Settling in to Salem

Looking out across the harbor from Pickering Wharf

House in the historic area

     It's been a fun first week here in Salem. I was a bit out of it when I arrived after a red eye flight, but luckily my new apartment mate picked me up, brought me back to our place, and she even took me out to get groceries and other necessary supplies that night. I definitely lucked out when it comes to apartment mates. I also lucked out with the apartment, and even my furniture. My friend, and former occupant of my room in the apartment, left behind a bed and dresser, and just a few days later a neighbor wanted to get rid of a nightstand and lamp, so I'm doing pretty well in the furniture department. I did somehow manage to cut myself while lugging the nightstand back, but that was a good reminder that I still need to buy bandages and antibiotic ointment, and the cut's healing well now. It was worth any pain because my room is actually starting to look homey and lived in now. In fact, about all I  could need now is a desk, and with everyone moving today as it's the last day of the month and school's about to start, there's a good chance I could find something.

Worth the pain

My new room

Just an old, awesome house covered in ivy

     I haven't just been getting settled in to my new apartment; I've also been getting used to my life in Salem. I've lived in the country for most of my life, so being in a city is a decent change already, and there's even more to get used to since it's New England. For one thing, the architecture is quite different. I actually rather enjoy the house styles over here, and I can't quite seem to stop taking pictures of the buildings I pass. Salem was founded in 1626 (just 6 years after the Pilgrims landed at Plymouth Rock for you history buffs), so it's full of some pretty old things. Houses in the older sections actually feature small signs that say when the house was built and for whom. There are historic sites galore around town as well, and the city has some pretty notable claims to fame beyond the obvious witch trials connection. The city was the birthplace of the National Guard, it became known for privateering during the Revolutionary War (there's now a pirate museum), and was the birthplace of Nathaniel Hawthorne whose works include The Scarlet Letter and The House of the Seven Gables. There is in fact a real "house of the seven gables" that can be visited today and according to Trip Advisor is the "oldest surviving 17th century wooden mansion in New England."

     Obviously the most well-known aspect of Salem's history is the witch trials. It's pretty much impossible to go anywhere in the town without being reminded of some part of it. On my way to work, depending on my route, I pass by The Witch House or The Witch Dungeon Museum, and if I swing down to the Salem Common I can pass by the massive Salem Witch Museum. Just down the road from work there's the Nightmare Gallery and scores of witch themed tourist paraphernalia can be found by taking a walk down Essex St., which is an area that should generally be avoided (especially during tourist season) by anyone who does not want to encounter large crowds, Grim Reapers, witches on Segways, or screaming Puritans. Even the Salem police have a witch on their logo. Things are decently calm at the moment, but we'll see how long that lasts since school starts next week for most MA universities, and leaf peeping season (the completely innocent activity of traveling different places to find the prettiest and most colorful leaves, which somehow earned itself a rather scandalous sounding name) is just around the corner. October should be a bit crazy around here. On that note, I have a couple little tidbits about the witch trials: 

1. Nobody was burned for witchcraft here. Most "witches" who were sentenced to death were killed by hanging. That's why there's a Gallows Hill in Salem, though the exact location is still debated.
2. Salem used to be much larger and most of the so-called witches were from an area called Salem village. That's now the city of Danvers, so, frankly, that town should be getting a bit more of the hype. 
3. A total of 19 people were hanged for witchcraft and one man was pressed to death by heavy stones before the Governor stopped the arrests, dissolved the courts that allowed for "spectral evidence," and released those still being held on charges.

Lighthouse at the end of Pickering Wharf

     Aside from all the witchiness, I've been having a great time just exploring Salem. As of last Monday I do have a car, but it's pretty much just for getting to the store and commuting to school at the moment, because I can walk almost anywhere I need to go. I've been walking to work, church, the library (I got a library card here as soon as I had valid proof that I was a Salem resident, and I've already been enjoying its offerings), and I've been doing a lot of wandering. I live close to a large park, but there are parks all over, which is quite nice. I've also been in search of a decent beach since the one at Pickering Wharf is a bit rocky and overrun by tourists, but it's so nice in any case to be able to just walk to the ocean. I did find a nice little beach at Collins Cove, but I happened to visit it just as a giant wall of fog was rolling in, so I didn't see much of the ocean. The fog was pretty cool by itself though. It's been very nice to have a week or so to settle in to Salem and to my job here before school starts next week, and I think I am very much going to enjoy my new little home. 

