Posted in Physician Assistant Journey

Beyond the Notorious Waiting Room

When people think of the emergency department what is the first thing that comes to mind? The wait, the dreaded wait. For many, going to the ED is stressful, inconvenient, scary, and oh so time-consuming. But from the perspective of someone in scrubs, other people’s misfortune, is an ER practitioner’s excitement! For rotation 9, I was in the IU West Emergency room in Avon, IN. I worked a few day and evening shifts, but a majority night shifts. The staff there was wonderful and I can’t speak more highly of my experience. It is not a Trauma 1 Center like Eskenazi or Methodist in downtown Indy so I didn’t see a bunch of crazy trauma cases like gunshot wounds and major car accidents, but I did get to do a lot of hands-on assessments and procedures.

Like any emergency department there is a wide variety of patients and not all of them come with real emergencies. On one end of the scale are the patients who treat the ED like their primary care office and come in for a sniffly nose, a “fever” of 100F, pain medicine, or just typical aches and pains.

Then there is a large portion of people who present with abscesses, lacerations, or broken bones. I got extensive experience with local anesthesia, stapling, suturing, and I&Ds. Additionally, I got to help with reducing fractures and placing splints. These procedures kept the shifts interesting and I really enjoyed improving in these clinical skills.

Next in increasing severity are the patients who present with stroke symptoms, chest pain, abdominal pain, or shortness of breath. So, there are a lot of things that can cause subjective weakness/numbness, chest pain, abdominal pain, and shortness of breath and an exact cause is not always identified in the ED. One of the key differences between the ED compared to other areas of medicine is that, in general, practitioners think about differential diagnoses from most deadly to least deadly rather than from most likely to least likely. In other words, rule out the things that would most likely kill the patient first. It was very important that I learn to work-up and think through these big and sometimes deadly presenting symptoms and I was thankful for the opportunities I got to do just that.

On the other end of the scale are the patients who arrive in cardiac arrest. One of the most memorable moments was doing CPR on a real patient for the first time. It was surreal. I have learned and practiced the technique plenty of times on mannequins, like thousands of other people, and have maintained a CPR certification since I was a young teenager. But, being in the midst of a true code carries with it a level of intensity and palpable adrenaline that is unmatched and unable to be prepared for. Unfortunately, our patient did not make it. However, he provided me a valuable learning opportunity and I can confidently say that I feel completely comfortable starting CPR and would not hesitate to jump in if I came across someone in need.

This was probably my favorite rotation thus far! I loved the shift variety, hands-on procedures, clinical decision-making, and overall energy of the ED. It came with its challenges, the most notable being the changing of shifts and accompanying fatigue being physically hard on my body and the odd hours making it difficult to talk on the phone with my long-distance husband. But, if the right opportunity opened up, I would certainly enjoy making a PA home in the ED!

Up next is one month of thoracic surgery. I cannot believe this is my last core rotation. Wow has this clinical year passed quickly! After this rotation I take my summative practical and written exam and then focus my attention on studying for my boards while I finish up two, three-week electives.

Watch out, I am going to be a practicing PA before you know it!

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Posted in Lifestyle

Navy Wife: First Year in Review

May 18, 2017 was the first morning I woke up without my husband by my side. I can remember so vividly the last night I saw my husband before he left for the Navy. I remember clinging to his final hug as I dropped him off. I remember the unrelenting stream of tears blurring my vision as I drove back to our apartment. I remember how our dog, Leia, anxiously looked out the window for hours before settling down for bed, confused as to why his car was in the parking lot, but he was not home. That has been my hardest goodbye.

 

Being a Navy wife is not for the faint of heart and so far, it has not exactly been a “fun” adventure. There has been no traveling to cool places, no establishing tight knit community, and no enjoying the sight of a husband coming home in uniform. While that may come down the road, for me, this first year has brought more challenges than advantages. My husband has been in several places around the country training while I’ve stayed put in Indy working toward a demanding graduate degree. In the past 12 months, I have seen him maybe a sum total of about 3 weeks. As for calling and FaceTiming, the time differences, busy and changing schedules, and spotty Wi-Fi have not always made that easy, convenient, or daily. Throughout the year, orders and plans have changed several times such that planning for tomorrow let alone months down the road is futile. However, we did our best to take each day as it came, make the most of the chances we did have to see each other, and continually committed to growing closer together despite our being farther apart.

