I am officially signed up to take my boards exam..the PANCE on January 10th, 2013. Words can't really describe how much my emotions are like a roller-coaster ride. Some days I feel I am fully prepared for this exam...that the last 27 months I have been preparing myself. Then other days I am anxiety ridden with feelings of failure and that I know absolutely nothing! I still have so much more to learn as I go down this path of medicine. I graduate on December 15th of this year. I am so excited and so thankful that I made it this far. I have one last exam to take on Monday that is a total of 240 questions that is a "mock" boards exam. I'd be elated if I scored an A on this exam because I would finish this semester with straight A's. I have to score at least a B on the exam to graduate with honors. Even if I don't graduate with honors, I will still be proud to call myself a physician assistant. It's weird, because during rotations I would sign my name PA-S. I don't think it will hit me that I am an actual PA until I pass the boards. I have a few interviews lined up, but passing the boards is my number one main concern. I can't work until I pass..so this is my main goal. I will try to post my PANCE study schedule soon and a list of books/websites I have been using for anyone that may need some advice. xo Ash

One patient that stays in my mind was a 21 year old female who was 38 weeks pregnant and had a chief complaint of nausea and anxiety. She was also concerned if she would be discharged in enough time to make it to the methadone clinic. Immediate concern washed over me for her soon to be child. I wondered how I could still show sympathy and compassion for my patient who I knew was taking a life threatening drug. Methadone could cause serious fetal defects for her baby. I was upset on the inside that she would take such risks to harm her baby. On the other hand, I had to find sympathy for her and her current condition—she was on methadone to stop her opiate drug abuse. It was really hard for me two separate the two situations. I know this won’t be the only time in my life where I will come across this situation. No matter what the situation is, as PAs, we are not to judge a patient’s current situation or past.

One of the hardest things about medicine is knowing how to come up with the best treatment plan for each individual patient. A patient that suffers from diabetes may not always be well controlled on just Metformin. Being that this rotation was internal medicine, many of the patients had the same problems: diabetes, hypertension, hyperlipidemia, and overall pain. Patients aren’t always compliant with their medications, but a medication that may be working well, may also give them side effects. I know once I start practicing, I will soon find the medications I like working with, but I am not there yet. What may work for one patient, may not work for another.

Working with veterans was such a great experience. I loved being able to listen to the their stories about their times in war. Working at the VA is different from other hospitals. First, working with a patient population that is dominant in elderly males rather than a mix of male and females was quite the change. I saw more inguinal hernias during my time there. You are also working with patients that have sacrificed their time and lives for our country. A sacrifice many of us haven’t made. Many patients would talk more about their times in war more than their medical problems. I am still learning even now how I can give the appropriate time to listen to the patient’s stories, but get a history and physical done in an appropriate amount of time. As always, some patients will need more time than others. Some patients just want and need someone to talk to. Sometimes, listening is the best dose of “medicine” you can give to your patient.

I know it has been so long since I have updated. My apologies to the ones that check this blog out or have been following me. I have been busy with rotations, and then advanced didactic year is just around the corner! I wish I could make comments on every rotation, but I guess it would be easier to answer specific questions. I have almost completed 8 rotations..Psychiatry, Family Medicine, Pediatrics, Dermatology, Surgery, Emergency Medicine, Internal Medicine, and OBGYN. My most favorite rotations have been Derm, Surgery, and ER. I have realized I love doing procedures. I love suturing lacerations, I just love working with the human body. It has always been a goal of mine to make the patient feel at ease, and make them say, "wow, that was a great experience with a PA." I graduate in December, and will be done with my OBGYN rotation at the end of August. I know once advanced didactic starts, I will be in full on panic mode. Loans, Applying for jobs, PANCE preparation, etc. The list goes on and on. Not to mention writing my paper for my masters. :) I will try to make it my goal to post once or twice a week from here on out. I love helping people who have any questions. Feel free to click on the "Contact me" link and it will send an email my way.

I often wasn’t allowed in cosmetic dermatology patient’s rooms. “They are self conscious,” the doctor would claim. If a patient was having Botox done, or laser resurfacing, they were often embarrassed about their conditions. The PA would often tell me that people who suffered with skin conditions such as psoriasis, took their diseases harder than those with diabetes or hypertension. “You can see the their disease physically with your own eyes. Normally, people on the outside can’t see the physical effects of hypertension or other diseases.” While with the dermatology patients, it was my goal to make these patients feel as comfortable as possible. I would talk to them about their disease, and educate them. They also felt more at ease when you were able to touch their skin condition without being afraid. It’s amazing what the simple human touch can do to a patient’s outlook of their skin condition and the way it eases their discomfort.

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.