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.



“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.

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.


My Month with Newborns and Hormones

Another four weeks. Another rotation complete. It’s hard to believe another month has passed, but here I am, at the end of my OB/GYN rotation. I cannot begin to recount all of the things I saw and did as there is quite a bit of diversity within this specialty. Obstetrics is all things pregnancy. I participated in the care of new moms, gestational diabetes, finding baby heartbeats, miscarriages, pregnancies with complications, vaginal deliveries, C-sections, and even infant loss. Gynecology is all things women’s health. I participated in caring for women concerning routine health maintenance, hysterectomies, menopause, STIs, managing and prescribing contraception, problems with hormones, and even cancer.

At the end of every rotation I have to take a 2-hour standardized exam, so I certainly put in the time and effort to ensure I gain a lot of medical knowledge throughout the month. However, being a good PA is more than just knowing a lot about making diagnoses and choosing the correct treatment. With that in mind, these are just few of the non-medical things I gleaned from this month.

ALL childbirth is beautiful.

For some reason there seems to be a lot of opinions and tension when it comes to birth plans and what is the “right” way to have a baby. But, honestly, all of that is so trivial. It doesn’t matter if a woman chooses an “all-natural” birth with no anesthesia or the first thing they ask for is an epidural. It doesn’t matter if baby comes with a surprise rush to the hospital or if there is a planned induction date. It doesn’t matter if the parents choose to keep the gender a surprise until birth or if they want to know the baby’s gender as soon as possible. It doesn’t matter if this baby is number one or number five. It really doesn’t matter. Every birth story is to be treasured. There is an undeniable beauty about seeing the look on the face of a mom as you place her newborn baby into her arms for the first time. At that moment, all the other details become oh so unimportant.

Unfortunately, we live in a world marred with brokenness, and there are also births that don’t end in such a way. However, in these delivery rooms, there is also beauty. To see the outpouring of support from community and family, to see the depth of love and loss that I cannot fully understand, to hear words of hope and encouragement in the midst of such pain. It certainly looks different and is incredibly heartbreaking, but there is beauty to be found in these birth stories too.

Talking about quality sex is important and doesn’t have to be awkward.

Despite how mainstream the topic of sex is in our culture, people surprisingly get real awkward real quick when you try to legitimately talk about it, even with healthcare professionals. That is so unfortunate! Sex has been debased to something that is raunchy, sensationalized, and a platform for comedy, making people hesitant to talk genuinely about quality sex, despite how vital it is to a healthy, thriving marriage. Talking about sex doesn’t have to be crass. Sometimes not being afraid to ask questions and actually speaking up can bring more comfort and enjoyment to your sex life and therefore enhance your marriage. With the consideration that talking about sex should never dishonor your spouse, there are certainly times and situations when it is good and appropriate to talk about it, and it doesn’t have to be awkward. In fact, one of my favorite conversations this month was with an 80 year old women who said, “Yeah, we still try to fool around.” And without hesitation I said, “That’s awesome! I hope to say the same thing when I am 80!”

Hormones are designed to be incredibly intricate.

I know I am outing myself for being a huge nerd, but the menstrual cycle is absolutely amazing. There are so many factors that have to be balanced and timed perfectly for conception to be made possible and cycles to be regulated. Women have hormones that are constantly fluctuating and throughout different phases of life, from puberty to pregnancy to post-partum to menopause, the female body changes and responds incredibly to the unique role and demands that are put on it. As a creationist, I think this exemplifies a beautiful picture of divine design. Hormones are regulated too accurately for them to be a result of chance.


While I probably won’t end up working in OBGYN (partly because there isn’t a huge role for PA’s in this specialty), I am thankful for all the incredible experiences I had this past month. Not only am I thankful for the generous patients who allowed me opportunities to learn and for the unique medical cases I was able to see and participate in. But, I am also thankful for the privilege to have worked alongside people that hold different beliefs than I do and with a doctor who exemplifies selfless patient care and has a true passion for what she does.

I am finding that each rotation in some way or another is helping shape me into the PA I want to become. Tomorrow, with great eagerness and humility, I will talk into Riley Children’s Hospital ready to be molded by my next month of experiences. Up next…pediatric cardiology.


Our Second Anniversary: Celebrating the Most Costly Year of My Life

There are many reasons why I love fall, but the most paramount is that I get a special opportunity to celebrate my marriage. While I am, of course, thankful for my husband and our journey together throughout the whole year, October 17 will always serve as an altar, a point of remembrance where I can stop, reflect, and celebrate the Lord’s faithfulness in our lives as husband and wife. (If you’re interested, I wrote about our first year of marriage here)

Unlike last year, this year my husband and I are celebrating our anniversary 2,000+ miles and 3 time zones away. We cannot plan for an extravagant date night or a romantic night in. I won’t be able to see his face or hug him when I tell him how much I love him. But, this is part of our story and I believe it makes it that much more important to celebrate well.

