Surgery rotation update!

Currently on my first rotation - Surgery! I have so much to say, no idea where to start!! It is so exciting!! Can you tell by all the exclamation points I am using!?!?!?!?! SO EXCITED!!!!!!!

My surgery rotation is at Holy Spirit Hospital in Harrisburg, PA with the Kunkel General Surgery Group. My first week here was rough. I mean really, really rough. Like, chicken running around with head cut off rough. Starting off rotations is overwhelming in itself, but starting with surgery is so incredibly intimidating. Probably the most mentally/physically drained I've been in my life. You don't know anyone, the hospital is a maze, you don't know how to use their computer system, you are working from 6am-6pm after being used to sitting on your butt in a classroom all day. Maybe it's just me, but even for the simplest things you have no idea where to start. I even remember freaking out to myself about where it was appropriate to sit down and have a glass of water (Do I sit in the physician's lounge? Or go to the nurse's lounge where they may all eye me suspiciously??? Maybe I'm not supposed to sit...didn't they say something about not taking breaks???). Just constantly walking around with this clueless, glazed over look on your face.

Every morning starts off with doing rounds. Rounds is when you do progress check ups on each of your inpatients, do a quick physical exam, check labs, vitals, then write a note, come up with a plan. In a nutshell: Are they pooping? Peeing? Walking? In pain? How do their incisions look? Feeling better, worse? Ready to be discharged? Can I feed them yet? This gets pretty routine but its fun when you get to know a patient after seeing them every morning.

After this, me and the other PA student, Jes, grab breakfast with the two surgical residents, Jordan and Chad.  They are cool. Always in a good mood. Answer our questions. Pimp us. Teach us. Make fun of us constantly. We make fun of them back. Share corny medicine jokes. We sort of follow them around like little puppies.

Then we head to the OR. Cases start as early as 7:30. We check the board to see what's on the schedule, decide which ones we want to scrub in on. Most of the time we stick with the general surgeons, so alot of the cases I see are lap choles, lap appys, hernia repairs, mass excisions, colectomies. Occasionally we get the rare treat of seeing a tumor removal, or some sort of emergency surgery. Sometimes I sneak into vascular for carotid endarterectomies. Those are my fave :) There is something so satisfying about watching someone slowly pick off the plaque from the inside of a carotid artery. Especially that moment when it finally becomes loose. Here just watch:

http://www.youtube.com/watch?v=9lDf3sx_ZrE

It gets good at 4:00 ;)

Anyway, before the surgery, I usually introduce myself to the patient, ask them about their history of their condition. Then I help with the pre-surgery prep. If they need to put in a foley, sometimes I ask if I can do it, or I might ask to do the intubation. When I can tell it's a complicated case or that everyone is in a rush, I hold off on trying to do things so I don't disrupt the flow. Prepping the skin is fun too. Maybe I am just easily amused. I do a pretty good landscaping, if you know what I mean har har har :P During the actual surgery, I am usually retracting, picking up skin, using the suction, holding the camera, deploying the endocatch bag, and I LOVE to suture. I am getting better and faster at closing up the incisions but I think it takes a while to get as fast as the residents and surgeons are. The lap choles and lap appys get a little repetitive but I still like scrubbing in on them because that just means lots of port sites for me to close!

After the surgery, I usually help with transporting the patient out. Then I go find the resident and ask to write-up the post-op orders or write prescriptions. It's good practice because you only remember things like dosing after writing them over and over again. 

Between cases, sometimes we get consults on the hospital floors to do things like take out drains, I&D abscesses, do biopsies. I cannot tell you how many anorectal abscesses I have assisted with draining in my short 5 weeks of being here. It just seems to me like an unusually high frequency. Other consults involve doing a thorough H&P on a patient and deciding if they need to go into surgery or not. These are nice because OR work mostly just tests your anatomy knowledge. Being on the floor lets me test myself clinically, see how good I am at figuring out what info is important, when surgery is absolutely necessary, interpreting labs and imaging, stuff like that.

When there is down time, I might go to the outpatient office with one of the surgeons. This isn't exactly my favorite thing to do since the point of being on a surgery rotation is to see surgery, so I've only gone to the office twice, but I still think it's important to get a full idea of how everything works. In the office, we mostly do pre-op checks, post-op checks, remove sutures/staples, and minor procedures like removing small cysts, lipomas, I&Ds. It's nice to see patients doing so much better in their post-op office visit after I helped operate on them the previous week. Sometimes Jes and I just hang out with the residents in the lounge and ask them to teach us about a topic. On Wednesdays, we have our weekly educational lunchtime meeting where we listen to presentations about various topics. I had to give a formal presentation myself last week. It was aite. I'll talk more on this later.

When I first got here, I was a little caught of guard by the surgeons here. Man are they feisty. Not all of them, but the ones that are...they like to bring up some pretty taboo conversation topics in the middle of the surgery. Some teach more than others, some make fun of you more than others, but overall I feel like they have a good attitude towards students. Sometimes you just need to have a thick skin and not be easily offended/embarrassed. Occasionally I see a temper tantrum, like a no-holds barred, foot-stomping, war-cry in the middle of the operation. I feel like I get pimped quite a bit, but I actually don't mind. When I get a question right, it just builds my confidence, and when I get something wrong, at least I'm learning. But you can bet I get a good amount right ;D.

OK I need to stop here because it is late and I need sleep!

I'm alive!

Oh man, I'm in trouble. Haven't blogged for dayzzzzz. I guess my lack of blogging is some indication of how busy we've been.  Alright alright I will catch you guys up with EVERYTHING we've been up to, now that we are starting our LAST didactic term!

First, the not-so-exciting stuff:

1. Study/class/books/exams/most of life - Slowly been making our way through all the clin med topics. So far, we have done Derm, EENT, Endocrine, GI, Hematology, Pulmonology, Infections Disease, Cardiology, Urology, Nephrology, Neurology, Rheumatology, and Orthopedics. That leaves us with Geriatrics, Pediatrics, OB/GYN, Surgery, and ER med to cover for our last term to get us prepared for rotations. Last term we had Radiology which from what I hear, is not offered by all PA programs. So overall I think we were glad to have that course. During summer, we drop Radiology and instead take Behavioral Med. Also, we are studying for our oral board exams. Don't want to scare any of you too much, but it's at the end of the summer term and basically you get pimped by your faculty on the spot to give your differential diagnosis for two symptoms, then you have to give them the full run-down for two different conditions. And it could be any symptom/condition from this huge list. And people are starting to study for it already. And I'm getting stressed out just blogging about it so I'll stop here.

Ok now more exciting stuff with pictures:

2. Clinical Skills Lab - We have had two so far, one in Winter, one in Spring, and have one left in the Summer. Basically these are the labs where you learn how to start IVs, give injections, insert NG tubes,  get ABGs, venipuncture, sterile technique, insert urinary catheters, etc. These are on a Saturday, starting around 8am and ending around 2-3 pm, and we usually get a week day off the following week. Although the days run long, they go pretty quick, are sort of fun, and a confidence booster to get your IV/venipuncture practice in. Oh, also we are fed breakfast and lunch which equals joy in my life. I'll let the photos do the rest of the talking:

First IV ever.

Practicing hemoccult tests with chocolate pudding fake poop shmears.

Capturing first-stick facial expressions. 

Please appreciate the textbook-worthy weal I made.

Free food = happy PA students.

 3. We finally got our individual rotations sites:

It was a big deal.

4. PA Olympics - This is an annual competition for all 5 of the Philly area PA programs: PCOM, Drexel, Arcadia, Phila U, and Salus. Each program raises money and at the end, all the money goes to the winning program's organization of choice.  I didn't go but my classmates did a great job representing PCOM and from the photos it looked like alot of fun. Didn't take home the trophy but we won trivia :) Also it is probably the only BYOB event of the entire PA program, so I'm sure that helps haha.

Bros getting swol.

Speculum egg race.

5. Community Service Projects - One of the courses unique to our program is Community Service. In the Fall term we write a paper and do a powerpoint on a community health non-profit organization of our choice. In the Spring, the continuation of the course is to address a community health need and execute a 45 minute presentation to our population of choice, educating them on whatever topics we feel are most important. At first, it honestly sounded like a drag but it ended up being one of my favorite experiences in PA school thus far. We decided to talk to a first-grade classroom about germs and the prevention of disease, focusing on hand-washing and proper coughing/sneezing techniques, but also including bits on the immune system, exercise, diet, and other healthy habits.

We had the kids act out the immune response, so the boy in the upper left is a B-cell making antibodies, and the girl in the lower right is a macrophage presenting an antigen to a Helper-T. Yeah that's right, we came up with that. So clever, I know, I know :)

I've never made friends so quickly before in my life!

The kids were so cute! They were so excited and happy to have us there, and they're at that age where they just love to participate and talk about themselves. I definitely think we cut ourselves a break picking young kids as our audience because they are really easy to entertain and work with. When I started my segment on drugs and smoking, immediately they all wanted to tell me about how persistent they were in trying to talk this relative/parent into quitting smoking, how bad drugs are for you - they all wanted to teach me! Anyway, it was one of the best days I've had so far, and reassuring for me personally to know that I may very well have a future calling in peds :)

6. Face of the PCOM PA program. No big deal ;D

7. Casting Lab - During our Orthopedics block of Clin Med, we had a one day casting and splinting lab.  Dr. Auth, director of the Drexel PA program, is such a great, entertaining, humble, and fun lecturer - probably my favorite guest lecturer we've had so far. He said when he first started practicing, casting and splinting was one of his favorite skills to do because it was the only thing he knew for sure that he was good at. I have to agree. It's basically paper-mache haha.

Getting plastered on a Tuesday morning wooohoooo! We are so wild and rowdy...aaaand I tell really lame jokes hahaha.

9. Advanced Life Support - This was a 3-day course built into our curriculum to get our advanced life support certifications as a continuation of our basic life support skills. Not much else to it, just brushing up on our CPR, EKGs, learning about what you really do when a heart stops beating, and taking an exam at the end.

Just trying to be an artsy fartsy hipster PA student during ACLS training.

8. National Quiz Bowl - Every year at the National AAPA Convention, PA programs compete against each other in a trivia style competition. A couple months ago, our faculty asked if anyone was interested in being on the team. Me personally, with my competitive figure skating/gymnastics/pageant background, how do I put this...I like to win at things hahaha. So of course I volunteered, and for the past few months the three of us met with Jen, one of our faculty, to practice and prepare. The competition started out with 64 teams that completed a 50-question M/C clicker competition projected on the big screen. The top 36 scoring teams then got called up round by round (4 teams at a time) to go up on stage and compete in the buzzer portion of the competition. Nerve-wracking to have to sit there and just hope and wait your team eventually gets called, and we were so ecstatic when we finally were! We were eliminated in the first on-stage round - Wake Forest ended up winning our heat and advancing 2 more rounds to the finals, so I guess I don't feel too bad we lost to them. I'm just proud of myself for buzzing in and answering the first question of our round correctly (even if I completely blanked for 5 seconds and almost choked on stage like Miss Utah haha) and I think I make a pretty good argument for being able to handle a good pimping from my future preceptors :) After it was over, the director of our program came up to us and shook our hands, congratulating us and telling us how proud the program was for our performance. Definitely another highlight of my PA school experience thus far.

Our fan club. <3 you guys back.

Our classmates and even our faculty were there to support us and cheer us on! 

Jen encouraged us to dress up in costumes and thanks to my ingenious idea, we were most definitely the best dressed team there.

The stage.

Who cares if we didn't take home the cup? Professional photogs be all over us *brushes shoulder.  This was during the multiple choice round. Obviously I am posing candidly, trying to look intelligent.

OK that's it from the last few months I guess. Sorry again about the lack of updates! School is just crazy. Hope you all understand...or you will eventually when you are in PA school too :)

Remember how last week I said I was going to work on my empathy?

SPs Part II

Quick update on the SP from last week. Nailed the diagnosis. Lucked out. I always feel like I luck out. Maybe I need to learn to give myself more credit. OK I am just that good. Hehehe.

I'm sure they're just starting us off easy but overall, it was actually, dare I say it, fun :) All those repetitive, draining SP encounters during H&P are paying off. Felt like I had a mystery to solve, and it was really cool to be able to say to a patient for the first time, "I think you have _____, and I'll prescribe you ____ which should take care of it." Then, after feeling on top of the world, this happens:

I debated whether or not I should post this but the message I'm trying to drive home is that PA school is great and making you feel average. Can't let it get to you. Above is how my standardized patient rated me. Our PARS scores don't really affect our grade - they're for our reference, and if anything alarming shows up, your advisor will sit down with you and address it. They explain to the SPs to rate us VERY critically, which is why the scale is from 1-9 rather than, say, 1-5. You rarely get 8s and 9s. Also, every patient rates slightly differently. In general, they say to focus more on the comments on the bottom. Sometimes you walk out of the exam room like you own the place and then you get your PARS score and it's all 4s. Other times you think "Crap I blew it...," turn to look at your classmate who also just exited their exam room next to yours, the look on their face says "Yup I blew it too,"...and then you get back your scores and it's 6s and 7s.  The one that really frustrates me is "Demonstrated empathy." I mean, how many times can I say "That must be really frustrating to work through," "Oh I know it hurts, I'll try to be gentle," "I'm so sorry your posterior nasal drip is waking you up at night!" to my fake patient with a fake illness before I start sounding over-the-top fake myself?!?

Anyway, last time my focus was on getting a gauge for our new 25 minute time limit and being thorough, which I feel I accomplished. Next time...I guess I'll work on my empathy.

Leaving you with a photo of how Jeremiah organizes his tools for the comprehensive neuro exam because you really do need tubes of cinnamon water and cotton swabs snapped in half. People who sew, better start making your tool belts now:

I'm half PA book smart

The heme exam I was studying for on new years was fine. I feel like some clin med exam topics are harder than others but in the end I always score about the same anyway. Not sure what that means.

Last week my advisor sent out an e-mail mentioning that we had already completed 31 weeks of school, and had 31 remaining until rotations. Which means that as of today, we are more than halfway done with didactic...and I have only blogged 4 times...I'll work on that. Anyway. Crazy. 30 weeks left. Felt like only yesterday when this photo was taken:

white coat swag

You mean that at this point I should be half book-smart to being a real PA?? Hah yeah right. Yesterday was our first Clinical Seminar small group meeting. This is where one student pretends to be the patient, another is chosen to be the PA, and as a group we chug through the differential, H&P, diagnostic studies, diagnosis, and treatment. The faculty seem to get really excited about students who go all out and dress the part of the patient (for example, old people, street walkers, using puppets...). I'm sure for them, they've done this so many times that it's like "meh...*yawn*." Don't worry teachers, I'll do something good when it's my turn!!

I was nervous because I didn't want to get called on to be the first PA. Thankfully I wasn't...but then I was called to be the scribe. This gives me anxiety because I write like a dude and I'm really embarrassed about it, but hey here is a photo and don't judge my handwriting!

Mrs. D did not seem pleased I was busting out my iPhone photography in the middle of seminar but I tried to explain to her that I'm the official class blogger and the authenticity of my posts would be severely jeopardized if there was a lack of photos!!!!!

Alec the PA (bottom left) was killing it up there. After narrowing down the differential, we figured out Mrs. D gave away that Jillian (bottom right) had mycoplasma pneumonia, an atypical pneumonia that tends to affect younger patients living in crowded areas and is characterized by having a slow-onset of generally mild symptoms, including cough with absence of sputum, headache, fever, sore throat, and fatigue. Unilateral lung consolidation in the lower lobe is usually found upon physical exam, and it is treated with macrolides (erythro, clarithro, or z-pack). Applicants, now you have one less condition to know when you get into PA school.

Tomorrow is our first standardized patient encounter of the term. This one is different from our previous encounters because we will do a directed history and physical rather than a comprehensive. This will also be the first time that we'll be on our own with the emphasis on attempting to hash out a diagnosis on the spot. After a whole term of seeing weekly SPs, I've realized the following things help get me through it:

1. Don't freak out.

2. Get yourself pumped! Don't be so worried about doing poorly that you start dreading it. Just remind yourself that this is a simulation of what you have always wanted to do and sometimes the SPs are fun and down to joke around and you're going to make mistakes and miss things and not nearly know everything but as long as you don't do anything malpractice-worthy it's cool.

3. Dress cute. Ok maybe that's just me but whatever.

4. Don't freak out. This really applies to PA school in general.

Waiting in the hallway just before our final SP encounter of fall term. Don't know why we were so excited about it because it wasn't like we weren't going to have SPs for the rest of the year...

I will let you know how the SPs go. Really though, I'm stoked. School is getting real. Also, for those of you lucky enough to be interviewing 1/18 next Friday afternoon, Camilla and I will be leading the tour. Can't wait to meet some of you! Interviewees always look like nervous uptight penguins walking around campus and it cracks me up (don't be ashamed, we've all been there). They put you in this waiting room with glass walls that faces the lobby and every time I walk by, I'm tempted to make funny faces against the glass and do the dougie or something, but then I think, "hmmm...better not."