 

This crucible has molded me and refined me (for the better, I hope) in ways that I didn’t even know I needed. As I reflect back on the last year and all that we’ve been through, these are ten things that I am thankful to have had the opportunity to learn.

1. I am more resilient than I would have ever thought.

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Leia and I repping our patriotism and military pride on July 4th.

2. The best way to fight self-pity is with thankfulness.

3. Even when I feel hurt, I can’t make my husband guilty for having to prioritize the job over me sometimes. (We chose this life together!)

4. I live in a new, constant state of unknown, so it is pointless to marinate in anxiety over my lack of control.

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Me and Louis at my white coat ceremony.

5. I must rely on the Lord, not my husband, to emotionally sustain and stabilize me. (This is how it should be!)

6. If I am not vigilant in guiding my thoughts, I am prone to compare, covet and idealize others’ marriages and situations (despite my skewed perspective).

7. Being intentional to pursue emotional and spiritual intimacy is the key to guarding a long-distance marriage.

8. Both sending and receiving a well-timed snail-mail letter can do the heart so much good.

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During boot camp, these were like gold.

9. There is an important difference between feeling lonely and being alone.

10. In a healthy marriage, the heartache of distance never goes away.

 

I know my first year of Navy wife life has not been the norm since some of our separation has been due to my graduate school. While I’ve had the challenges of figuring out things like Tricare and moving reimbursements,  I don’t have a clue about life on base or many other aspects of being a military dependent. In other words, I still have a lot to experience and figure out. Throughout this next year, I look forward to the opportunity to finally spend some extended time with my husband again and to begin to plug into the unique community military life naturally cultivates. I have no doubt the challenges will keep coming, but I have decided that I am content in that as long as the lessons do to.

…..

To the countless other men and women and their families who serve and sacrifice in ways much greater than me, I thank you. I have much to learn from the examples of the strong men and women who make up this community.

Posted in Physician Assistant Journey

Back on the Floor

After four months of outpatient medicine, last month I finally got to settle into the world of inpatient medicine and with it, all the rounding, consults, progress notes, and beeping sounds I could want. (If you’ve been on a hospital floor for long, you can totally relate to the cacophony of beeping.) And oh how I loved it!

The last time I worked on a hospital floor was just over two years ago before I started PA school when I was a patient care tech (nurse support) on a Heme/Onc floor. To be back in this setting, but this time in a white coat, albeit still a short one, and being the one to help make the medical decisions…wow. What a visual reminder of the Lord’s faithfulness?! These past two years have been rigorous and unpredictable, but I can clearly see how the Lord has provided me the energy, focus, patience, and support that I would need to get here. This pipeline has certainly felt long at times, but I blinked and here I am 24 months into PA school with only 3 more to go!

For the past four weeks, my days were spent with a hospitalist team that worked on a cardiac PCU floor, which mainly consisted of patients who were post cardiac surgery. Though I was primarily with the hospitalists, I was privileged to work very closely with cardiovascular surgery, in addition to some work with peripheral vascular surgery, infectious disease, GI, and neurology. Throughout the month I got to pull chest tubes; adjust, add, and discontinue medications based on lab values, vitals, and signs/symptoms; manage insulin regimens; assess new symptoms and implement interventions; and attend several inpatient educational presentations on a variety of topics.

Of all the things I learned, the most universally applicable is that quality healthcare requires a team and the patient is the most important part of that team. I got to work with some amazing physicians, physician assistants, nurse practitioners, social workers, dietitians, pharmacists, physical therapists, occupational therapists, speech therapists, nurses, care techs… you get it, a LOT of staff who diligently worked on behalf of each and every one of their patients. They excelled in their rolls and used their talents and experience to the best of their ability. Aside from the staff, I also got to work with a variety of patients. After dozens of hours and dozens of patients, I found that no matter what surgery or medical conditions a patient had, it was consistently apparent that the patient’s attitude toward recovery and their willingness to push through barriers can make a huge impact on their progress and healing. Turns out, think positive is a maxim that really does seem to carry some influence. This pearl is one I will no doubt carry with me for both patient encouragement and personal application in my rotations and career to come.

