeknight! (Okay that last one might be a little too optimistic, haha!). My mother suggested a possible visit to see Cutest Nephew Ever I and II. Very tempting, I have to see how the remaining finances** go when I figure them out. I haven't come across too many jobs yet, especially since I may be commuting from Riverside for a while. There's an opening in Thermal (near Coachella/Indio), CA. Like I said, I haven't come across too many openings yet. We'll see what happens.

* I initially felt no anger of bitterness, but I later realized that the way that I was laid off was, as my mother puts it, "despicable" and was very unprofessional. It was an insult to me and to the physician assistant profession. I am not one gets angry very often, but I will say that this issue left me very, very disappointed.

** I have also decided that applying for unemployment is not a bad thing, especially since 1/3 of my paycheck (even my final paycheck) goes to the government anyway.

My first complaint

This week I got my first complaint from a parent of a patient. Normally, this would be a traumatizing moment for me, as I am a bit sensitive and need to thicken my skin for for future incidents. The last thing I want to do is offend someone or make a bad name for myself, but I know I am not perfect, parents are not perfect, and I will unintentionally offend someone again. I actually found this incident kind of funny and an example of why patients and parents need to use common sense and courtesy.

Monday one of the doctors came to me and said that she received a call about one of my patients. My heart began to race. She told me the conversation and I knew exactly who she was talking about.
Rolling back to Friday... An hour after the scheduled appointment, I see a girl about 8 years old with a chief complaint of runny nose, congestion, and fever for three days. She had not had a fever since the first day, no fever now, and had not taken any medicine for fever (Tylenol or Motrin). No cough, no history of asthma or allergies, no sick contacts. The only thing I found on physical exam was a really congested, runny nose. Meanwhile, the mom had been talking on her cell phone in a heated conversation for about 75% of the visit. Yes, there were signs in the room about cell phones, and I did have the right to leave the room and come back when her conversation was over or have one of the assistants tell her to turn off the phone, but I was feeling a bit laid back and decided to ignore it. I wrote a prescription for some Sudafed Cold and Cough to relieve the congestion; (yes, I prescribe over-the-counter meds all the time because Medicaid will pay for it, and I figure even if it saves them a couple bucks, a couple bucks may be their children's lunch money). I explained that it's most likely a very bad head cold caused by a virus, that antibiotics won't help (when she asked if I was going to give her the "pink" medicine), and with the combination of lack of fever, no sinus tenderness, length of time, and her age, it most likely was not a sinus infection, and that because it was a virus it just needed some time to pass. I told the mom that if it did persist for more than a couple weeks without any relief, to come back in. The mom was not very happy about the medicine and just shook her head on the way out and mumbled about how "this stuff don't work."

Fast forward to Monday and the doctor tells me about the call she received from the same parent of the same patient. The mother said, "I don't mean to be mean, but I saw your assistant on Friday and she told me it was a cold and gave me some Sudafed." The doctor said that the mother's voice got angrier when she started telling her about her experience after the visit. During that same weekend (not sure if it was the same night of her visit or not), she went to an urgent care (wonder if she had to pay a co-pay, but that's another issue). The mother's anger reached it's climax when she said, "your assistant said it was a cold, but they (urgent care) diagnosed it as a VIRAL infection!!" The doctor reassured her that the two diagnoses were the same thing and that I was correct in my decision.

If only this parent had not been on the cell phone, she would have heard me say "virus" at least three times. Oh well. I guess the stronger the medical terminology, the more reassuring it is to the parents... I have also learned my lesson on cellphones: it's gotta be zero tolerance from here on out...

Welcome to Pediatrics

Now that I've been in my job for over a month I guess I can share some experiences. Jumping into pediatrics for my first job has been quite an experience. I've learned a lot and still have so much learning to do. There's been some ups and downs. Downs including demanding parents (PLEASE check your attitude at the door), kids coughing in my face, the shock of having over a third of my paycheck go towards the government, and a few others. Ups include the sincere thank yous, working with great staff, the smiles that I get from kids of all ages, the opportunity to express standards and morals (monitoring TV programs, abstinence, etc...) while being viewed as "an authority" - that part is still a little weird. I appreciate those little opportunities where I hope I make a small difference in someone's life during such a short encounter. And then there are those weird, crazy, and funny moments, some are as follow...
* A rule for parents: please do not bring your puppy to your child's doctor appointment. Even more important, do not weigh your puppy on the baby scale or use any other clinic equipment on your dog.
* Another rule for parents: Please do not steal soap from the rooms. That is just ghetto. Ghett-o.
* I do confess that there are quite a few parents who ,"do not present themselves well," as one of my friends would say. Sometimes they don't have to say a word and sometimes their kids will say it for them. I had one tot whose first words, according the parents, very closely resembled "shut up" and "stupid." The only response I could say was ,"Wow." I remember my program director in PA school very early on in our training teaching us the importance of the "thought bubble" - as seen in cartoons and comic strips - and keeping our potential reactions and thoughts inside that bubble. I have used my "bubble" often.
* I am often humored by "creative spelling" of kids names. I know with some of the parents English is their second language, and some parents are trying to be unique, but I can't help to chuckle when I see names like "Melony" and "Marical" and quite a few others. Plus, it makes me look a little foolish when I attempt to say their name after I read it off the chart.
* One of the important rules I learned in pediatrics: Teenagers will always take more time. Always.
* I love my Littman stethoscope. It has endured some trauma during this past month, but its durability has not let me down. On my one week anniversary working at the clinic, I came down with the stomach flu. Near the end of the day as I was observing one of the doctors start putting some sutures into the last patient of the day, my stomach could no longer keep my breakfast and lunch down. Before I bowed to the porcelain god, I threw my stethoscope off my neck and onto the floor. After I finished what I needed to do, I noticed that the chain was broken in the toilet. I removed the lid of the tank and placed it on the trashcan so that I could reattach the chain. As I was fiddeling with the toilet , the trashcan tipped over and with with a loud noise (enough to scare another staff member and have her knock on the door) the tank lid fell right on top of the bell of my stethoscope. Fortunately, the tank lid didn't break and the only damage my stethoscope received was a crack in the rubber no-chill ring. Sooo lucky.
Fast forward to yesterday. I had a three year old patient who was going through a major mood swing. After yelling at his mom and calling her some not-so-nice names, he grabbed my stethoscope, pulling it from my ears, bit down on it and pulled on it as hard as he could. After I kept my cool he calmed down almost instantly and with my constant praise for his good behavior, he was an angel for the rest of the visit. After sanitizing my scope with some alcohol, I noticed that there was no damage, no teeth marks even. Amazing! A vet student friend of mine commented on how her stethoscope has survived being stepped on by cows. Huzzah for Littman stethoscopes, Huzzah!!

