I Never Cry

Alice showing why he is rock's consummate performer in a classic and heart-felt performance of my favorite ballad

Thought I'd take a slight detour while I'm in between rotations and serve up some pure music. This entry is dedicated to Alice Cooper, who was a local legend for me growing up in Detroit, and again over the past decade as I've lived in Phoenix.

Alice recently played at the ASU graduation ceremony, performing his epic scholastic anthem "School's Out" (how cool would that be if you were graduating that day?) He performed the tune with his son Dash, who is a current ASU student, and also shared the stage that day with some guy named Obama.

At any rate, I have enjoyed Alice's music and tour-de-force live shows that are Broadway musical-meets-arena rock for most of my life. I'm sure you all remember the infamous scene from Wayne's World where Wayne and Garth get backstage after an Alice show and instead of the expected booze-n-broads shenanigans are shocked to find out that Alice is both intelligent and eloquent. On a related note, I recently digested the audiobook version of Mr. Cooper's recent release, Golf Monster. In this book, you are treated to a fascinating look into the life and career of Alice. He talks about his childhood in Detroit and moving to the West Coast, his early band years and subsequent rise to fame, hilarious encounters with his many celebrity friendships (Peter Sellers, Dali, etc), as well as his spiral into alcohol addiction and recovery. Also, there is plenty of golf talk -- some might be surprised that Alice has been a devotee for many many years and is actually quite a good shot. The audiobook is read by Alice himself, and you can't help but be drawn in by his spellbinding oration -- he pulls off some great impressions and really comes across as an intelligent and passionate guy. The audiobook consists of 4 discs and there isn't a dull moment to be had. I highly recommend it to anyone. Alice, thanks for being an inspiration over the years...

Border Song

Just a little note to say that I've survived my ER rotation, maybe not unscathed, but I did make it. Also, I completed the remediation from my last clinical assessment, which went fine. I was still nervous, but things went much smoother. The official clinical assessment day this go-round went well this time too. I passed the computer exam as well as the practical exam with the standardized patient as well as the SOAP note write-up.

As a matter of fact, guess how many of us in my class passed the practical exam this time? Read Gary's lips:



As some of you may or not may know, I did my ER rotation on the border of Mexico. Shifts were usually 4 12-hour days or nights in a row. I was able to see & do a great deal. Here are some of the diagnoses or procedures I was able to perform:

• suturing a-plenty: eyes, cheeks, chins, lips, ears, knees, elbows, legs, arms, you name it, I stitched it
• full codes -- ranging from heart failure, aystole, diabetic keto-acidosis, stroke, etc
• various and sundry insect/animal bites/stings ranging from scorpions, rattlesnakes, spiders, ants, and dogs
• neuro procedures like lumbar punctures
  
• gastrointestinal disorders including pancreatitis, cholecystitis, cholelithiasis, vomiting, diarrhea, nausea, peptic ulcers, reflux, small/large bowel obstruction, diverticulitis, etc.
• fractures of all kinds, ranging from long bones, fingers, wrists, and even skulls resulting in intracerebral hemorrhages
• Psychiatric diagnoses including schizophrenia & bipolar disorder
• Helicopter transfers of serious cases
• Reducing a dislocated shoulder and dislocated jaw
• Removing a toenail
• pulmonary disorders like pneumonia, atelactasis, lung cancer
• HEENT disorders like peritonsillar abscess, otitis externa, corneal abrasions (with slit lamp exam), strep throat, herpes zoster (aka shingles)
• Plenty of interesting pediatric cases such as a young girl who superglued her eyelids shut and another one who stuck a necklace bead up her nose (removed via suction and alligator forceps)
• Cardiac cases like atrial fibrillation, malignant hypertension, pericarditis
• Renal/Urinary disorders such as UTI, pyelonephritis, nephrolithiasis, BPH
  

This is only a smattering of the cases -- most of the general areas fell in these parameters, but I know I'm leaving a few extraordinary cases out too. The 6 weeks went by in a blur, and before I knew it, I was driving back home.

Unfortunately, I did lose 2 patients during the rotation, which was not entirely unexpected but still tough to deal with. I have worked in nursing homes and hospitals in the past, so it wasn't the 1st time losing a patient, but it never gets easy. And perhaps the most difficult and gut-wrenching thing I had to do was inform a 40-something pregnant woman that her vaginal bleeding was a spontaneous abortion.