Up next: emergency medicine! This past month has given me new vigor and showed me that despite having tried to convince myself otherwise, I seem to most enjoy managing higher acuity patients. I eagerly suspect the ED will be a good setting for that. Not totally sure how this early-to-bed-early-to-rise girl is going to make it through all of these night shifts (maybe my need for coffee will finally outweigh the awful taste?) but I know I will and am committed to being a better PA for it!

Posted in Lifestyle

Some Friendships are Built, Some are Chosen

Most people think of friendships as something to be built. Start with what is safe. Test the waters. Share some lighthearted laughter and pleasant conversation about shared interests. Over time, as trust and camaraderie are built, begin to give glimpses of deeper thought and emotion. Take a few bricks out of your walls. Then, after significant investment and assurances of emotional safety, vulnerability can become more constant. Eventually, though rarely, that vulnerability may even become unrestrained.

Unfortunately, as someone who craves intimacy yet is a major introvert, I have often struggled to sustain the emotional patience needed to pursue the small social investments that are required in the beginning stages of building a friendship like that. Some people find deep conversation overwhelming. I find surface conversation underwhelming. The result of both is avoidance, which it turns out isn’t all that helpful when trying to make friends. Thus, it has been difficult to claim many true friendships in my life, which has led to a lot of loneliness and heartache… and a lot of self-pity.

However, what I thought was sabotaging my chances at friendship actually helped lead me to the best friends a girl could ask for. Contrary to the general thought that friendships are built, my deepest friendships were chosen. We vocalized our desire to pursue invested friendship and freely gave our commitment to one another. In doing so, we skipped the social dance and made vulnerability and transparency the standard from the very beginning. Vulnerability wasn’t going to be the goal of our friendship; we decided, up front, that it would be the foundation. This radical view of friendship is what has made these ladies part of what I cherish most in this life.

Vulnerability is costly though and something we often ration, arguably out of fear. We fear being wounded, being judged, being used, being misunderstood. We fear exposing insecurity, pride, jealousy, lust, animosity, or doubt, as if by not taking about it, we make ourselves more palatable for potential friends.

When we do that though, when we make ourselves more palatable, we rob the gospel of its glory and its ability to beautify and deepen our friendships. The beauty of the gospel is that we aren’t palatable. We are messy, selfish, hypocritical people who are prone to wander in search of our own stubborn way. But, God knew that about us and loved us still. By the blood of Christ, He as redeemed the bad, the ugly, and the repulsive in each of us. He takes our brokenness and makes it beautiful and purposeful. He uses it to teach us, to help us recognize His goodness, to equip us to encourage and walk alongside others, to develop perseverance and self-control, and to humbly remind us that we could never do enough “good” to earn the favor He has freely offered to us through Jesus.

When we walk in that freedom, we don’t put the burden of approval on our friendships. We no longer have to build slowly and cautiously. Instead, we can choose to invest and love generously.

There is much value and necessity in having friendships across all different depths and commitment levels. And certainly, great friendships can come from years of faithfully building your lives alongside on another. But if, like me, that’s doesn’t come so naturally… that’s okay. Don’t be afraid to rest in the gospel, commit to vulnerability and choose friendship.

……

…an inner circle of individuals who care for each other’s souls as if they were their own, for the purpose of helping each other be rooted and built up in Jesus and established in the faith.
– Brent Crowe

 

 

 

Posted in Physician Assistant Journey

Primary Care: Clinic, Clinic, and More Clinic

Despite my lack of updates, PA school has continued to move along. Each day has been another chance to get more experience under my belt and to learn about people and healthcare from the inside. The past two months I have been working in primary care, the frontline of healthcare. Interestingly, even though many PAs are now being utilized in specialty settings, the role was initially created to help compensate for shortages in primary care, especially in urban and rural areas. Well, that is exactly where I have been. In December, I was in Richmond, IN at a county health clinic and in January I spent most of my time at the Methodist family medicine residency clinic in downtown Indy. While I thought I would fall in love with primary care, I have come out of these two months a little shell-shocked and unsure. Primary care is no neurosurgery, but it is no cakewalk either.

Many patients are noncompliant.
I have come to realize there are several reasons for this.

1) Financial hardship. They may have difficulty affording their medication. When people have to choose between keeping their lights on or buying their medicine, the former often wins out. They may not have reliable transportation. If someone doesn’t have a car, relies on the public bus schedule, or depends on a family member, they may have difficulty keeping appointments, picking up their medications from the pharmacy, or going to the grocery store (especially in food deserts, like in certain areas of Indianapolis).