The fog rolls in to Collins cove

Getting In: Shadowing and Volunteering

     My last post covered direct patient care experience, which is required for most PA programs. While some schools only consider direct patient care as acceptable for their medical experience requirements, some school also accept shadowing and/or volunteering hours. In fact, some schools are beginning to require shadowing hours because they believe it gives prospective PA students a better understanding of what a PA does and even find it more helpful than direct patient care. When it comes to volunteering, schools differ widely on whether or not they will accept such hours for the prior medical experience requirement, but such hours always look good and demonstrate a commitment to serving one's community. So let's tackle both topics, starting with shadowing. 

     Shadowing is a wonderful opportunity to really learn what life as a PA looks like on a day-to-day basis. If you can shadow multiple PAs or doctors, it's also a good chance to compare different specialties and see what attracts you before you even start school. However, actually getting the chance to shadow a PA or doctor can be more difficult than one would think. Many hospitals and private offices are willing to let high school students do job shadows, but this often changes once these students turn 18 and become legal adults. After this, those same medical offices often require that any shadowing opportunities be arranged through a university or college. Some hospitals will only offer shadowing opportunities to students at schools with which they already have prior agreements and will not allow students from other schools to shadow. I learned this the hard way. My college in MA certainly had no agreements with any of the hospitals back in OR, but without a car it was rather difficult to arrange anything with any of the hospitals close to school. there were some hospitals near my home who said there might be a possibility that I could shadow a PA with them, but finding the right person to contact and actually getting through to them was also rather difficult. In short, it was a lesson in frustration. Despite all this, I was able to get at least some shadowing hours, though perhaps not through the most conventional methods. 

St. Josefskrankenhaus

     The first was to shadow a friend of mine who is a PA. While I was limited in the number of hours I could shadow him for, any experience was beneficial and shadowing him really did give me a much better understanding of what a primary care PA does. Having a friend on the inside also meant that the process of going through all the necessary steps to be allowed to shadow went much smoother than when I tried to do things by myself. If anyone is looking to shadow a PA, I'd suggest that they see any friends within a hospital or medical office who can help them find the right people to contact or help arrange things. The second way I was able to get shadowing hours was when I studied abroad. I was a German major during my undergrad so I spent a semester in Heidelberg during my junior year. My language partner there was finishing her last years of medical school and she was able to contact some of the hospitals in the area to see if I could come shadow for a day. I hadn't believed that it could be so easy since I'd experienced so much frustration back home, but Germany is a different country. I got to spend an entite day shadowing multiple doctors in Internal Medicine and Cardiology at St. Josefskrankenhaus (apparently I have a knack for ending up at hospitals named for St. Joseph). The doctors let me go through patient's charts, help examine and interview patients, and, if I'd been trained at the time, would have even let me help with phlebotomy. I even got to wear a white coat and look legit. At the end of the day, the hospital offered to let me intern there, but, unfortunately, my semester was almost up by this time and I was leaving a week later. Obviously, having an internship in Germany is not a viable option for all prospective PA students, but I would encourage anyone trying to get shadowing hours to pursue any avenues open to them. 