I got to work with a wide variety of doctors and learned quite a bit from the techs and nurses as well. To be honest, I was able to get everything I had wanted out of my Emergency Room rotation. I met lots of great people and while it was tough being away from home this summer, I am very thankful for the experience. To sum it up:

Blinded By The Light

Cut loose like a deuce, another runner in the night...

It's funny how we sometimes seem to dwell on the one negative thing amidst a sea of good. I just finished my 1st rotation in Pediatrics, got an excellent End of Rotation write-up from my supervising doctor, completed all the necessary paperwork for both my Continuing Medical Education as well as my required Clincal Master's projects and thus was ready for the random paperwork audit that day, attended my 1st Clinical Assessment Day, and scored rather well on the computer exam in Pediatrics. So all-in-all, not a bad wrap-up of my 1st rotation. However, the Practical section didn't fare as well. I went in feeling nervous but fairly confident, but then it blew up in my face, David Lo-Pan-style...



What am I talking about? Well, the Practical part of our Assessment Day requires us to interview a standardized patient, complete a Physical Exam, order appropriate diagnostic testing and interpret the results, formulate a presumptive diagnosis, recommend a plan (medication, lifestyle changes, education, etc) and then present the entire case verbally as if we were reporting it to our supervising physician. Of course, there is no pressure ... other than the proctor in the room watching you and making notes on a clipboard, the video camera rolling in the upper corner of the room, and the knowledge that your professors behind the 1-way glass are most likely chuckling with glee as you stutter and stammer and clumsily fumble about and otherwise make a fool out of yourself.

I am of course exaggerating as always -- the staff goes out of their way to try to relax everyone and make it a low-pressure situation, but especially on the 1st one, it is simply not possible to be totally relaxed, and the tension and jitters in the air was palpable.

To get to the real point -- I blew the diagnosis. What presented as a possible migraine headache was actually an underlying temporal arteritis. There were sufficient clues present to tip you in that direction, but I simply missed them in my near-panicked state. The acute treatment for temporal arteritis is a high dose of steroids. Failing to do so could end up permanently blinding the patient. And so even though there will be a remediation process for me, and life goes on, I will forever have the knowledge that had it been a real situation, I would have BLINDED MY PATIENT (a fact my brother and roommate rammed home for my edificiation).



So instead of celebrating my successes, I am left with an unsettling feeling that I have a *long* way to go. But, I have to look it at this way -- my training is only 1/2 done, and the rotations are there for us to hone and polish our skills as well as to continue learning. I will say that it was a good "kick in the butt" and I plan on being better prepared for the next one.

My next rotation begins tonight -- Emergency Medicine and I'm in a ER down by the border. The shifts are 12 hours and I'm kicking things off this week with the graveyard shift -- 8pm to 8am. More on that later...

Cold Turkey

John Lennon was always tuned into the pulse of the street... (groan)

Just one more post to ram home the changes hinted at in my last entry.



7-8-9 -- an easy day to always remember.

That is all, and that is enough.

Old Habits Die Hard

This is going to be a short post, but a very momentous one perhaps unparalleled in significance. Those who know me will be able to figure out the crude metaphor. Nothing funny this time, just ol' Mick laying down some truth...


'Old Habits Die Hard' by Mick Jagger

The Kids Are Alright

Well, my Peds rotation continues to go smoothly, and I've now passed the halfway mark. Equally amazing, I've yet to get sick or pick up any nasty bugs or infections, despite treating more than 100 cases of sinusitis, rhinitis, pharyngitis, laryngitis, otitis, conjunctivitis, and every other -itis that kids are getting these days. My doctor has let me do quite a bit, right from the start, and so I continue to do all kinds of fun stuff like deliver immunizations and inject rumps with Rocephin and Decadron. Yes, I've caused quite a few tears in my short stint there, but many more smiles. I have found Pediactrics to be quite enjoyable actually, despite not having any kids of my own.

It is a little weird to not be sitting in a lecture hall right now. Strange how you almost miss that routine. I guess if you do anything for a year, it will seem odd when your start a totally new schedule. One thing that remains consistent is the late-night studying though. That won't be changing anytime soon.

