Passing

Me and my father.

What does this word imply, what does it mean in our lives? 

The new "A"

 

Last Fall was my first semester in PA school and passing was everyone's new goal.  We were all suddenly downstream of torrents of information that had to be absorbed, cataloged and integrated on a precise schedule.  Passing is optimal in this situation.
Our scholastic aspirations had been about earning A's and getting into physician assistant school, scrambling toward our dream of becoming a PA.
But now we were suddenly happy to get a passing grade. 
A "C" was the new "A."  Many of us never thought we would see this day but we did. 

Passing on 

And then my father passed away on January 31st. 

Passing.  What a word.  A polite way of saying that a loved one is now deceased without having to mouth the unpleasant words--"my father died last week" which sounds so abrupt almost impolite, indeed disrespectful.  

And one thing a medical education quickly teaches the new student is to respect life and death.

My father, Jack Collier, in the Navy in WWII.

My father was a corpsman in the U.S. Navy during WWII, which he entered at the tender age of 17.  When he returned he finished his college education at Morehead State Teacher's College, now Morehead State University.  He could have easily pursued a medical degree--his father was a doctor in a small mining community in Kentucky and he tried to persuade his only child to go to medical school in his footsteps.  But my father refused and instead got his PhD in Biology at Chapel Hill and went on to do basic research in embryology and development.

I was an only child of two intellectual parents.  My father never allowed or wanted me to call him "Dad."
He despised the words "mom" and "dad."  Instead, I always called him Jack.  My friends thought this odd.  I think his caregivers at the nursing home, where he spent his last years, thought this strange also.  But you accept what you grow up with.

Passing.  A new ending, and a new beginning.

We pass to another side.  We pass to a new day or a new phase or era in our life.
But in my personal life the passing of both my parents and grandmother all in the last year and a half has brought a closure to many aspects of my life.  There are no more available answers to questions about things in my past, events, objects, trips and so much more. Factual access to personal history is gone.

Jack holding me in a Cape Cod snowstorm.

Each time I return home, from Buffalo, my parents passing takes on an added meaning with a slightly different nuance.

What pieces of their past and my history will I discover and have to disassemble this time?  And how do I continue to integrate this into my new life as a full time student?

Going forward, bringing the parts of the past that matter with us into our future -- that must be passing.

Meet Mr. Bones

Mr. Bones at Kiehl's

Mr. Bones stands up for Canadian AIDS Society

We went up to Toronto this weekend (extended birthday celebration tradition) and I visited Mr. Bones again at Holt Renfrow Department store.  He was wrapped in paper sayings when I saw him this time.

"You have a screw in your sternum"

Mr. Bones is part of a fundraising effort sponsored by Kiehl's and The Canadian AIDS Society.  I took my picture with him earlier this year at Holt Renfrow and wrote a blog post on preparing for PA school while shopping.

Me and Mr. Bones in April 2012

This is one of my favorite posts because I wrote about my son's sternum reconstruction surgery in Norfolk, VA at Children's Hospital of the King's Daughters.

If you are interested in pediatric orthopedics, there is a cool video clip in that post of his surgeon, Dr. Robert Kelly doing a pectus carinatum (pigeon chest) corrective surgery, like the surgery my son had.

Owen goes back next month to see Dr. Kelly to determine when they need to do the surgery to take out the steel bar that supports his sternum and ribs.

First anatomy lab

Tomorrow is my first day in the cadaver lab in PA school.  I'm nervous and excited at the same time.

I will pull my blue scrubs out of the drawer and and hope they aren't too tight.  I swore I would burn these scrubs after leaving my microbiology position at the hospital.  But I never got around to it, and now I'm glad.

Anatomy Lab Post Script -- the scrubs fit.

So we had our introductory anatomy lab today.   All went smoothly.  We didn't actually see our group's cadaver yet.  One cohort of our group dissects the back tonight and we get to do our first real lab next Monday.

We learned the ground rules for the lab today and saw the new iPads and dissection videos that the faculty spent the summer preparing for us.  I admire their dedication in making these instructional videos.  I think they will be very helpful in learning the techniques of dissection.

My scrubs did have a mild formaldeyde fragrance when I got home, so I threw them in the laundry.



 

Positive Predictive Value: the "Truth" of PA School

The positive predictive value (A/A+B)
for me liking PA school is currently at 98%.

So here is a simple chart that we learned on our first day in Pathophysiology class that shows positive and negative predictive values given a % prevalence of a disease relative to the sensitivity and specificity of a test or assay.

So here's my question:

WHY after so many years of being in clinical lab medicine and teaching clinical lab medicine (and being Program Director at two different colleges!) have I never encountered this chart!?!  Interesting....

I find it very interesting and enlightening to re-learn clinical lab science from the other side of the coin, so to speak.  I am learning it now from the ordering side as opposed to the performing or testing side.  It is a very different perspective.  Most informative.  It really makes me see the BIG PICTURE in a way that I did not previously.  Good stuff.

Physician Assistant School

I am only at day three here, so...bear in mind that this COULD (and probably will) change.  I accept that.....maybe.
I still think we (saying my class as a whole) are off to a good start.

So here's to a good start!

LIKE:

• Classes
• Students
• Professors
• Material
• My schedule

DISLIKE:

• Parking shortage

'Nough said.  Back to organizing and studying.

What to do when a woman wants to show you her breast at a football game?

This is not a riddle or a Mardi Gras story

--but a true experience from my years as a lactation consultant 

 

This anecdote came to mind when I read a post on Dr. Bryan Vartabedian's blog, 33Charts, on how medical practitioners handle questions from patients and non-patients on social media and in social settings in general.

I have many, many fond memories and humorous stories from my years owning my breastfeeding store, Mother's Best in Baton Rouge.  And this one stands out vividly.

I had just finished a busy Saturday at the store on this particular Louisiana Saturday in September.

My family was already at Tiger stadium, aka Death Valley, waiting for me.  I had stayed after hours helping a customer with her nursing and was already late, and in fact had not only missed kick off but the better part of the first half of the LSU football game I was trying to get to.

I was grateful to find a parking spot not too far off campus and was making my way along a half mile trek to the stadium when I was approached by a friendly past customer just outside Tiger Stadium.

She stopped me to say hello and update me on her baby's milestones.

Hello quickly evolved into "I have one quick question" and can we go over here "so you can look at my breast for me?" 

So there you have it ladies and gentleman,

how you get asked to look at a woman's breast at a football game.

 

How did I handle it, you wonder?  I told her that her baby was adorable and asked her to come see me at the store.

P.S. 
I once worked for a family practice doc who would scratch his fingernails over the cell phone receiver saying "I can't hear you, the reception is bad..." when his service put through a call about constipation while he was at a ballgame.


What would you have done?  Tell me in a comment.

What Not to Wear on Your First Day of PA School

Because I love a good list, here goes:

The hit parade of what not to wear:

#1 The Bikini 

Even if you look like this wearing one--don't. 

Actually, especially if you look like this wearing one--don't!

 

 

 

Reasons:  obvious

 

1.-class mates (girls) will hate you instantly

 

2.-class mates (guys) will never look you in the eyes again

 

3.-professors- 

either #1 or #2, possibly both. 

 

And guys, this means 

SPEEDO = NO for you.

 

Just say NO to the Bikini concept, your life in PA school will go smoother.

 

 

 

 

#2 The Tux

 or any Formal Wear 

 

Anything that suggests you just rolled in from last night's adventure is a definite NO!

 

Again, Reasons:  obvious

 

You are here to learn to be a physician assistant, a medical professional, not a reality show celeb -- that comes later.

If you have to think too hard about this one (or #1), revisit your choice of profession. 

 

#3 Stiletto Heels 

Or any type of "fun shoe"

 

Reasons:

 

-Preserve the longevity of your feet, and your ability to stand on them and be a PA when you finish school.

 

-Don't look like you violated choice #2

 

And guys, I guess this means no cowboy boots for you, unless you live in Texas.  

Then anything goes!

 

#4 Absolutely anything you wore last summer!

For me, this will include the above outfit worn in Cairo this past summer (see my Egypt post, "View from a Camel") with my uncle.  

We were trying to blend in, hence the head scarf and long black robes. You will NOT see me in this in PA school.

Reasons:

 

Wear something new and different.  Last summer is so five minutes ago! 

 

You are starting a new and important phase of your life!  Wear something fresh, comfortable and appropriate.

 

 

Buy some new mechanical pencils, highlighters.

Stock up your book bag and open up a new page in your life! 

 

YOUR TURN:

If you are a fellow PA student or a school veteran, let me know in a comment what you would add to this list!

 

 

 

 

Thanks go out to my fellow blogger at TheLondoner for her photos.

http://www.thelondoner.me/2011/09/glad-rags-rag-muffins.html

Microbes & Spiders

Bread mold - Aspergillus niger

Microbes we love to hate

I found this cool article on some fascinating microbial organisms we take for granted.   Some of these organisms are beneficial to us yet we fear their reality.

There are many microbes that we are unaware of, many that we know and love and many that we fear disproportionate to their power to interact with us.

Personally, I feel very comfortable handling many pathogenic bacteria and I did so for a living for several years.

I can't say the same for spiders.  I have a disproportionate fear of all spiders.  There will be NO spider pictures on this blog.

Spider Seuss

I do not like spiders.
I do not like them in a tree.
I do not like them with a flea.
I do not like them one or all.
I like spiders not at all.

I don't want to know if there are beneficial spiders or should I say spiders that are beneficial to humans.
I understand that there are many that are helpful to plants.  That's fine plants don't know any better.  I do.

 

Camp Effie 

Live Oak trees at Camp Effie

A visitor saw a brown widow spider in my yard today. 

It was under a large tree in the front yard hanging on a thread of silk.  She identified it and offered to knock it down.  I declined her kind offer thinking that if it ran on the ground I couldn't see it and it might run up my leg.  Yes, probably irrational.  I'm over thinking spiderness. 

She had previously been bitten by a brown widow and was told by the ER doctor that her hallucinations were a common effect of the bite and "enjoy the trip."

 

Brown widows a gift from Katrina

These brown widow spiders, a nasty relative of the black widow, were blown into our state from the Caribbean during Hurricana Katrina.  Interesting how weather shapes our for years to come.

Medical Professionalism for PAs (and students thinking of PAdom)

Jim Anderson's article on medical professionalism in this month's JAAPA, brings up some important topics for PAs.  He presents a hypothetical scenario of a supervising physician whose personal life has taken a tumble and their professional conduct has been tarnished by alcohol abuse and a personal, romantic relationship with a patient.  The PA working in this practice has a longstanding relationship with this physician and their obligation of action is brought into focus.

I am very interested in how communication between clinicians and impacts patient care.  This article touches on some key points in communication as well as medical ethics.  The juxtaposition of these two topics is fascinating.

The hypothetical scenario that PA Anderson writes about is shaped by the relationship and rapport that the supervising physician and the PA share.  Therefore, their communication style and habits are key to the central quandary presented in the article.


These are the issues at hand that I see:

• When does "one" equal "one too many"? OR When is a single violation of ethical behavior at work enough to warrant a whistle blowing action?
• What are our personal and professional obligations to report bad behavior?
• When does this become a legal matter that requires participation to avoid legal consequences?
• How does reporting unethical behavior change our professional relationships?  How does one react to these changes?
• How are we teaching medical professionalism in PA school?

As I approach the start of my PA school, I am eager to learn more about how we handle situations that challenge our interpretation of medical professionalism.  I've just completed a course this summer in Medical Ethics and was exposed to many fascinating case studies and situations.  I wrote a post on my privilege theory that evolved from my theory of "don't do dumb stuff."

I have worked in healthcare for the last twenty years and have seen instances in the workplace that called for intervention or at least reporting to a manager for action. 

Often the guidelines and standards we learn in school are difficult to apply to the gray edges of everyday life.  We make friendships and collegiate alliances with those we work with and seeing exactly how to act and doing so at the right moment is not always as obvious as it appears in a textbook or classroom scenario.