As the title wound suggest, this past year has been costly, for the both of us, as the cost of obedience and investment can be steep. In this season of our lives, we find ourselves passionately investing in our careers, wisely investing in our financial future, and persistently investing in our marriage, all in ways that we hope will yield bountiful dividends in the years to come. These worthwhile pursuits have cost us time, energy, convenience, money, physical touch, emotional availability, comfort, sleep, assurances, and so much more. If I’m transparent, this has left me weary and discouraged at times.

Paradoxically, even as the investments have mounted and though this season of life is here to stay for a little while, my husband and I have found our joy to be sustained and can confidently say that we have never felt depleted. At every turn we have discovered that life is most abundant when we hold loosely to our resources, our comfort, and our plans. A year of having to give a lot of that up has so beautifully taught us that. Instead, we have learned the value of clinging tightly to each other and to Jesus, who redeems every cost for His glory and our goodness. Part of that goodness is giving us experiences that allow us to learn, stretch, and grow in ways that we otherwise wouldn’t.

I am a better woman because of what we have walked through during this year. The Lord has taught me more about grace and flexibility in this past year than I could ever have imagined. I have become confident that when I come to the end of myself, I find Jesus… every.single.time. Learning to refocus myself on thoughts of eternity has been able to overshadow the frustrations of momentary inconvenience. Truly taking thoughts captive and choosing joy have been hard skills that I have begun to value and hone. I have become better at identifying selfishness in my own heart, which is the first step in confronting it. As my husband’s helpmate, I am better at encouraging and affirming him, continually learning to speak to his heart in ways that no one else can. All of these are life lessons that I would not trade for a year that was “easier.”


You only love as much as you’re willing to be inconvenienced. So thank you, year two, for showing my husband and I just how strong our love is. Now, I look with great hope and expectation for what year three will bring.


My Month In A Psych Ward

For four weeks I spent every Monday through Friday in the locked, inpatient psychiatry unit at the VA hospital in Indianapolis. As a physician assistant student in my clinical year, I get to spend a whole year learning hands-on in a wide variety of medical settings. As both an ex-military daughter and a current military wife, I chose to spend my psychiatry rotation at the veteran’s hospital. Many veterans struggle with mental illness, whether as a result of combat or just human brokenness, and it is estimated that 22 veterans commit suicide every day.

I saw a variety of people over this month. Some stayed for a few days and others were there before I was and were still there when I left. Some were in their 20s while others were in their 80s. Some saw combat and some did not. There were a variety of diagnoses including schizophrenia, PTSD, depression, personality disorders, and especially drug abuse. There was a lot of drug abuse. And behind all of that, was an incredible group of doctors, pharmacists, and social workers who graciously allowed me into their daily environment to learn and work alongside them.

After a bit of time to process all that I saw and experienced this month, these are three of my main takeaways.

1. You can’t make people change

I personally know people who have had rough pasts and yet they worked hard to create opportunities for their success. This month, I have also seen people with rough pasts who have been handed every opportunity and given every benefit of the doubt and yet they find themselves in the same despondency. Change is not the result of opportunity or privilege; it is the result of choice and determination.

It’s hard to watch people who continue to make bad decisions. It breaks my heart to know that some people could have a happier, more fulfilling life, yet continue not to choose it. On the flipside though, it is an indescribable joy to watch someone who tightens their metaphorical bootstraps and commits to putting in the work to make the hard decisions to choose that life. Those are the people you want to truly come alongside and throw in everything you’ve got to help them. I saw both.

While there certainly is a time and a way and a place to help both of these types of people, I found freedom in giving my best to every person, every single day, casting aside the pressure for the outcomes to be a measure of my effort.

2. Coping is a learned life skill

There is a general understanding of the need for children to physically develop. Pediatricians track growth charts from infancy and society recognizes the signs of puberty and physical maturity. Children are told to eat well and stay active so they can “grow big and strong”. There is also a general understanding of the need for children to mentally develop. There are rigorous school performance standards and numerous programs that encourage kids to stay in school. Some parents spend tens of thousands of dollars for their children to go to college and earn a “higher education.” What is lacking though, is the general understanding of the need for children to emotionally develop.

This month I interacted with adult men who would crumble under the stress of daily responsibility or relational conflict. Overwhelmed by their emotions, they would turn to drugs and alcohol or be overpowered by thoughts of suicide and depression. To be honest, there were times when I struggled to have empathy because the thought of not being able to handle stress seemed so childish to me. But that’s exactly the point. These men were never taught how to handle everyday stress well; therefore, they do handle stress like children.  The mind, much like the body, is a product of training. Whatever behaviors and coping mechanisms are taught and reinforced as we grow up, including bad ones like drugs, avoidance, and angry outbursts, are the ones we turn to as adults. While many of the men I met thrived under the routine and structure of the military, trying to live within the messier, interpersonal, and unpredictable civilian word proved to be a challenge they were not emotionally prepared for. However, many of these men are currently connected with group therapy where they can learn and practice different coping mechanisms. They are given outlets to externally process and become more mindful of their thinking patterns. It took me some time to realize this, but coping well doesn’t come naturally and it can be hard to learn as an adult; but, intentionally learning good ways to handle emotions is a skill that has dramatic implications on one’s quality of life.

3. There is a definite roll for medication in mental health

Over this month, I saw some incredible changes in people’s mood, thought content, orientation to reality, and ability to cope with the help of medication. It seems socially acceptable to acknowledge that other health conditions, like high blood pressure or diabetes, are best treated with lifestyle modification and medication; yet, that belief is not held so much when applied to mental illness. While as a future clinician my preference is still for strongly promoting lifestyle change/habit modification as much as possible across all health conditions, I greatly appreciate the role of medication when used correctly by thoughtful providers. Medications shouldn’t just be blindly thrown at problems, but they can be can important part of a treatment strategy. For some people with moderate to severe mental illness, medication truly is a significant part of their treatment.

At the end of my rotation, I came to these conclusions: People are messy and broken and mental illness is complicated.

However, I also found myself encouraged by these truths: God is in the business of redeeming messy, broken people for His glory and, mental illness is real, but so is God and He offers hope that can reach through even the darkest moments.

I am thankful for my time at the VA and the ways I was able to engage and invest my time there. There are so many people who dedicate themselves to serving our veterans everyday and it was an honor to work alongside them. However, I was just passing through. For me, up next is…OB/GYN!


Cultivating a Healthy Long-Distance Relationship

For the past several months, this is the field I have been laboring in. There have been weeds and thorns to pull, watering to be done, and a lot of planting. There have definitely been days that have left me emotionally exhausted and ended with a good, stress-relieving cry. But, my husband and I can both attest that we have also seen this to be a very rewarding labor of love.

Marriage, even without distance, is hard. There are a lot of external pressures that can so easily and insidiously begin to chip away at unity. Without constant attention and care, marriages stop blooming and over time can begin to whither. For long-distance relationships specifically, I have discovered, that thriving comes down to a battle between feeling and knowing. If I don’t engage my mind and choose my reactions, my heart will take control and my emotions will sabotage me. Missing someone is a really strong emotion. Really strong. It gnaws and it lingers and when we least expect it, it comes rushing in, demanding our attention. I strongly conclude that how we choose to handle this weighty feeling of missing someone ultimately influences the health and longevity of our relationships.


The first option is to choose resentment. Let bitterness build up and over time, you begin to cast blame on your significant other for the heartache that distance inevitably causes. Rather than being upset by the situation, you become upset with him/her. You begin to feed those negative emotions, giving them power. Then, over time, they become powerful enough to destroy whatever unity is there such that you now view the other person at the impediment to your happiness and fulfillment. At that point, the only solution you can see to restore your happiness is to leave behind the weight of the relationship.

The second option is to choose isolation. Sometimes as a coping mechanism, it seems best to just harden your heart and try to shut off the feelings altogether. As if the physical distance isn’t enough, you find that the emotional distance begins to grow. Out of stubbornness, denial, and hurt, you refuse to bend to the new rules that govern your communication and vulnerability. Over time, you begin to feel as if your significant other doesn’t know you anymore. You feel uncared for, unappreciated, and unvalued. At that point, the only solution you can see to restore your feeling of worth and connection is to find someone new who can give you the affection and attention you long for.

The third, and hardest, option is to choose love. I’m not talking about infatuation. I’m talking about gritty, messy, ride-or-die love. This kind of love requires active mental engagement. Sometimes the feelings of longing and heartache overshadow any feelings of love. Consequently, if you don’t feel love, the only way to cultivate it and protect it, is to choose it. What does this look like? Well, this probably looks different for every couple, because personalities and maturity definitely come to bear on the dynamic of a relationship. However, my husband and I, through our flexibility, commitment, and profound care for one another, have found some practical ways to choose love on a daily basis.

Choosing to love my husband well begins with joyfully putting on my wedding rings every morning and reminding myself of the vows I made to him; this shapes my attitude and allows me to better extend grace and understanding. To maximize our communication, I write down “keywords” that will jog my memory so that the next time we get to talk, I can quickly update him on things I did or thoughts I had so as to included him in my daily life. I send him text messages encouraging him with reminders of my faithfulness to him and to our marriage, not just messages full of fluffy, romantic, “I love you’s” (though I definitely send those too). More than just praying for God to “be with him,” I strive to pray for my husband with specificity and diligence, often times sharing those specific prayers with him. When people ask me about my husband, I take the opportunity to recount the ways I am thankful for him and how I cherish being his wife. Sometimes love looks like spending an hour and a half putting together a section of a 500 piece puzzle from the dollar store so that I can make a cute, crafty card. When days are busy, love looks like making time for a short phone call just to say goodnight. On the weekends, love looks like making FaceTime a priority.


If we don’t actively choose love, we passively choose resentment and isolation, because it is love that keeps our hearts tender. Thus, if you love well, the heartache will always stay fresh. Cultivating a healthy long-distance relationship involves working against the elements and staying vigilant. But, if you put in the work to weed and water and plant, you can be confident that the Giver of growth will bless you with a satisfying harvest. It is not easy, but, after these past several months, I can say without a shadow of a doubt that it is always worth it.

I chose love the day that I married my husband, and I will choose it every day until death do us part, no matter the distance.