Clinic might be the death of me.
One thing that I appreciated about taking night call on trauma. No clinic. Don’t get me wrong, I love seeing happy patients who come in for their post-op follow up appointments. I like removing staples, giving injections, and performing aspirations. On the downside, there are those patients who are just chronically unhappy, are major pain management problems, and just overall needy like no other. There’s only so much Norco that I will willingly prescribe before I say, “No more!”
Also, rule of thumb — the number of cancellations in the morning is proportional to the number of add-on appointments in the afternoon. Either way, you will never leave clinic on time. Especially now during the wintertime where I enter clinic before the sun rises and leave after the sun sets.
But on the bright side, I do have night, weekends, and holidays off. After working a year and a half as a night owl, that is a major plus in my book.
Every week, I dictate H&Ps (history and physical examination) for the patients that we operate on. I follow a template I made so I remember to hit all the insurance-required buzzwords so that we and the hospital don’t get dinged by insurance companies. So there’s a lot of complaining going on in the H&Ps I dictate for my patients.
"Mrs. ABC is a 57 year old female complaining of right knee pain."
"She also complains of popping, locking, catching, swelling, and stiffness in her knee."
"Mr. XYZ complains of an antalgic gait and would like discuss a total hip arthroplasty."
The transcriptionists who listen to my dictated H&Ps must think that I have the whiniest patients in the world with all the complaining that I say they do.
Spent an hour retracting in a primary total hip arthroplasty on a 300+ lb male.
Arms feel like jello.
Happy PA Week to the people who knew what going through PA school was like. And to those going through it now, ::hugs:: this too shall pass.
So I am no longer working in Ortho Trauma.
Long story short, I’m still in Ortho however now I am working in Total Joints and instead of working with a big group of Ortho Trauma attendings, I am now working one on one with my supervising physician, a Total Joints orthopaedic surgeon. Exciting? You betcha. Am I terrified? A little. It’s good to have a little fear when you’re new on the job.
So today was my first day and I spent it in clinic with my attending. I have not been in a clinic setting since I was in PA school. After a year and a half on trauma call, it’s weird to see patients fully clothed, sitting up, without a cervical collar, not a speck of blood on them, and not screaming for pain meds. I’m like in this weird alternative universe where patients are actually peppy.
So after a long day in clinic, I got to got home, change out of my business casual clothes (note to self: need new clothes), kick my feet back and watch some football. And I’m having a running commentary on Facebook with one of the Ortho trauma attendings about Monday Night Football. Just another day at the office. I could get used to this.
Campbell University PA Anthem Part II - Welcome to the Creek - YouTube -
This. I love.
I really need to start keeping my promises. Or stop making promises that I can’t keep. Whichever it is, I apologize for the lack of updates, tidbits, etc of my Ortho PA life. Usually, the last thing I want to do when I get home from a night shift is to write about it. Sometimes work gets me frustrated and even the thought of rehashing the experiences gets my blood boiling again.
However, this past weekend wasn’t the case. I ended my work week on Thursday morning and made plans for my “long weekend” off. For some reason, I confuse people when I try to explain my shifts so I won’t even try to start here. Simply put, the way my shifts work out is essentially I’m on every 7 nights with a night off in the middle and then I’m off for one glorious week. So Friday night, one of the attendings hosted a resident roast night at a local hotel. Basically, it was an excuse for the department to get together, cut loose, drink a little, and relive the residents’ greatest moments and laugh at their not-so-great moments. Embarrassing pictures were projected on PowerPoint, OR blunders were relived, and everyone basically busted their guts from laughter. It was a great night and everyone had a blast.
There’s a fine line when it comes to socializing with the people you work with. After all, it’s hard to maintain a modicum of professionalism with coworkers in the work setting if you’ve seen them drunk off their asses the weekend before. I feel like in the medical field, it’s different though. As medical professionals, we see and deal with things day in and day out that the everyday layperson watches on the latest TV medical drama or reality show. We work side by side dealing with those stressors day in and day out. Our job is to help people and that’s what’s expected. Dealing with that kind of high-pressured situation every day of your career, in my opinion, gives you some leeway to cut back and cut loose every once in awhile. And it’s hard for non-medical professionals to understand, try as they might. Even if you try to explain in descriptive detail, it’s difficult for anyone to understand unless they’ve experienced it as well. Which is why it felt comfortable to be able to dress up, laugh, and have a couple of drinks with my residents and attendings. We’re in the trenches together, might as well celebrate together.
And as for what happened when the liquor started flowing? Well, there’s that unspoken rule of the OR: what happens in the OR, stays within the OR.
I’ve blamed the craziness tonight on the supermoon. From the start of the shift to now, I’ve seen the usual MVC, MCC, and fall from standing.
AND THEN there’s the airplane/hang glider crash, burning building, ATV rollover, fall from highway overpass, suicide attempt in front of train, moon walk collapse, the patient peeing in the trauma bay, and the other patient with the explosive diarrhea in the trauma bay.
I’m sure I’ve missed one or two but those were the highlights of my night.
It’s the supermoon, I’m telling ya.
'The Rains of Castamere' is probably not the best song to be humming when I'm suturing/reducing/splinting down in the ER. People might think that I'm about to bust out a reenactment of the Red Wedding.
I have a couple questions about becoming a PA, and I was hoping you could help answer them. I’m wondering how to know if you’re cut out to be PA. I graduated high school with a 3.4 gpa, and I’ve always done well in school (except math). However, I went to a community college to get my AA degree before I transferred to a 4 year college. Since my mother hardly ever let me go out for most of my high school years, when I went to college I got involved heavily with the “party scene” & my (grades) have dropped considerably. I was able to get through community college despite my party habits, but now that I’m at a university I am on academic probation, probably now having to ask the school to let me back in. My mother, who has never wanted me be a PA, is telling me I need to change majors. Problem is, I know this is what I want to do. I just allowed myself to get caught up with the wrong crowd. I know if I disconnect from those people & actually out all of my focus into school, I can get my grades up.. My focus has just been taken away from school and living the “party” life I never had in high school. I’ve experienced it, and I’m ready to focus on school. The only true struggle is chemistry, due to the heavy math at this level. Now that you know my background, do you think I should pick another career? At the end of the day, it’s what I truly want to do & what interests me.. I’m just not naturally inclined. (I also work as a nurse aid & have medical work experience).
Disclaimer: So, I’m going to be blunt here so I going to apologize in advance if anything I post comes off as rude, sarcastic, arrogant, insensitive, etc.
Ok, so you had a rough couple of years in college. You got caught up in the whole “college party” lifestyle and your grades took a hit. Yikes. So you’re thinking that with the grades you’ve got, there’s no way you can be a PA, right?
Knowing is half the battle. You know what the problem was:
My focus has just been taken away from school and living the “party” life I never had in high school.
And now you know what you have to do to fix it.
I know if I disconnect from those people & actually out all of my focus into school, I can get my grades up.
The fact that you have medical work experience as a nurse’s aide helps balance your crummy GPA. But if you can retake courses, especially your basic science courses, then retake them and ace them. Also, from what I remember from the application process, there are several GPAs calculated including your basic science GPA, your overall GPA, and your GPA calculated from your most recently take 16-24 credit hours. PA schools are competitive and while grades are important, PA schools also want their applicants to be well-rounded. So take that in consideration, hunker down, work on improving your GPA and be prepared to explain those dips in grades when asked.
Now, I’m going to be blunt and jump on my soapbox for a bit. I don’t know you and I’m not going to begin to understand the relationship that you have with your mother. You stated that because your mom didn’t let you go out during your high school years, that was the reason you went all “wild and crazy” when you got to college. I’m going to call bullshit. This is me speaking from my own experiences. My parents were strict on me during high school. I didn’t go out. I was sheltered. And when I went to college, yeah I went a little wild and crazy. But that was all on me. It was no one’s fault but my own. I made the choice to go out and party hard instead of hunkering down in the library and studying hard. And it wasn’t because my parents didn’t let me do it high school. Also you mentioned that your mom doesn’t support you becoming a PA, so what? You’re a grown up. I’m assuming you’re over 18 and therefore in the US, you are considered a legal adult. Therefore, you can make your own decisions. If you made the decision to be a PA, own it.
I’m sorry that you’ve had such a hard time in college and that your grades suffered as a result. It’s a lesson that we all learn in our own way in college. Those years in college are spent finding yourself. You find out who you want to be and what you want to do. For some, it takes longer than others. But at least you’ve got your head screwed on straight again and you’ve found your focus.
You asked me how to know if someone’s cut out to be a PA. I’m going to answer your question using your own words:
I know this is what I want to do.
At the end of the day, it’s what I truly want to do & what interests me.
I guess I have Dr. Cranquis to thank for the influx of new Tumblr followers and I’m going to try to make my posts more frequent. Life and work do take priority but I will try not to leave this blog on the back burner for too long. Suggestions, questions, comments are welcomed as well.
So a brief refresher/introduction for my new followers. I currently work as a Physician Assistant in Orthopaedic Trauma at a major urban teaching hospital. What’s Ortho Trauma, you ask? Simply put, broken bones. A lot of broken bones. I work three 12 hours shifts a week, from 7 pm to 7 am, seeing orthopaedic consults in the Emergency Room. I do the initial history and physical exam, order x-rays and labs when needed, and I get to flex my muscles doing closed reductions, splinting, and drilling Steinman pins. That’s the majority of my job. Other responsibilities include checking on post-operative patients, discharging patients, fielding calls from nurses, and every once in awhile I’ll get to scrub in on some surgeries. Going into this job, I knew I liked orthopaedics but ortho trauma was a whole new can of worms within the specialty of orthopaedics that I had absolutely no clue about. A year into this job, I’m still learning.
One of the biggest issues that I’ve noticed when working with trauma patients is the tendency to focus on the obvious injuries. Where I work, whenever a trauma patients rolls into the ER, depending on their injuries they will be evaluated by emergency medicine, the general surgery trauma service, neurosurgery, and ortho trauma. A patient rolls in with an open fracture of their extremity and everyone starts yelling, “Call Ortho!” Starting out, I assumed every ortho injury qualified as an emergency and wondered why the night float resident would drag their feet to go downstairs and see the consult. Of note, literally out of the hundreds of broken extremities that I’ve seen and evaluated in the past year, there were maybe only a handful of true orthopaedic emergencies.
What qualifies as an ‘orthopaedic emergency’? Compartment syndrome and neurovascular injury that threatens the viability of the limb. Really it’s only those two. Ortho injuries fall under the secondary survey of the ATLS protocol, after all, the patient has to be alive in order to treat their ortho injuries right? Of course, I’m not saying that I’m not going to treat a fracture but in the list of life-saving priorities, I think ortho falls pretty low on that list.
What happens more often than not is that when a patient rolls in with an obvious ortho injury, it’s like everything else falls to the wayside. An example is awhile ago there was a patient that came with open fractures in their foot. The cause of their injuries was a motorcycle crash at high speed and they were not wearing their helmet. However, this patient came into the ED, awake, oriented and quite combative. What was the first call that was made? Orthopaedics. We were called to see the patient even before they were taken to CT to be imaged! The initial CT scans were negative and it seemed that this patient’s only injuries were the foot fractures so with Trauma’s approval the ED wanted to admit this patient onto the Orthopaedic service. However, it was hard to believe that anyone could be that extraordinarily lucky to come away from a MCC with only foot fractures. And sure enough, at our insistence, a repeat brain CT showed a blooming subdural hematoma. Then panic sets in, Neurosurgery is quickly consulted, Trauma is called back and the patient is admitted under the Trauma surgery service.
My point? Don’t be distracted by the obvious. Examine the patient from head to toe. Don’t trust the exams of others. Do your own exam. Don’t assume the best. Expect the worst. My supervising attending physician constantly harps to me and the residents to “Always seek disease and don’t hope for wellness.” It’s a pessimistic view, yes, but in expecting the worst you’re surprised when the outcome is for the best.