Man! I Feel Like a Woman (19/30)

Greenlawn Cemetery, a great place to relax if I get home early

      Yet another month has come and gone, and with it has come the end of my psych rotation. Going into the psych rotation I hadn't expected that I'd be sad to leave it, but I was. I had a great preceptor who taught me so much and who helped me grow as a practitioner, and I was surrounded by so many other healthcare practitioners who were just as friendly, encouraging and helpful. It was also such a great thing to see actual differences in the lives of the patients. The best part might have been finally seeing an improvement in one of my patients who was in the ward for my entire rotation, and who didn't respond to treatment for quite some time. When the patient finally said that they were starting to feel better (something we'd been seeing, but the patient hadn't previously admitted), and when the patient's family members mentioned that they thought that my time with the patient had made a difference, my heart felt full to bursting. It's one of the sad things about leaving the rotation that I cannot know how things ended for that patient, but I hope and pray that they continued to improve and were discharged soon after I left.
     Now that I'm done with my psych rotation, as well as my first End Of Rotation Exam (EORE) and PACKRAT (Physician Assistant Clinical Knowledge Rating and Assessment Tool), I've moved on to rotation #2: Women's Health. Although country is one of my least favorite genres of music, I have to admit that I did love some Shania Twain when I was younger and thinking about describing my new rotation kept making me think of her song "Man! I Feel Like a Woman" (plus it seemed a bit more appropriate than "Lovely Ladies" from Les Miserables) so for anyone who wants a bit of mood music while they read this post, here you go: 

     Women's Health has been quite fun so far. As an introvert, it can be a bit difficult for me to adjust to meeting new people every five weeks, and it can take about a week before I really start feeling comfortable, but for this rotation I'm paired with another girl from my class, so it's nice to have a friendly and familiar face with me. Our preceptor for this rotation also likes to pimp us with questions more than my preceptor in the psych rotation, so it's been good to be able to brainstorm with someone else, and somehow not knowing the answer to a question feels less horrible when the other person is just as clueless. Not that we're okay with being clueless. Oh no. My fellow student and I try to spend our time between patients and at home look up any questions, and often try to look at the patient list a day ahead of time so we can study up on pertinent issues ahead of time. We still get stumped frequently, and getting asked questions still makes me nervous, but at least we've started to answer questions correctly, sometimes to our preceptor's surprise. Plus, we've also realized that, as nerve wracking as it can be to not know the answers, our preceptor often cares more that we are thinking through the questions, pushing ourselves to learn more, and to answer with confidence than that we actually know the answers right away.

This isn't quite related to my rotation, but I found this
girl at the beach to be adorable.

     I think there might have been some people in my program who questioned the necessity of a required rotation in Women's Health, but I am so thankful for it. I'm also not simply thankful because I am a woman and thus the things I'm learning seem particularly relevant to me. The truth is that it has become apparent to me that there is widespread ignorance of women's health issues, even among women. For one example, it seems like most post-menopausal women I've seen thus far have some form of urinary incontinence or prolapse or both, yet these are not issues commonly talked about. Both in this rotation and in my life in general, I've also found that many women, young and old, are fairly ignorant of their own anatomy. I'm not sure if this is simply because male genitalia are talked about more in public, but whatever the reason it does women a disservice as they know neither how to describe their problems, what causes them, or how to prevent or treat them. Even trying to explain how to perform Kegel exercises resulted in at least one woman becoming uncomfortable and deciding to simply have surgery instead, despite the fact that Kegel exercises are simple, non-invasive, and decently effective for her condition. Though I'm a woman who's trained as a healthcare professional and covered women's health in school, I'm still struck by how much I've already learned on this rotation and yet how much I feel I still need to learn. Whether in the office or the operating room, there's something new every day. I'm excited to keep learning for the remaining three weeks I have here, and to be able to share this knowledge. In fact, I wish I could write more about this rotation and some of the things I've already learned and done, but I'm tired and I have to fit in some studying for tomorrow's patients before bed, so I'll have to save those things for my next post. 

I don't often have time to go exploring, but Salem really is quite lovely, even on cloudy days.