Keeping track of visitors to the Birth Center

     When it comes to volunteering, there are generally more options readily available than shadowing, though even volunteering positions can be tricky to get. I found that quite a few hospitals require that people who volunteer must be able to commit to at least a year of service. This is because it takes time to train new volunteers and it is also nice for the staff to actually get a chance to know some of the volunteers, which is difficult when they change every few months. I was lucky enough to volunteer at a community hospital near me, the one described in my Snippets from the ED post. Originally I just volunteered there during the summers, but I've been able to do more there while at home this last year. I began by volunteering at the Front Desk. There I helped patients find their way around the hospital and transported those who needed help, but since my shift was 6am-12pm, there were often not many patients and I did a lot of reading. Last fall I left the Front Desk and worked for a while at the Birth Center. There I was a bit of a "Baby Bouncer" since it was my job to make sure that only authorized people went into the Birth Center and no one left with a baby when they should not have. It was a fun position, and allowed me to see lots of babies and get my EMT homework done, but eventually I had to give it up to work a bit more. Luckily I still had my position in the Emergency Department. 

      I started volunteering in the ED shortly after I began at the Front Desk. I'd wanted to start there right away but the department manager wanted to speak to me ahead of time and make sure I knew what I was getting myself into. He therefore described, in elaborate detail, all the sights, sounds and smells I might encounter while volunteering there. I was undeterred, and probably just more intrigued by the time he gave his approval for me to begin. I began volunteering on Tuesday mornings because there was an opening, but I eventually realized that not much happens in the ED at that time. It was primarily people who really should have visited an Urgent Care, or people who had gotten dizzy and fallen down. It was a good environment to learn in though, and soon I added a Friday evening shift. I was able to see a bit more then, but my duties remained the same. My primary job was stocking, which meant that, as they opened, I would visit each patient room and make sure that the carts were fully supplied and throughout the night I would check the bathrooms and specialized carts as well. I also ran samples to the lab, which trumped any restocking duties I had at the time since it was more important to get those samples taken care of quickly. Some nights I barely had any samples to run, whereas other nights I seemed to be going every ten minutes. Between restocking and running samples I'd do other tasks like cleaning rooms, answering patients' calls, getting warm blankets/water/food for patients, and just generally acting as a liaison between the patients and their care providers. 

One of our more difficult patients (who was being
especially uncooperative and wouldn't let the doctors
do what they needed to in order to make a diagnosis)
left us this message one night.

     I became friends with the ED techs, nurses and doctors during my time volunteering at the hospital. Whenever things were quiet we'd have time to chat a bit, which I loved. By the end of my time there most knew that I was planning to be a PA and that I am a licensed EMT, so I would occasionally be asked to come to patients' rooms to help or observe. That was always the most fun for me, even when the patients were mean, frustrated, or just smelly. It was sometimes difficult to deal with those patients, but it was always helpful to remember that many were not exactly acting like they normally would. After all, if they were in the ED, there was usually something seriously amiss. Of course, no matter what you did, there were always some patients who would be irrationally upset. All in all, even the difficult patients were good for character building.

     If you're considering volunteering, I would do it, even if most PA programs don't count volunteering as part of the medical experience requirement. I saw so many different conditions, learned so many new terms, and really just got a good idea of how hospitals are run through my time volunteering. If you're having a problem with hospitals that have a service length requirement that you can't meet, I'd suggest speaking personally to the person in charge of the volunteering department. They often can help you figure something out. 

Getting In: Direct Patient Care

     In my last "Getting In" post I wrote about the courses required for admission to PA programs. Today I'm going to tackle another requirement: medical experience. I was actually torn over which topic to post about first because both are things you should start thinking about early. Like course prerequisites, the required medical experience differs from program to program. It differs not only in how much is required, but also in what kind of experience fills the requirement. Some very rare school require no prior experience at all, whereas others require 3000 hours of direct patient care, preferably paid. Some schools will accept shadowing hours, some will not, and some will actually require shadowing. Often the schools that require shadowing are those that require less direct patient care. The difference often seems to be regional. Schools on the West Coast, where there's only a few options (just two in Oregon and only one in Washington) tend to have much higher requirements and are also stricter about what they accept. Schools on the East Coast and in the Midwest, on the other hand, tend to require fewer hours. Many are even moving away from medical experience requirements because the evidence doesn't necessarily indicate that PA students with greater prior experience do better in the end. The median requirement tends to be about 500-1000 hours, and direct patient care is recommended or required for these hours. 