(the Medical Term of the Day will be returning shortly, but I thought I'd share some of the clinical pearls I've picked up and so I present a new feature...)

Baby Instructions
(click on the picture to enlarge so you can read them)

Don't Talk to Strangers

especially if they look like this:


Just kidding!



Turns out Ronnie James Dio , much like the other singer from Black Sabbath -- Ozzy -- is a harmless fuzzball...

Don't believe me? Then check this video for "Love Is All" from Roger Glover's Butterfly Ball children's album and listen to Dio's infamous and ominous pipes as he takes the form of a ... frog? I really dig this song -- has always striked me as a tip of the hat to the Beatles tune "All You Need is Love."



Now that we've all thoroughly enjoyed our Dio, you may be wondering what's with all the kid's stuff? Well, I started my rotation today in Pediatrics. I am at a very nice and modern doctor's office and think I'm going to really love it. In the interest of anonymity and confidentiality of the patients, I am going to refrain from being too specific as I talk about my clinical experience. That being said, it was a busy and eye-opening 1st day. We ended up doing 3 circumcisions before lunch -- wasn't expecting that off the bat, but was pretty fascinating to witness to be honest. Also saw a myriad of common cases involving things like asthma, sinusitis, otitis media, and dermatological conditions. There were also many well baby/child visits, which usually corresponded with the current round of immunizations.

I have a really great preceptor. He's an MD who has been practicing for 20+ years and has a nice little practice with very loyal and appreciative families. He speaks fluent Spanish as well, and we saw several Spanish speaking families already, so I am hoping that I can continue to improve in my grasp of that language. He has a great sense of humor, is very easy-going, and loves to teach -- he is going to provide a mini-lecture every day before lunch on various topics which will help prepare me for his office, my upcoming pediatric exam, and also just to share his own style and preferences. The office staff is all very friendly and encouraging as well, and made me feel very welcome right from the start. I am feeling really good about this rotation -- it should be a great start to a very exciting upcoming year.

Medical Term of the Day: Urticaria

Urticaria is the medical term for hives.

Get on the Good Foot

PA School Part Deux: the Clinical Year

Last post I mentioned that I had officially passed all of classes of my didactic year and was on the cusp of entering the next phase of my post-graduate education. Let me further elucidate by providing my rotation schedule:

Rotation 1: Pediatrics
Rotation 2: Emergency Medicine
Rotation 3: Primary Care
Rotation 4: Surgery (Orthopedic)
Rotation 5: Dermatology (Elective)
Rotation 6: Internal Medicine
Rotation 7: Psychiatry
Rotation 8: Women's Health

This is my own personal rotation schedule -- every student in my class has their own unique schedule as well -- there is no set order that they need to fall in, so it all depends on how they are scheduled. There are 7 required rotations, and 1 elective. Each rotation is 6 weeks in length, and there is both practical and written exams to take at school after each one. Also, I have Master's work (CME's, case studies, conferences, volunteer work, etc) to do -- in case you thought clinical year was just showing up to your residencies, think again. In fact, I think I will probably be busier this 2nd year than I was in the 1st. However, I am told that I will be able to regain some semblance of a personal life again. I have my doubts about that, but it's of minor importance as I love what I'm doing. The above 8 rotations will take me through another full year. Following that, I still have 3 months of school left to complete my Master's track project. Since I chose the clinical track (to clarify for some -- my program allows for a selection of 4 unique Master's tracks -- clinical, research, education, or bioethics -- to further refine your degree), I will have 2 more 6 week rotations to complete. Tentative plans are to complete those and spend the summer of 2010 in Texas, splitting my time between Austin with Kevin, Rachel, and Syndey, and Dallas with Aaron, Ana, and Casper. I am really happy right now with my rotation schedule -- I have some great preceptors lined up, and I'm even fairly happy with how the order came out (Peds off the bat, Women's Health last, etc).

There is a lot of learning to be done in the next year, and the onus now falls on me more than ever to make sure that continues. I think it's finally sunken in that I've accomplished a great feat by surviving the academic year, and I feel ready to put my head down for another year. As Bob Schneider once said, "I've got a long way to get before I get back home."

Medical Term of the Day: Osteomalacia

Osteomalacia is a softeneing of the bones due to inadequate mineralization (calcium and phosphorus). In children, this disorder is known as rickets. A common cause is inadequate stores of Vitamin D, which is obtained through diet or by exposure to the sun.



Scurvy is a deficiency of Vitamin C. Vitamin C (or ascorbic acid) is necessary for collagen synthesis, and this disorder causes fatigue and muscle weakness, joint pain, rash on the lower extremities, and bleeding gingiva (gums). It was common among sailors and pirates as they were deprived of fresh fruits and vegetables for extended periods of time.

A typical Scurvy patient:

School's Out

for some more Alice, go to: http://www.youtube.com/watch?v=fHr6GbWPBVQ
(thanks to Malu for the clip)

I find myself in quite a memorable stretch of time right now -- I have officially made it through my didactic year of PA school! I get a small break before starting the next phase of my education, the clinical rotations. I am still in amazement at how fast the time went by -- I'm not sure a year in my life has ever passed so quickly, like a thief in the night. I stand here looking at bulging folders and endless stacks of written 4x6 notecards and can scarcely believe that I somehow covered all of that material. It just doesn't seem possible. It took a few days before I could even really relax and celebrate -- I find that lately I have almost forgotten how to relax and unwind. However, despite my humble leanings, I have to say that I have never been more proud of myself and what I was able to accomplish. There were ups and downs during this last year, to be sure. Countless hours of study, many nervous afternoons waiting for test scores to be posted, many draining finals weeks and the dreaded "hell weeks" that sporadically fell in between finals, early morning lectures that required every ounce of effort to remain attentive and conscious when every fiber of my being wanted to just sleeeeeeep. It wasn't easy, by any stretch of the imagination, but boy was it fun.

I've toyed with the idea of starting a new blog to chronicle my year of clinical rotations -- any opinions from my faithful readers? (that means you, Aaron & Nala) More than likely, I'll just continue with this blog, but maybe change it up a little to signify the next step in my quest for world domination.

And since I got some positive comments from the last installment, here is another Medical Term of the Day: Epistaxis
(this clip demonstrates the most common etiology for epistaxis, as well as a brief illustration of the anterior packing treatment at the very end)

I Can't Quit You, Baby

the great Chicago bluesman Otis Rush

Led Zep

Wow, it's been quite some time since my last post. As you can plainly see, the rumors of my death have been greatly exaggerated.

So what has happened in the last month? Well, I have taken a few more tests, including one of the hardest ever, the big Pharmacology test on antibiotics. I didn't ace this one, but still did rather well. As a matter of fact, the only tests left in my didactic year of PA school are my finals next week. That still hardly seems possible -- I'm not sure a year has ever flown by so fast.

Last week we were finally given our Clinical Rotation schedules, which as you can imagine was a HUGE deal. It basically outlines what and where we will be for our upcoming clincial year. Next post I will outline this in more detail - I just wanted to mention it now and then fill in some more of the holes since my last post.

In Clin Med, we finished up the GI section and have moved on to Neuro. Topics include Myasthenia Gravis, Multiple Sclerosis, Cerebrovascular Disease aka Strokes, Seizure Disorders, Peripheral Neuropathies, Amytrophic Lateral Sclerosis aka ALS aka Lou Gehrig's disease, and other disorders of the brain...


We wrapped up our ACLS class and I now have my updated certification for BLS (Basic Life Support) & ACLS (Advanced Cardiac Life Support). The testing for that was a blast -- we had simulated codes with a mannequin, which included intubation (trickier than it looks at first) and a chance to use the defibrillator paddles.

CLEAR!!!

In other news, I plan to move very soon, back to the East end of town where I have spent most of my time. I have to say it was a wise decision to move close to school for the didactic year -- not having a long commute was sooo nice. More time to study, more time to sleep in, etc. I've decided to move in with my old friend James, a kindred spirit who I've lived with in various locales all over the Phoenix valley. As a matter of fact, I was just thinking this over and tallying it all up, and this will be the *6th* different residence we have co-habitated. All I can say is that it's nice to live someone who can deal with your idiosyncracies and quirks and I think the reason we get together so well is mutual respect. And it will be nice to be back in a house again. I can't say I ever had any major issues at my current apartment complex, but there have been countless frustrations that are things that I suppose just go with living so close to so many different people. Some of the more memorable ones:

• the drunk neighbor on the corner who rides his bike to his night-shift job at Circle K, and then proceeds to get rip-roaring drunk at least every other night, complete with stumbling all over the complex, all the while spouting obscenities and vulgar jibberish at the top of his lungs
• the teenagers who jump the fence of the pool overlooking my patio in the middle of the night and then proceed to "hang out" at the pool with boombox blaring
• the paranoid neighbor below me who thinks I keyed his pick-up truck for some reason, even though we've barely spoken
• the time the management company running my complex went belly-up and closed up shop without so much as a peep, leaving many of the residents like me who didn't leave the complex like rats from a sinking ship wondering if our water would be shut off as we watched the weeds grow and the garbage bins overflow since the workers had even stopped getting paychecks
• the near-nightly cavalcade of police cars. I live right next to a hospital, so I expect to hear sirens from ambulances. What I didn't expect was the steady stream of police cars, lights flashing, on such a regular basis. On the one hand, it's good to know that the police were keeping an eye on things. However, the fact that most nights you'd come home at night and see a cop car in the complex with it's lights flashing means there was a lot of "shenanigans" going on that required the police intervention in the 1st place
  
• the typical parade of poolgoers who ruined me ever getting any use of the pool by their tacky behaviors. My biggest pet peeve -- if you must insist on smoking at the pool area, AT LEAST HAVE THE DECENCY TO GET OUT OF THE POOL TO DO SO! It was a normal scene to see someone puffing away at the edge of the pool, ashing into a freshly emptied can of Bud Light. There are plenty of tables there with umbrellas there, but these people don't even muster up the energy to get out of the pool before huffing down their smokes. I just don't get it -- whatever happened to manners, decency, consideration for your fellow man? And lest you think I'm exaggerating, here is a sign the management company put on the pool door (along with a padlock) overlooking my patio as a result of this weekend's dual debauchery of the slovenly daytime denizens and the defiant delinquent teenagers hopping the fence at night:

• Another thing that gored my ox was my neighbor's friends who would come over, smoke a cigarette on the patio, and then casually chuck it down to the sidewalk. Apparently the world is their ashtray.
• And then there was the parking debacle....

This situation necessitates me leaving the bulleted mode so I can present the entire situation in it's own rant, paragraph-form. Each resident at my complex was granted the usual covered and numbered parking spots. Apparently, the fact that some spots had numbers and were covered didn't seem to phase a lot of the guests at my complex, as at least once a week I'd come home from school to find a random car in my spot. Of course, there were always PLENTY of empty uncovered spots no more than 3 or so spots over, but why should a visitor have to put up with having their car bake in the open sun when they were just visiting a friend for a while, right? Well, one week about 10 months into my lease, I started to notice a PT Cruiser in my spot on a frequent basis. One morning on my way to school, I came to car to find a note on the windshield, with the following message: "Stop parking in my spot or I will have your car towed." I went down to the office to try to make some sense of this, and it turns out some lady in the back of row of apartments didn't want to have to drive to the back, where her apartment was, and asked the apartment manager to give her a different spot. Why they would mess around with the pre-assigned spots is beyond me, but the manager gave her my spot by mistake. Now, if you had requested to move to a different spot, and found a car parking there, I would think you would doublecheck with the office 1st before leaving notes threatening to tow someone. I just found it incredulous that someone was going to tow me from taking their spot when I had been parking there for 10 months. At any rate, I told the office workers that I was tired of dealing with the whole mess and that I would just park up front in guest spots from now on (I am moving out soon anyways and I have bigger things to worry about to be honest). So now I am missing a few of the nasty speed bumps on the way to my old spot, but occasionally in the afternoon, I have to wear gloves to drive to prevent my hands from melting to the blazing-hot steering wheel. Ah well, lose some, lose some I guess. I probably should have just put this in my spot IMMEDIATELY:



Ah, I haven't had a good rant like that in a while. I feel much better now.

And now for a new likely recurring feature -- the Medical Term of the Day:

Emesis (thanks to my Uncle Ralph for the audio clip below)

I've Been Working

Some more funky Van Morrison as the tune today -- one of my faves of his -- the groove is unstoppable. I think that's one of the things that sets him apart from some of his peers in the "legendary singer-songwriting" category like Dylan or Neil Young: Van's band > their bands. Not even the E-street band can compare. Early-era Van always lifts my spirits...