We're All Mad Here (18/30)

From Alice's Adventures in Wonderland by Lewis Carroll

     This month I finally began my very first clinical rotation! As you might be able to guess from the quote I chose for this post, I started off in psychiatry of all places. I'll admit that I was a bit nervous when I looked at my rotation results after the Spin and saw that. After all, in school we tried to cover everything we could possibly see in practice, but rather than having a section in clinical medicine that covered psychiatric conditions, we covered everything in primary care psychiatry during our first year, and then hit upon conditions again as they related to our systems or topics (delirium and dementia in neurology, autism spectrum in pediatrics, treatments of anxiety and depression in therapeutics, etc.). It made sense to do things that way since the majority of the cases we'll see in practice will be medical and not psychiatric, but it does mean that I spent the last month of classes reviewing my notes from previous psych lectures and feeling woefully unprepared as my first day loomed closer and closer. And then it was here. 
     I lucked out with my first day of rotation because the morning and afternoon were primarily filled with orientations on different subjects and so I was sort of eased into everything. I didn't know that would be the case ahead of time though, so I'll admit that I was pretty nervous as rotations came closer. I actually texted my boss the night before I started and asked if she'd be willing to "mother" me a bit and give me a hug in the morning if I stopped by to get coffee on my way. She did even better than that and not only gave me a hug and coffee, but she sent me inspirational clips from the Rocky movies and an encouraging message. It was exactly what I needed, and, after another message of "good luck" from a dear friend, I was ready to tackle this first rotation with gusto.
     Because of concerns about HIPAA, I cannot say specifics about my rotation, though after three weeks in psychiatry, there are certainly stories I'd enjoy telling. Instead, I'll just include a few of the lessons I've learned so far.

• It is so important to get input from multiple disciplines in order to treat a patient. In part, this is something I already knew. I actually chose to be a PA partly because I love that one of the major emphases of the profession has always been to recognize that PAs work as part of a team to provide care. It's one thing to know this in theory though, and another thing to see this in practice. In psychiatry, it's not just the PAs, NPs, MDs, and RNs working together, but there are also the occupational therapists, mental health counselors, and social workers. It's been so helpful to see how many people can work together to provide care for a patient, whether it's a social worker who helps the patient plan for discharge or a nurse who is the first to notice a change in mental status or an OT who can provide insight into a patient's participation in groups. Family members are also key players because they know the patient best and can provide clues that you would have noticed on your own. It's tricky to get the whole picture without everyone contributing their pieces, but when people work together, it's a beautiful thing.
• Sometimes you cannot "fix" the problem. Sometimes the problem is a condition that progressively worsens over time and you might be able to return a patient to their baseline, but not to "normalcy." Sometimes the problem is not a medical one, but a personal or social one, and all you can do is provide the patient with the tools they need to make changes, but those choices remain their own. Sometimes you do everything right, you use treat the patient with the standard of care, and it doesn't help, or it works, but so, so slowly. This last case might be the hardest and most frustrating, both for clinicians and patients, but it doesn't mean we give up or stop looking for other options. 
• I've come to recognize the joy of "normalcy." It's the joy of realizing that the problems being discussed at a family meeting are no longer a patient's psychotic delusions, but rather issues that could be seen at any family counseling meeting. It's the difference between asking a patient, for example*, why they think their parents are spies for the KGB, and asking the patient to explain to their parents why they would like a little more privacy and responsibility when they return home, and to be treated like the young adult that they are, and not like a child. It's the joy of realizing that your patient has improved to a point that you can now identify with their problems. 
• Sometimes you just have to jump right in. I hate talking to people on the phone, but when your preceptor tells you to call another doctor for a consult, or a patient's family member to get more information, you have to do it. You have to swallow your fears and your nerves, pick up the phone, and announce your name and title with pride.
• When passing through locked doors, always make sure no one is following you through who shouldn't be. Just trust me on this one.

We are ridiculous, but great.