That's it for now, I'm sure I'll have more stories from the trenches, in a HIPPA-protected sort of way. Stay tuned!

"There's Always the Mariana Islands."

Earlier this year I was looking through some of the job openings for PAs at potential government -reimbursed clinics. There was an abbreviation that I didn't know, and looking it up (yay Google!) found out that it was the Northern Mariana Islands. "Where are the Northern Mariana Islands?" you ask. I was thinking the same thing so I wikied it (Wikipedia) to learn more. It's in the Pacific just north of Guam, and eyeballing it on a globe, looks like it's halfway between Hawaii and China. There are about 84,000 people there and the languages spoken include Chamorro, Carolinian, and English. Only about 2% of the Islanders are Caucasian, so I would probably stand out. It does have the highest female:male ratio in the world of 100 females to every 77 males, so that would be a disadvantage for the Island dating scene for me. My mother and I were discussing future job locations and I told her, "There's always the Mariana Islands." She replied with, "You're making Alaska look better and better."

I haven't 100% settled on a location. I do have a job offer in southern California but I'm not sure if I'll take it yet. There's still more job searching, particularly out-of-state job searching, that I haven't done yet. Earlier this year I was pretty open to going wherever there was a job, but then I figured it would be nice to stay in SoCal if possible... But who knows... There's a lot of things to consider: commuting, cost of living, weather (this 105 degree weather is making Alaska look better and better), population - rural vs. city, family med vs. pediatrics, salary, etc... I'm going to start a poll and if any of you want to leave a comment with a recommendation of where I should work, it would be welcomed and pondered upon. By the way, the Northern Mariana Islands job is no longer listd.

I still want a kayak...

PANCE Fever: Boogie Woogie Woogie

Ah, yes, PANCE fever... I could also include PANCE indigestion, PANCE attention deficit disorder, and PANCE tension headache (Oh Sven, Swedish masseuse of my dreams, where are you??). I have less than three weeks before the Physician Assistant National Certification Exam (PANCE). The pressure is on!! I have been studying for a while, but of course it is now becoming more intense. I've been working on my focus for long blocks of time to prepare for the 6 hour test ahead. My social contact is decreasing. There are some things that are helping me get through this.

One has to do with finding a good study spot. If there's no one around and watching TV, there's a spot I like to study as recommended by my cat (cats know the best spots). It's the carpet of the living room where the sun comes in and leaves a warm sunny spot that moves throughout the morning. Studying on the floor has an advantage because it is harder to fall asleep.

I do have to take an occasional break once in a while. One of my favorite things to do is play peek-a-boo on the stairs with my nephew.

Hopefully exposure to study materials is not a health hazard and will not be considered a form of child abuse.

He flew back to Alabama today and I'll miss him, especially his goofy expressions. I could always use a laugh.

Most people have heard that listening to music is a good study technique; what I have found to be helpful and enjoyable listening to an Icelandic group called Sigur Ros. I find their music to be very beautiful and mind-stimulating. Plus, it is easier to not be distracted when I don't know the words. I have learned that it is still possible to get their songs stuck in my head, so the best I can do is a fake - falsetto-Icelandic rendition. I think it would be hilarious to try to make anyone do this at a social gathering. There's a few samples of their music below.

Well, on to more studying... heart murmurs, pharm, and arrythmias are calling me. Until next time...

12th Post: 12 Things I learned in PA school

Now that PA school has come to a close, here are just a dozen of the many things that I learned these past three years...other than all that medical stuff. So, in no particular order...

12. Everyone needs a Crazy Hat Day to offset the monotony and stress of school.

11. "Herpes, like true love, lasts forever." -Dr. Holtom

10. Provigil is great stuff, especially for the OB Labor and Delivery night shift.

9. Sleep and sunlight are things not to be taken for granted.

8. Trail mix brings people together.

7. I will always need a creative outlet, I think that is how I discovered my talent for rapping.

6. USC football is truly amazing.

5. Dim sum is a pretty interesting experience, especially when you have the real stuff in Alhambra.

4. The last patient of the day in pregnancy clinic will be a new patient on her double-digit number pregnancy (example: This is her 13th pregnancy, and I would need to take down the pregnancy/birth history of her previous 12 pregnancies -- yes, a bit time-consuming).

3. A STD (sexually transmitted disease) is almost always a differential diagnosis.

2. People's wisdom (especially the lack thereof) will never cease to amaze me.

1. The ability to keep a straight face is a divine gift.