Wedding Excitement

     In case anyone's confused, I'm not getting married. My sister is though and I am incredibly excited. So excited in fact that I made a fake movie trailer for her and I'm sharing it here even though it has nothing to do with PA stuff. :D

Getting In: Course Prerequisites

     An undergraduate degree is required before admission to most PA programs, and with that comes particular prerequisite classes. My undergrad college had a pre-health professions concentration with a PA track option that included classes required by most PA programs. However, the required classes for this track were somewhat flexible as PA programs can vary widely in what they require. So here's my first piece of advice: when you know you want to pursue a career as a PA, start checking out the schools you are interested in to find out exactly what classes they require. I sort of love spreadsheets, so when I started looking at schools I used Excel to compare all the schools. Here's a snippet of that spreadsheet:

The whole spreadsheet ended up being quite helpful in deciding to which schools I should apply, as well as let me know what other classes I needed to take.

     As can probably be seen just from this smaller section of the whole, there are some similarities between schools, as well as some big differences. Here are the things required by every, or almost every, PA program that I looked at:

• Statistics, or Statistics and Algebra
• Year-long course of General Biology
• Year-long course of Human Anatomy and Physiology
• Year-long course of General Chemistry
• Microbiology
• Biochemistry
• 1-2 courses of Psychology

You'll have to do it at some point.

     If you have taken all of these courses, you're on the right track for a PA program. However, as I've already stated, schools can vary widely in what they require. For some schools, this might be enough. Other schools required Genetics, Sociology, Medical Terminology, Anthropology, Pharmacology, or Pathophysiology. Unlike many medical school programs, PA programs tend to require, or at least recommend courses in the social sciences, which is part of what drew me to the program in the first place. Many schools required General Chemistry or Organic Chemistry, and some required both. If I had chosen to do the accelerated PA program at MCPHS's Manchester or Worchester campuses, I would have needed at least one semester of Organic Chemistry and one semester of General Chemistry, but just two of either would not work. Also, most schools required either Algebra or Statistics and not both, with many favoring only Statistics. Western University, oddly enough, required both Statistics and College Math, but would not accept AP credit as a substitute for the College Math course. I thought this was a bit silly because many students take the AP exam to avoid having to take the basic math classes since they have already shown their proficiency in such courses. Western also required a College English course, like most of the other programs, though they would not accept higher English courses without a copy of the course syllabus (not the course description which was all that was required by many other programs). It wasn't really a problem, but it is something to be aware of if you're thinking of applying to Western or another school with similar requirements.

     Many schools do not require all prerequisites to be completed before applying for the program, however, there is usually a limit, such as only 1 science class may be incomplete, or only 3 classes total may be in-progress. Again, this differs from program to program, but all require that every prerequisite be completed with a passing grade before the program begins. Schools also vary in whether or not they will accept an online course. I did Genetics online while going through my EMT program, and that was completely fine for the schools that required it. If you're ever not sure if classes you've taken fulfill a program's requirements, you can always check. Some programs, like Pacific University here in Oregon, even have a form (found here: Prerequisite Form) you can fill out and submit for verification. The admissions counselor there will check all your classes and let you know which ones are approved and how much you have left to complete. Quite a few programs do this, so I would certainly take advantage of this if it's available. Even if there is no checklist, you can still usually email the graduate admissions counselor and they will often let you know if you're on the right track for fulfilling all your prerequisite requirements.

Lessons of the post: Never assume that all programs require the same courses, always check for yourself, and ask for help when you're not sure.

Oh How the Days Fly

With my sisters and my (soon to be!) brother-in-law enjoying some summer fun

Boston may have J.P. Licks, but I'll miss fun
Oregonian places like Salt & Straw

     As my family recently discussed plans for the Fourth of July this year, I was reminded of how I celebrated America's Independence Day just one year ago: a Bon Voyage party before I trekked off for a month in Kenya. It's a crazy thought. I almost cannot believe how much has happened in one short year. When I started this blog my future was fuzzy to say the least. I knew where I wanted to go, but I was having a hard time figuring out how to get there. At that time I didn't have as much medical experience as I wanted, my EMT class had just been cancelled, I was pretty sure that I needed to take at least one more prerequisite class, and I was starting to seriously doubt that I could pull everything together in time to apply. It really did feel like I was facing a path full of chasms with no bridges in sight. Now though I'm accepted at MCPHS, I have housing in Salem, and I just bought my ticket to fly back to the East Coast. At each step along the way God has been faithful, even when the road has semed crazy, and it's really only the beginning of the adventure. 

I'm also going to miss seeing Mt. Hood from my street
and downtown Portland.

     Of course, my plans to become a PA did not start with this blog. I've spent years preparing and planning to get to this point, and I've learned a good deal about what it takes to apply and get into a PA program over these years. Much of what I've learned has come through the hard lessons of trial and error (mostly error) as this has been very new territory for me. In light of that, and as I spend this next month and a half preparing for my journey back to Boston (and my sister's wedding at the end of July!!!), I thought it would be a good time to share some of these lessons that I've learned to make life just a little bit easier for anyone else thinking of pursuing a career as a PA. Obviously, I don't know everything about the process, and I'm not claiming that I do. I just want to help others avoid some of the mistakes I've made. I'll be dealing with a different topic for each post (getting medical experience, prerequisite classes, dealing with CASPA, interviews, etc.) and just giving some tips and thoughts on things to do or avoid. I hope they're helpful to anyone else just starting the journey. 

Halloween's Going to Be Interesting This Year...

     After months of much frustration and searching, I can finally announce that I have found a place to live! I'm going to be living just north of Boston in the ever so historic city of Salem, Massachusetts! It's a cute little apartment just outside of downtown and I'm very excited. It's especially exciting because I'll be living with some good friends, plus I'll be decently close to the college I attended for my undergrad so I'll be able to see many of my friends there. I'll even be able to return to the church I attended during my undergrad years, which is delightful. 

Cast member of "Cry Innocent" which depicts
the trial of Bridget Bishop

     I'll have to commute into Boston for classes, but that's not really a problem. I did that for a year before, so I know what I'm getting myself into. Boston has a pretty decent public transportation system, so I'll be able to zip around on that and use the time to study. While I would have liked to have been closer to Boston, Salem is a pretty good mix of being within reach of both the city and my undergrad friends. The area is so nice too. I'll be within a mile of the Atlantic Ocean, which is a definite bonus, and Salem is certainly a town full of beauty, character, and history. I sometimes think it's like an older version of Portland, OR but with less hipsters and more witches. I think it'll be quite fun. I'll just have to remember to stay inside on Halloween though because, as I quickly learned during my early days in MA, Salem gets kind of crazy once October comes. There's a million tourists, and the already quirky residents (What Not to Wear did an episode where their subject was a Salem witch and this performance happens everyday June-October, multiple times each day) just get even crazier. It's not all fun and games though since people actually do keep their pets locked indoors on Halloween lest they be used in some sort of ritual, but it'll be interesting at the least. 

     All in all I'm terribly excited to finally have housing settled and I'm looking forward to moving in August! 

PSA: Drowning

This doesn't happen when someone is actually drowning.

     Today I'm taking a brief break from PA school news to share a quick PSA. The weather's finally getting warmer, and the sun is actually making an appearance again, so clearly summer is on its way. This means that a lot of people will be spending a lot more time in or around water. In light of this fact, I found this article very relevant and important. As the title says, "drowning doesn't look like drowning," which means that many of our preconceived notions about drowning (drawn primarily from movies and tv) are false. This is part of why many children drown, even while under adult supervision. I'd suggest that everyone read the article for themselves, but here are the key points of the Instinctive Drowning Response, which is what to look for when someone is drowning: 

• Drowning people cannot call for help. The body prioritizes breathing over speech, so drowning is actually very quiet.
• The mouth of someone who is drowning may both sink and reemerge from under the water, but not long enough for them to inhale or exhale, and thus they cannot shout for help either.
• Drowning people will not wave for help because the natural instinct is to use the arms to press down on the water to push the body up.
• Drowning people cannot perform voluntary arm movements, so they will not be able to grab on to a rope, lifesaver, or even a rescuer.
• Drowning people will be vertical in the water, without any supporting kicks, so they will only be able to keep themselves from being submerged for less than a minute.

     Before someone actually begins drowning, they may enter into Aquatic Distress. This is a bit closer to the public's idea of drowning because a person who is only in distress, and is not actually drowning, will be able to shout for help, wave their arms, and grab onto lifesaving objects thrown to them. The article provides a list of some helpful signs to look for and then ends with a suggestion anyone can do: if you have any suspicions that someone may be drowning (e.g. if they remain in the same spot, appearing to just tread water and stare into space), simply ask them if they're alright. If they answer, they're probably fine, but if they don't reply at all, you might have less than a minute to act. 

I hope you all have a happy, and safe, summer!

Snippets from the ED

Clearly we're always very serious in the ED

     When I returned home after my junior year of college, I sought out ways I could spend my summer volunteering and gaining some medical experience. I soon found out that even most volunteer positions require some sort of medical training or experience, which certainly limited my options. Fortunately, I was able to begin volunteering at a local community hospital. Since I started I've worked at the front desk, the birth center, and the emergency department, but the latter has certainly been my favorite. Today I present to you a few of the things I've learned and/or seen in the ED. They're kind of random and might not flow very well, but I hope you enjoy them anyway.
      One night a patient had been asking repeatedly if he could get a referral to a mental hospital. When the doctor came in to ask if they could draw some blood to do a toxicology screening, this conversation happened: 
Patient: "Doctor! If they draw some blood can I go to a mental hospital?"

Doctor: "No I don't think that'll guarantee you a spot."

Patient: "Well what will?"
Another time a patient was just trying to get some drugs, and kept mixing up his story. When the doctor confronted him on this and told him that what he'd just said directly conflicted with what he'd said earlier, the patient's response was, "stop living in the past, doctor!"

     As you might guess from the previous paragraph, there are often patients who are a bit off who come into the community ED. Some legitimately suffer from mental health problems, and we try to help those the best we can. However, it can be hard to tell who those patients are because we have many patients who fake problems. Some are merely drug seekers who roam from one ED to the next looking for a prescription, some are homeless people who just want a warm place to sleep, and some pretend to be suicidal either to gain attention or medications. For the record, that last idea is a very bad one, which the fakers soon discover. If any medical professional hears a person voicing suicidal thoughts, even if they may have seen this person do this many times before and are pretty sure they're not serious, they are still required to keep them under watch for a certain length of time. This is not pleasant for anyone involved. Firstly the patient's room must be stripped (everything but the bed and monitor is removed), and then the patient is put under constant surveillance, so a nurse or guard must sit in a chair outside the room with the door open and the patient in view. This lasts for hours and is awkward for everyone involved. I don't know how many times a patient has joked about being suicidal but later recants their statement after just a few minutes. It's too late then though, because we have to be prepared for the possibility that this time the suicidal ideations are real.
     Some nights in the ED one problem is fixed, only for another problem to be discovered. That happened one night when a 70-year-old woman came in because she fell and hurt her wrist. It seemed like it was just a basic case and the woman would simply need a splint. However, upon hearing that the woman had hit her head as well when she fell, the doctor ordered a CT scan to see if there was any cranial bleeding or fractures. He didn't find either of those, but he did find a very large a brain tumor. That was a tough message to deliver, and you could see it all over the doctor's face. Of course, there was another night when we thought we'd be delivering some tough news (that a man had diabetes), but then the nurses realized that his blood sugar was just really messed up because he'd been drinking and hadn't told them right away. 

There's almost always Juanita's in the break room.
I pity the people outside Oregon who have never
experienced these chips.

     With all the crazy things that can happen in the ED (though frankly the ED is rarely as hopping and dramatic as you see on TV), you sometimes need reminders to slow down and take a breath. I usually stay by the ED techs and secretaries whenever I don't have anything else to do, and whenever their computer goes to screensaver, it simply says "Breathe...." Humor is also pretty important in the ED. However, people unused to the humor of medical personnel, particularly those who work in EMS or EDs, could be rather thrown by the jokes since they are often rather dark. Occasionally doctors and nurses will play a game of "high-low" and try to guess anything from the number of meds a person is on, to the number of times someone has been to the ED recently, to the length of the object a person has shoved up their rectum (true story -a guy can in with a large shaving cream can stuck all the way up there. The x-rays were impressive and there was a long discussion about the best way to remove it. When asked how the can came to be there, the patient simply replied, "I sat on it.").

One of the most common ways to handle stress
in the ED: eating sweets. Seriously, people
should get stock in this company because the
nurses and doctors eat so much.

     The most stressful day I've ever experienced in the ED was in the week between Christmas and New Year's. Apparently this week is well-known for being the worst time of the year for EDs and I soon saw why. The night I came in, I had been there less than three minutes when I was asked to strip a room for an incoming patient with suicidal thoughts. Just a short while later, all the beds were filled (something I'd never seen before) and an arriving team of paramedics had to wait with their patient in the hall. By the end of the night we were in "full deferral" which means that we'd told the dispatcher not to send us anymore ambulances because we could not handle more patients. Apparently that had happened the night before as well and when other hospitals in the area became similarly overloaded some patients were sent all the way to Vancouver, WA. Luckily that night we were able to discharge and admit some patients and accept one last ambulance, the most serious patient of the night. 
     Although I've practiced CPR many times, I had not yet been able to actually see it in practice. That night we received a call from paramedics in the field telling us they had a 37-year-old woman in cardiac arrest and were bringing her back to our hospital. The thing is though, she'd already been down for 40 minutes before she arrived, and some of the nurses were annoyed that her death hadn't just been called in the field. No one thought she would be resuscitated, but they were willing to try since she was so young and her death had been caused by an overdose, not preexisting heart problems. The paramedics had also been performing CPR the entire time, so that was a point in her favor. Although I could not help because I was only there in a volunteer capacity, I was allowed to watch the entire process. The doctor and nurses performed CPR for about 10 minutes (with a break every 2 minutes to check for a pulse, which only one nurse reported and no one else confirm) before the doctor asked if everyone was ok with him calling the patient's death after the next check. Yet again no pulse was detected, however, much to everyone's surprise and disbelief, the heart monitor showed a tiny bit of electrical activity. The doctor called for a shock and suddenly the heart that had been still for almost an hour began to beat again. Unfortunately I had to leave to run samples to the lab shortly after, so I never got to see the woman wake up, but I did find out that she was later admitted to the hospital, so she stabilized at the very least.  
     I have more tales from the ED, but I'm realizing that this post is already rather long, so I'll end here and continue on with more stories (most of them a bit more humorous than these here) in a later post. Now it's off to work on scholarships and housing once more. 

The Real World, Housing and Excel

     A short while ago I got the somewhat terrifying picture above in an email. It was yet another reminder that I'm in the "real world" now, and that soon I have to start spending the big bucks to pay back the loans I accumulated as a young undergrad student. It's not a pleasant thought, but it is made more manageable by the facts that I at least have a couple jobs now so I actually have money to spend on these loans, and once I start PA school in a few months, these loans will be deferred until I finish the program. I'm just hoping that I'll be able to avoid acquiring even bigger loans to pay for that. So, it's off to find and apply for scholarships, as well as develop a better budget. My previous budget plan could have been summed up (rather tongue in cheek) as "don't spend any money," and while that has served me well thus far, I realize it's not very realistic and it certainly won't work once repayment arrives, not to mention in the rest of life. Despite my apprehensions about loans and repayment, this has given me a chance to embrace my German side and have some fun with Excel. I have a feeling that my budget system will be tweaked over the upcoming months and years, but I kind of like it right now, and it's even color-coded. :)

     Before loan repayment starts in a couple months, I have some other important issues to resolve. The biggest one is probably housing since that will determine how I get to school everyday, whether I'll need a car, if I can work a little on the weekends, etc. This issue has certainly been bothering me, but I have to admit that I'm not 100% sure of the best way to tackle it, and whenever I try to come up with a solution I tend to get distracted by more minor matters like how I'll decorate or how I'll manage to bring my crockpot, waffle maker and fluffy robe back east. It's a good thing I can laugh at myself and luckily I have friends and family who have gone through the same issues and who are willing to help me figure things out. I could always use more help though, and if anyone reading this has advice on the best way to find housing near Boston, I'm all ears. And if anyone particularly knows of a kindly, old lady who drinks tea and wants to rent a floor of her house to a young grad student (one suggestion from a friend), just drop everything you're doing and tell me right now because that would be a dream come true.