     I still have two more weeks left in this rotation, and I can only imagine what more I'll learn in that time. It seems like everyday is filled with lessons about conditions, medications, treatments, what questions to ask, and how to solve tricky diagnoses. I actually might just miss psychiatry when I move on to my next rotation, which is not something I expected I'd ever say. I still don't know if I'd go into psychiatry once I begin practicing, but I will admit that this time has been challenging, but fun. There's never a dull day. Of course, I must admit, there's a very good chance that I enjoy it so much because I'm not that "normal" myself (after all, how many people spend part of their last day at home convincing their parents to join them in dressing up like hobbits?), but I'm okay with that, just as I'm okay with keeping my options open for all the rotations to come so that I can enjoy and learn from each of them in turn. It's an adventure, and I'm enjoying it all.

I love my parents.

*This is not a real patient example.

Crunch Time (17/30)

"Our Lord has written the promise of the resurrection, not in books alone, but in every leaf in springtime." -Martin Luther

     So... If anyone's wondering what happened to my Lent posts, the answer is that school happened. I'm on my first day of my last finals week ever, and two weeks from the start of my first rotation. While last week had only one exam, and the week before that was, mercifully, exam-free, the week before that one featured two big exams: clinical therapeutics and clinical medicine. The medicine one was confined to the topics of pediatrics and geriatrics, but the therapeutics one covered topics ranging from pediatric fevers and pulmonary conditions to psychiatric drugs to every microorganism that lives on your body and how to treat soft tissue infections. It is probably not  so surprising that the therapeutics exam hit people harder than the medicine one, though it was a bit shocking that about 40% of us didn't pass. There were a variety of reasons why so many failed, but the good news is that everyone who failed was given a chance to remediate, and a review session was held for the whole class to make sure we all had those subjects down pat before starting clinicals.

     Today's test on history and physical exam was not too bad, but now I should get back to studying medicine (neurology and miscellaneous topics) and therapeutics (cumulative for the semester, plus CVA and TIA). I still have thoughts I wish to share on Easter, and I have two half-finished Lenten posts (one on justice and one on the unity of the church, which, oddly enough, were the two main topics of the sermon at my church last week), which may appear sometime soon, or may be saved for a more appropriate moment, but in either case they'll have to wait a tad longer. For now I will simply say that N.T. Wright had it right when he said that Christians should celebrate Easter bigger and better than most of us do. Easter is, after all, the most important holiday for Christians, and is certainly a cause for celebration. In honor of this, my roommate and I decided to try something new this year and begin Easter morning with special breakfast, complete with French press coffee, waffles, and mimosas. I think we'll keep this tradition. :) And now, back to the joys of medicine!

Look out, world! These 96 future PAs start seeing patients in 2 weeks!

Being Quiet

     This week has been another busy one, so, once again, I missed my Wednesday post for Lent. I apologize to anyone who was disappointed. I chose two delicious recipes for the post to help make up for it. I'll try to make the rest of my post of few words, as befits the topic I've chosen for this week: quiet times.

     Throughout human history, people far wiser than me have expounded on the benefits of times of silence and solitude, as well as the difficulties of procuring such times. I won't try to top their wisdom today. Rather, I will simply admit that, even for an introvert like me, planning times of quietness, particularly to be used for prayer or meditation, can be a struggle. I can find time on the train to read a chapter of my book, but blocking out the world is not always easy. I find that I often have to take myself out of my normal environment to truly have time alone. Like many others, I prefer to find the quiet places outside, and use those spaces to meditate and pray as I walk or sit in contemplation. However, sometimes the weather works against you (Massachusetts is welcoming the first day of spring with a new snowfall as I type), and you have to improvise. For me this has meant using my walks to the train or to work as times to pray, rather than listen to music or a podcast. This didn't come easily at first. Prayer is something I've struggled with for a while. My mind wanders, or I find it hard to be silent for long enough to actually listen. I've found though that, even if I don't do this every time I walk, the habit of praying is slowly becoming ingrained into my life. 

     I wouldn't say that I "pray without ceasing," not yet at least, but it has become much easier to simply take whatever quiet moments I have throughout the day and use them for prayer. Sometimes the prayers are just small, scattered things like a simple thank you for beauty or a request for a friend, whereas at other times prayer becomes fluid, almost like breathing -breathing out a request or frustration and breathing in God's response. Sometimes my prayers sound a bit like one of David's psalms, the ones where he simply cries out in frustration at God's apparent inaction or at his own failure to perceive what God's purposes are. Like David, I don't always get a specific answer. When I say, "why?!" or repeatedly remind God how much more I'd like to know, God doesn't always explain. Sometimes the answer simply seems to be the reminder that He is God, and I am not, or that He is trustworthy. These aren't always the answer that I want, but they seem to be the answers I need. No matter what shape my prayers take, whether a wrestling with the Creator or a friendly conversation or respectful awe, the key thing I'm learning (ever so slowly) is that you never get better at doing something if you never try. Prayer is hard. Being silent is hard. Giving yourself time for meditation and self-reflection is hard. But they are so worth it. Perhaps this Lenten season you can try to find moments of quietness, even if just once a day or once a week. 

World's Easiest Cinnamon Rolls

I'd been waiting to try out this recipe for a long time and I was so happy that I could yesterday morning because I had it off. These were the first cinnamon rolls I've ever made from scratch entirely by myself and they were delicious. My opinion can be confirmed by the two friends lucky enough to try these rolls. I could have had more expert testimony, but these rolls disappeared to quickly to let anyone else try.

Brownies

I made these last year for one of my vegan friend's birthdays. They are soooo good. I was very happy because I've been, and still sort of am, looking for a great from-scratch brownie recipe and voila! These are both easy and tasty. However, I will caution you that they are also very fudgy, even after baking a bit longer and adding a smidge more flour than the recipe called for. 

A Time for Compassion

     Two Sundays ago, the sermon at my church began with the story of Rev. Everett Swanson, the founder of Compassion International. Swanson traveled to South Korea in 1952 during the Korean War to preach the gospel to the soldiers. When he arrived though, it was the many children orphaned by the war that consumed his thoughts. Their needs were great, and when Swanson told a fellow missionary about the situation, his friend asked him what he was going to do about it, challenging Swanson to action. He returned to the U.S., unclear of his next steps, and was presented with two checks, completely out of the blue. With this money Swanson returned to South Korea and began caring for 35 orphans. Swanson told American Christians of the situation and eventually set up a sponsorship program. Through this program, people anywhere in the world were given the opportunity to sponsor a child, providing them with food, shelter, clothing, medical care, and education until the child became an adult. What began with one man caring for 35 orphans in South Korea is now a program sponsoring 1.5 million children in 26 countries. 

     So why do I retell this story? Is it simply because it's an inspirational tale that might restore some faith in humanity? Or is it just a tale of how one person can make a big difference, or of how God can use us in ways we didn't expect? All of these lessons could apply, but I tell this story now because I think it is appropriate for Lent. While it may have been forgotten in these modern days, or in denominations that don't traditionally celebrate Lent, the Lenten season has long been a time of increased compassion to the poor, above and beyond what should normally be found in a Christian's life. This was once the time when Christians were expected to give alms, if they didn't do so already. It makes sense. After all, if you are giving up certain luxuries (such as meat or sweets) for over a month, you should find yourself with some extra money. Rather than saving it up or spending it on other luxuries, the tradition has been to use this money to give to others who have less. I think it's a beautiful tradition, and one which should be revived and given more attention. Just as a break or relief in a fast on each Sunday during Lent reminds Christians that the hope of Easter, and all that it entails, is coming, so giving of yourself to others during Lent can be a way of joining in the mission of Easter and working to help build God's kingdom in the the here and now. I'd suggest that this is something we should be doing at all times, but the times of reflection, sorrow, and penitence during Lent might be an ideal to truly take a look at the world around you and ask how you can help relieve suffering.
     Here are a few ideas to get you started:

• Sponsor a child -Compassion International and WorldVision are great ministries to help you do this
• Find a ministry to support -whether it be the coffee shop that helps homeless youths, the food kitchen at your local church, the church services that began as an outreach to ex-prisoners, or a ministry dedicated to bringing clean drinking water to all -there is likely already a group you can support to help them serve others. 
• Sign up for Pledgeling -Right now Pledgeling will give you $5 to donate to a charity of choice, just for signing up
• Give -The simplest thing you can do is to simply give money yourself, directly to someone who needs it. In the U.S. right now I think there's a lot of worry that any money you give to someone on the street will be used to buy booze or drugs. It's a valid concern, but I'm not sure that should stop you. You might take a chance, and your fears might be proved correct, or you might make the biggest difference in someone's day. An alternative to cash is always to give gift cards (either to restaurants or grocery stores), or to offer to take the person out for a meal. Who knows? If you try the latter option you might just find that they change your life as much as you change yours. 

Just some happy little vegans, both temporary and permanent

The two recipes for this week come from last Thanksgiving. I decided to stay in Salem, work in the morning/afternoon, and then celebrate "Friendsgiving" with two coworkers and one of my roommates. One of my coworkers is a vegan, and even though they said we didn't have to eat vegan for our feast, the rest of us all decided to do it anyway. The result was a seemingly traditional Thanksgiving feast (complete with stuffing, mashed potatoes, rolls, green beans, and pie) that simply lacked a turkey. If some omnivores could eat an entire vegan feast and be completely satisfied, I figured the recipes were worth sharing.

Garlicky Green Beans with Pine Nuts

Simple and delicious, these were a big hit. I could be biased because I always love anything with garlic, but the green beans were so tasty, and the pine nuts added a little something special. I have yet to try making them myself, but my source tells me that they were quite easy.

Walnut-Apple Stuffing

If you're going full vegan, you should double-check there's no dairy in your bread (you'd be surprised how often milk is an ingredient), but otherwise this is a scrumptious stuffing. My roommate made it and I wanted there to be leftovers so I could enjoy this for days. Sadly, everyone else agreed with me on how good this was and devoured it all. 

A Week of Prayer and Spring Break Begins

     If anyone was keeping track, you may have noticed that last Wednesday came and went without a post of suggested recipes for Lent. I apologize. Thanks to snow days and exams getting moved around, last week we essentially had mid-terms in the PA program. Tuesday was the only exam free day and the whole week was packed to the brim with studying. I made the executive decision that passing my exam on Women's Health was a tad more important than writing my post on time, so here we are. My apologies to anyone who was disappointed. I have two very good recipes to share this week, and these will certainly be posted on time as I am currently on spring break (when my friends and I went out to lunch after our last exam our awesome waitress overheard us talking about brought us free desserts to celebrate)! To make up for the lack of recipes last week, I present seven prayers from Christians of the past. As Martin Luther once said, "To be a Christian without prayer is no more possible than to be alive without breathing,” so perhaps this week for Lent you can take a prayer for each day to think over and try praying yourself. You don't have to use these prayers; they are merely suggestions. 

1. Give me yourself, O my God, give yourself to me. Behold I love you, and if my love is too weak a thing, grant me to love you more strongly. I cannot measure my love to know how much it falls short of being sufficient, but let my soul hasten to your embrace and never be turned away until it is hidden in the secret shelter of your presence. This only do I know, that it is not good for me when you are not with me, when you are only outside me. I want you in my very self. All the plenty in the world which is not my God is utter want. Amen. -St. Augustine 

2. Behold, Lord,

An empty vessel that needs to be filled.

My Lord, fill it.

I am weak in faith;

Strengthen thou me.

I am cold in love;

Warm me and make me fervent

That my love may go out to my neighbour.

I do not have a strong and firm faith;

At times I doubt and am unable to trust thee altogether.

O Lord, help me.

Strengthen my faith and trust in thee.

In thee I have sealed the treasures of all I have.

I am poor;

Thou art rich and didst come to be merciful to the poor.

I am a sinner;

Thou art upright.

With me there is an abundance of sin;

In thee is the fullness of righteousness.

Therefore, I will remain with thee of who I can receive

But to whom I may not give.