     So what counts as direct patient care? Essentially the term means sort of what it sounds like: you have to be directly involved in the patient's care. Some schools call it hands on care and the ability to have physical contact with the patients you see if a good indicator whether or not your medical experience will be accepted. Another good way of judging whether certain medical experience will count or not is to ask if your actions, decisions, or input will have an impact on the patient's care. A technician in Radiography may not have a great deal of physical contact with a patient, but their knowledge will directly affect how the patient is treated and thus can count as direct patient care. Tufts provides this helpful list for prospective PA students to help them determine what experience will count: 

     Not all direct patient care experience is created equal. The University of Florida's PA program warns prospective students "Patient care experience in settings such as nursing homes and private homes utilizing the services of home health aides, offer limited exposure to a wide range of patients and providers and are therefore not as favorably regarded by the Admissions Committee as settings such as hospitals, clinics, and physicians’ private practices." This one of the first times I've actually seen a school state this opinion outright, but UF is certainly not alone. I've heard this thought expressed before from members of another program's admissions board, so it is something of which to be aware. CNAs are excellent and necessary members of the healthcare field, and becoming one is often a popular option for people hoping to gain medical experience, but as CNAs are primarily employed in places like nursing homes it might not be the best choice for those hoping to use this experience to later apply to PA programs.
     You may have noticed that some of the suggestions for gaining medical experience to start a PA career are careers in and of themselves. Most require at least some schooling, and some require a few years. This is part of why becoming a PA can be such an excellent choice for people who worked as a paramedic, exercise physiologist, or respiratory therapist who decided later that they wanted to go further in the healthcare field. However, this is also why it can be so difficult to apply to PA school straight out of undergrad. Personally, I chose to go on a medical missions trip and then do an accelerated EMT course, as well as a bit of shadowing, to get the experience I needed. I loved it all and only wish that I had done my EMT program earlier.

     Medical mission trips may be one the best ways to gain the necessary experience for students in or after their undergrad programs. For one thing, they are typically in rural, poverty-stricken areas that so desperately need any and all medical help, so medical mission trips are a great way to help out around the world. For another thing, you can often get a great amount of experience in a short amount of time. Depending on the trip you may have a set schedule, or the amount of work you do could be entirely up to you. If you're motivated enough to work, you can usually gain a lot of hours and do some pretty awesome things. Most medical mission trips take place outside of the US, so the opportunities to learn and perform a variety of medical tasks are often much more available. All this to say, if you are looking for an interesting, fast, and rewarding way of gaining medical experience, I would recommend some sort of medical trip. 

     I wish I could recommend a particular program or place to go on a medical missions trip, but sadly I cannot. My own experience is limited to my trip to Kenya with Medics to Africa (described in the first posts of this blog), and it seems that a variety of problems have arisen with that program since I went there. The most recent, and most serious, problem involved three students being held hostage at the hotel in Migori because the hotel claimed that the program director had not paid the bills. The students did eventually escape, the program director was temporarily arrested, and it appears that the problem was partly due to the hotel owner breaking some agreements, but it still seems like there is much work to do to redeem the honor of the program. The story from the perspective of one of the students can be found here. 
     My next post will cover two other types of medical experience: shadowing and volunteering. Both are wonderful options, but may not be viewed as favorably by PA schools as direct patient care, which is why I did not include them in this post. 

Leaving on a Jet Plane

     The time has come for me to leave my beloved state and journey east. After a lovely year at home full of new experiences, quality time with the family, weddings of friends and loved ones, and rekindled friendships, it's time to take the next big step in my PA journey. I'm trading in Dutch Bros for Dunks, the MAX for the T, and roads that actually make sense for street designed to kill as many drivers and pedestrians as possible. In short, I'm heading to Massachusetts. I'm sad to leave my friends at home behind, but I'm thankful for how easy it is to keep in touch nowadays, as well as for the chance to see old friends in New England, and even make some new ones. Even though it feels like it's already been quite a ride to prepare for PA school, it's even crazier to think my first day of PA school is just a week or so away. I guess all that's left to say now is: