My first patient at SJC hospital was an 8 year old male who was wheel chair bound. I was nervous because I have always had adult and adolescent patients. He seemed more fragile to me. He had a tracheostomy and a breathing machine because he was born without his left lung. He also had a gastric tube. These were two things I was not used to. “Good morning, my name is Ashleigh. I am the physician assistant student,” I say to the mother. I look down to the young boy and say “good morning” with a smile not even sure if he can even speak. He holds his arm out to shake my hand and greets me with a “Hello!” and a bright smile. After taking a history from his mother, it was now time to do a physical exam. I examined his head, eyes, ears, nose, and neck with no problem. I knew pulmonary, cardiac, and abdomen were going to be harder for me. He was fragile in my eyes and I felt he was too delicate to touch. I didn’t want to have him over exert himself during auscultation and I surely didn’t want to palpate his abdomen once I saw he had a gastric tube. “I have to press on your belly now okay? You tell me if it tickles or it hurts ok buddy?” He looks at his mom with weary eyes that made me more nervous. A giggle leaves his mouth and I start to become more at ease. I palpate more, “Ow, that hurts.” My first pediatric patient wouldn’t be my last pediatric patient to say “ow” or to cry. During my rotation at SJC, I would have many more children that would cry out in pain. All of these patients became fragile and delicate to touch in my time of care. In school, we learn to do a pediatric physical exam but you have to find your own flow of how you want to do your physical exam. Pediatric patients are different. They aren’t like adults, they don’t stay calm (most of the time), and they don’t understand that it will all be over in a mere few minutes. As delicate as they seem, a proper history and physical is critical for their health and for a correct diagnosis. It was hard to overcome the thought that I was causing them more stress and pain. It’s also not easy to hear heart sounds over a child that’s crying. Focusing in on those heart sounds or breath sounds, and performing a quick and thorough physical exam was something I had to adapt to. It’s not something that I mastered overnight, but something I gained experience in as the rotation progressed.

For those that have tried to use the "Contact Me" Link in my blog, it probably hasn't been working for you. I really apologize!! I have now updated it, and it should be working again if you have any questions! :) Depending on the browser you use, it should come up with some silly words you have to type in that are case sensitive. If you don't see those silly words, it won't work for you. You can always leave a comment with your email and I will get back to you that way also. Thanks everyone for reading!

Im in my second rotation now. I am currently doing family medicine at a FL health clinic in a rural area.

My patients are very sick, poor, and most of the time have no insurance, or very little money. I mostly see patients that have diabetes, hypertension (high blood pressure), hyperlipidemia (high cholesterol), depression, and other various diseases.

Many patients will come in suffering from many issues, it is my job to sort out the most important ones. I wish I could spend an hour with every patient I see, but sadly it is not realistic when you have a schedule of 30+ patients.

The walmart and publix drug lists are becoming my best friend. If I need to prescribe anything, I try to go off the list so patients get their meds for free, 4$ or 10$. For you future students on rotation, put a list of these in your pocket. They are very useful and they are not just for the patients that have no insurance, everyone should put them to use.

I also recommend that you download some applications for your droid or Iphone. Some good ones are medscape, epocrates, ICD9 codes. Make sure you ask your preceptor in advance to use your phone. Some dont mind, and some mind a lot. I use medscape mostly especially for drug dosages. I'm getting to the point though where I keep using the same drugs over and over and I don't need the dosages at all...thank goodness! :)

I hope everyone is enjoying the fall and everyone is counting their blessings. God is good...God is love, hope, and encouragement.

My dad and I went shopping today. It happened to be at a place where Cory and I were at near the end of our relationship. It flooded my brain with memories of him. This past Friday, the 21st, marks 5 months since he has passed away. There is still not a day that goes by that I don't think about him.

His death doesn't get any easier. Do I know he is in heaven? Absolutely. I know our heavenly father called him to come to heaven at the young age of 25. Lately, it has been hard for me to have any patient mention the word "cancer." I can feel the tears welling up in my eyes because my mind immediately goes towards memories of Cory and his cancer.

Today, I sat in Nordstroms trying on shoes. I could see Cory a couple years back sitting with me and shaking his head while I tried on shoes. Cory thinking, "this girl is crazy! She loves shoes way too much." I happened to buy the same brand of shoes today that I bought with him. Which I didn't think about until now...

Having someone pass away is hard. As I have said previously, I will never get over it but I will get through it. It doesn't matter that Cory and me have been broken up for two years, he still holds a very special place in my heart.  He has taught me so many wonderful things that I hope to show and teach others. He is just that type of person that makes big impacts on a lot of peoples lives. I hope to do that too someday...

I miss you Cory

So when I first started reading about "pimping," I was not yet accepted into PA school. I thought what in the world does that mean? Getting pimped by a preceptor is when he/she will ask you medical questions. Sometimes you will know what they are talking about, and other times you will have no idea what they are asking. If you don't know just say, "I don't know but I will have the answer for you by tomorrow."

I got pimped for the first time last week by one of my preceptors. I thought I knew that answer, but I happened to be wrong. I was embarrassed at first, but then I got over the embarrassment because I realized there are going to be many more questions I don't know the answer to. Psych is going well, and I have some amazing people that are in the practice.

Everyone is so kind at the hospital and greet you or wave hello. The nurses are helpful and will show me things if I ask them where something is. Im learning as I go. So far I have been able to see patients on my own, write progress notes, and dictate.

I am very thankful and have been happy with this rotation. I only have 4 weeks left, and I will be sad to say goodbye to the people I have gotten to know.

Soldiers, firefighters, police and other public servants show great courage every day. They may feel fearful at times, but they overcome their fear and act with bravery and assurance when others are in need.

I give thanks for these heroes, past and present, who courageously performed their duties at great personal risk. I know that God is with them, now and always, just as God is with me.

Then an angel from heaven appeared to him and gave him strength.--Luke 22:43

Remembering 9/11/01