Amen. -Martin Luther

3. O God, early in the morning I cry to you. 

Help me to pray

And to concentrate my thoughts on you;

I cannot do this alone.

In me there is darkness,

But with you there is light;

I am lonely, but you do not leave me;

I am feeble in heart, but with you there is help;

I am restless, but with you there is peace.

In me there is bitterness, but with you there is patience;

I do not understand your ways,

But you know the way for me….

Restore me to liberty,

And enable me to live now

That I may answer before you and before men.

Lord whatever this day may bring,

Your name be praised.

Amen -Dietrich Bonhoeffer

4. Thanks be to thee, my Lord Jesus Christ, 

For all the benefits thou hast won for me, 

For all the pains and insults thou hast borne for me.

O most merciful Redeemer, Friend, and Brother, 

May I know thee more clearly, 

Love thee more dearly, 

And follow thee more nearly: 

For ever and ever. -St. Richard Chichester

5. Gracious Father, we pray for thy holy Catholic Church. Fill it with all truth, in all truth with all peace. Where it is corrupt, purify it; where it is in error, direct it; where in any thing it is amiss, reform it. Where it is right, strengthen it; where it is in want, provide for it; where it is divided, reunite it; for the sake of Jesus Christ thy Son our Savior. Amen. -The Book of Common Prayer

6. Lord, make me an instrument of thy peace.

Where there is hatred, let me sow love;

Where there is injury, pardon;

Where there is doubt, faith;

Where there is despair, hope;

Where there is darkness, light;

Where there is sadness, joy.

O divine Master, grant that I may not so much seek

To be consoled as to console,

To be understood as to understand,

To be loved as to love;

For it is in giving that we receive;

It is in pardoning that we are pardoned;

It is in dying to self that we are born to eternal life. -St. Francis of Assisi

7. Dear Jesus, help us to spread your fragrance

everywhere we go.

Flood our souls with your spirit and life.

Penetrate and possess our whole being so utterly

that our lives may only be a radiance of yours.

Shine through us and be so in us

that every soul we come in contact with

may feel your presence in our soul.

Let them look up and see no longer us, but only Jesus.

Stay with us and then we shall begin to shine as you shine,

so to shine as to be light to others.

The light, O Jesus, will be all from you.

None of it will be ours.

It will be you shining on others through us.

Let us thus praise you in the way you love best

by shining on those around us.

Let us preach you without preaching,

not by words, but by our example;

by the catching force -

the sympathetic influence of what we do,

the evident fullness of the love our hearts bear to you.

Amen. -Mother Teresa

10 Weeks and Counting (16/30)

Everyone's terrified of being placed in northern Maine

     This morning at 9 AM, final preferences for clinical clerkships were submitted. Now the magic of E*Value begins and "The Spin" decides our fates. By the end of this month my classmates and I will know where we're going for each of our rotations, and in just 10 weeks we will begin the first one. For anyone not sure what I'm referring to, here's the gist: every PA student is required to go on at least 8 clinical clerkships/rotations in different specialties (Primary Care, Pediatrics, Medicine I and II, Surgery, Women's Health, Psychiatry, and Emergency Medicine). Most schools also have at least one elective rotation, which can either be a repeat of one of the core rotations, or something completely different (e.g. dermatology, neurosurgery, orthopedics, NICU, etc.). My school lets us have one elective rotation, and also allows certain specialties (e.g. cardiology, ICU, urgent care, endocrinology, etc.) to count as our Medicine II rotation. MCPHS has clinical sites all across New England, and we can be placed in any of them. When we submit our preferences, we are telling a computer where we would like to go. To do this, New England is divided into zones, and we rank the zones for each rotation, knowing that we cannot pick particular hospitals, just the region, and there is not necessarily a site in each zone for every rotation. It's a bit anxiety-inducing to weigh the pros and cons of each zone for each region, and for Medicine II and our elective there's the added stress of preferencing the rotation specialty first and then working with whatever zones are available for it. It's all done now though, so there's nothing left to do but wait. Well, wait and study our tails off because this week is filled with four exams. However, next week is spring break, so a rest is in sight. :)