2) A lack of self-discipline. Stopping old habits and making new ones takes will power and consistency, which is usually not easy or fun. Adjusting one’s diet to improve their diabetes, consistently using condoms to prevent STIs, actually doing the at-home physical therapy exercises, putting on sunscreen. The examples are endless and every person can relate to at least one of them.

3) A lack of understanding of the long-term consequences of one’s choices. We live in a society that likes immediate feedback and results. If I have a rash, I put cream on it and it goes away. Most people can get on board with that kind of treatment. However, what about high blood pressure (hypertension) for example? With hypertension people often do not feel short-term effects. Many can walk around for a long time with hypertension and not even know it. So, when their provider communicates the importance of taking their medication, avoiding salty foods, exercising regularly, etc., they are less inclined to follow through because they cannot directly see or feel the effects of these changes. However, chronic hypertension puts people at greater risk for vision loss, stroke, heart attack, heart failure, and chronic kidney disease. Those things are serious. Thus, when patients do not have good basic health education, they have a hard time appreciating the importance or gravity of their medical conditions and their choices, especially the long-term consequences.

Many patients just want a pill.
Unfortunately, many people believe their trip to the clinic is only a success if they walk out with a prescription for something they can pick up at a pharmacy. Sometimes, I would even argue that often times, a pill is not the answer. Sometimes the answer is rest, exercise, eat fresh food, cut back hours at work to reduce stress, stretch, go talk to a counselor to unpack the anxiety and/or pain that you are carrying, drink more water, get more sleep, do something you enjoy, get some fresh air, do some reflective journaling, get out of a toxic relationship… Those things don’t get run through your insurance, they are not picked up at a pharmacy, and they aren’t limited to a certain number of refills. Even though this is what most people need, it is not what they want, so there is tremendous pushback to such “frivolous” suggestions.

Many patients have a skewed sense of pain.
While pain is certainly subjective, our culture in a lot of ways has recalibrated the pain scale. People think that they are entitled to feeling no pain, no discomfort, or no repercussions for their health choices. If you are overweight, it will accelerate the development of osteoarthritis in your knees, and that will hurt. If you foster stress and anxiety in your life, it may manifest as physical discomfort. If you have a weak core, it can contribute to the development of low back pain. Even harder to accept is that sometimes pain is not a result of personal choices, but rather an effect of circumstance. For instance, if someone has been in a severe car accident or if someone was hit by a roadside bomb in the Middle East while serving in the military, unfortunately their pain level may never be at a 0 again. I don’t say that to seem insensitive, but to point out that reality should shape our expectations rather than our expectations shaping our reality, especially when it comes to pain. For more information, just Google “US opioid epidemic.”

 

Over the past two months I have found primary care to be draining. And while the same things may not be true of all primary care settings, they have certainly been the bulk of my experiences thus far. I would be lying if I didn’t say that it isn’t making me question what area I want to work in after I graduate and whether primary care would be a good fit for me. However, whether I end up in primary care, I certainly hope that the challenge of interacting with patients serves to build up in me compassion rather than cynicism. This next month is urgent care followed by a month of community medicine, so we’ll just have to see where I am at come the end of these next couple of months.


 

Posted in Physician Assistant Journey

“Heart Kids”

My, oh my, what an incredible month with some truly remarkable pediatric cardiologists! I got to spend 4 amazing weeks working with various pediatric cardiologists at Riley Children’s Hospital in Indianapolis, IN. Because of my interest in pediatric outpatient care, I spent most of my time in the outpatient clinics trying to train my ears to appreciate the intricacies of normal and abnormal pediatric heart sounds. However, between the outpatient clinic and the various other settings, I was able to see and do so much, things that the average student doesn’t get to experience. As with my other rotations, I walked away thankful for having gained a vast amount knowledge, both about medicine and people.

Experiences that were had:

  • Spent the day in the pediatric ICU where kiddos were waiting for heart surgery or had just recently had heart surgery
  • Saw an infant’s heart held in the hand of a surgeon above an open chest in the OR (a moment of pure awe and wonder)
  • Saw an infant who had complications after surgery and was on ECMO (extracorporeal membrane oxygenation: a dialysis-like machine that functions like lungs to oxygenate blood)
  • Watched the collection and interpretation of fetal echocardiograms to identify and monitor congenital heart disease (including discussing birth plans with a mom that involved rushing the baby off to surgery immediately after delivery)
  • Listened to a lot of unique heart murmurs
  • Watched catheterization procedures, one for a PDA closure and one to get a biopsy to test for heart transplant rejection (had to wear a full lead ensemble throughout the whole procedure to protect against Xray radiation)
  • Visited parents, whose precious children were in the NICU, to draw pictures and explain their baby’s abnormal heart physiology
  • Made a lot of kids smile

Lessons that were learned:

  • A healthy baby is truly a miracle.
  • Kids are incredibly resilient…like, it’s amazing how resilient they are.
  • In the face of restrictive health conditions, kids push themselves and are self-limiting. Adults…not so much.
  • Parents of these “heart kids” are strong and should be admired, encouraged, and prayed for.
  • Children can survive with only one functioning ventricle…incredible!
  • The beauty of a healthy heart is not to be taken for granted.
  • Lots of “holes” in baby’s heart close up all on their own. Sometimes doctors just have to prescribe time.
  • Cardiologists are liked skilled musicians who have trained themselves to appreciate the subtle nuances of the heart’s music; it’s beautiful.
  • There are a wide variety of pediatric cardiac conditions with a genetic link.
  • For some patients, it takes a lot of work to convince them that they (or their child) is healthy and physiologically normal.
  • Kids say the funniest, most honest things.
  • Each heart transplant usually only last between 10-15 years. So babies who need heart transplants, often need several in their lifetime.

It seems like an injustice to just have bulleted lists, but it would have been a bigger injustice to try to write in more detail all that this month-long rotation entailed. If you are interested in knowing more about my experience, feel free to ask. Also, while I didn’t have much exposure to the surgery aspect of pediatric cardiology,  if that is of particular interest to you, I would recommend the book Walk on Water: The Miracle of Saving Children’s Lives by Michael Ruhlman. It’s very good.

Next rotation: outpatient medicine at a local county health department clinic. Let the learning continue.

Posted in Lifestyle

Timing Is Not Everything

When desires are unfulfilled and life does not go as planned, it is easy to appease my anxious heart by convincing myself that things will work out “in due time.” If I continue to trust God through this unexpected setback, God will surely provide down the road. I cope by extending the deadline for my expectations. Rarely though, is it my propensity to give up the expectations altogether.

I have realized that often times I am willing to concede the timing of my plans to the Lord, but I hold onto the plans themselves with a white-knuckled fist. I feed the illusion of control as if I know what is best for me and I simply just have to wait for God to give it to me. Trusting God is more than just trusting him with the timing of your life plan, it is trusting that he has already set in motion a better life plan.

 

We tell ourselves that we can wait on God’s timing to deliver us our desired outcomes, but what if God’s desired outcome is totally different than ours?

 

If you are struggling with infertility. It could be that God’s timing is different and he will bless you with a baby down the road. But what if God’s plan is that you never conceive?

If you have someone in your life you pray would change. It could be that God’s timing is different and he will bring forth understanding and conviction down the road. But what if God’s plan is that they never change in the way you want?

If you are experiencing constant setbacks while diligently working toward a certain dream job or career. It could be that God’s timing is different and your patience and fervor will be abundantly rewarded down the road. But what if God’s plan is that you invest your life and resources in a completely different career path?

 

Don’t get me wrong, there are many times in our lives when what we desire is good and God could simply be developing our patience and perseverance as we wait on Him and His direction. However, I also know that, sometimes, good things become idols and we can become blind to the way we begin to chase after worldly things under the guise of submitting to Christ.

What areas of your life do you find hard to give fully over to the Lord? To give over your timeline is part of trusting the Lord, but it is not everything. Do you truly believe that His plan is better than whatever you could plan for yourself?

I challenge you to be honest and frank with the Lord about your emotions and desires. (Speaking to myself here, too.) Invest time in studying His character and reminding yourself of Truth. Be faithful to wrestle with ways you are struggling to submit and be expectant for the Lord to show up and mold your heart.

One of my favorite verses in the Bible comes from a story in Mark 9 and it says, “I believe; help my unbelief!” May that be our prayer as we learn to find true joy and comfort in fully surrendering to the Lord, confident that His plan is vastly better than whatever we could imagine.