Well, I continue to plug along in my final didactic quarter. I would say the classes/tests this quarter are not as intense and unrelenting like last quarter, but I find myself being just as busy as there are a lot of miscellaneous things to get done before clinicals start -- immunizations, financial aid, etc. I also need to get some dress clothes and find a new apartment as well.

In case any of you were wondering -- I aced my 1st Pharm test! That was such a great feeling to get an A in the bag -- there are only 3 tests in that course, so you don't get many chances to prove yourself. I like to do well on the 1st test in any course as that give me a psychological buffer and makes things less dicey come final time when the tests are one after the other and you never feel like you can really get prepared.



Hmm, when I started this post, I thought I had a bunch of things to say. Now I'm running out of words. I suppose I am preoccupied by the 2 tests later this week, and I should probably get back to studying. But not without your droll daily -- they sure don't make action movies like they used to:

Wandering Spirit

I'm a wandering spirit, yes I am a restless soul
I'm a wandering spirit, there's no place that I can call my own



I've decided to move again for my clinical year -- it has been nice living 5 minutes from campus during my didactic year, but since I only need to be at the school maybe 10 times during my clinical year, I've decided to move back to the side of town I'm more familiar with and comfortable in. Which got me thinking ... this will be my 7th move in just less than 4 years. As you can imagine, you learn to travel pretty light when you don't let the grass grow under your feet. And for about 2 of the last 4 years, I lived with basically whatever I could pack into my car (the bulk of my belongings spent time in storage sheds in Michigan and Texas, as well as in my brother's garage -- even my "stuff" can't seem to stay in the same place for very long). Those of you who know me well would probably attest to the fact that I'm a sleepless nomad, so it's not so surprising, but the number of moves lately even leaves me a little stupefied when I sit down and do the math. Had to include my favorite solo Jagger tune (with rot-rod guitar by the groovy Jimmy Rip) as I've been on a rockabilly kick lately (my musical appetites shift like the winds too...) Mick name-drops so many exotic locales in this tune that I almost feel like I'm listening to Warren Zevon's Excitable Boy album.

So what's been going on in school, you wonder?

Well, after enjoying the usual test-free 2 weeks of the new quarter, I had 2 exams this week -- the honeymoon is officially over and it's all downhill from here.

In Emergency/Surgery this week, we covered the various forms of shock (hypovolemic, cardiogenic, septic, and neurogenic.)



In Clincal Medicine, we are starting the GI unit. So far we've covered Alcoholic Liver Disease, bowel obstruction, peptic ulcers, GERD, diarrhea/constipation, Hepatitis, and Irritable Bowel Syndrome, which is not to be confused with the benign condition known as "guitar face", illustrated below by Gary Moore, one of my favorite Irish guitarists :



To the non-guitarist readers, I know what you may be thinking, and let me just say that no, "guitar face" and passing a kidney stone are not related either. It has more to do with a hyperemotive personality state or a manic phase -- a sublime channeling of one's emotional essence that makes its way from the soul and into the fingers and then is transformed into electrical and sonic energy. Someday I'd love to study the physiologic effects that music has on the body...

And with that, I'm off to sequester myself to study for my Pharmacology exam on Monday.

It's Not Easy Bein' Green

Happy St. Patrick's Day everybody! Hopefully you are all celebrating for me tonight. I am spending the night in, studying for a few tests coming up. It is soooo tempting to just walk down to the local dive and have a green beer or two (though I would be having a Guinness with a shot of Jameson's, followed by a Black and Tan), but I find it easier to be a teetotaler when classes are in session, and saving up for the breaks to cut loose a bit. I guess I don't trust myself to have only 1 or 2 drinks -- once you're bellied up to the bar, it's too tempting to have that 3rd, and then a 4th, and so on...

Even though I just had a Van Morrison tune on my last post, I wanted to post "Bein' Green" for today and his is by far my favorite version (no offense Kermit), plus he is a Belfast boy after all, so all the more appropriate for today.




None of these folks got pinched today, like I did -- I had it coming though for not donning the emerald...













Well that felt good to bask in my sci-fi/fantasty/comic book fanboy geekdom a bit.

Not too much else new to report here -- just easing into my 4th quarter and starting to get a good feel for the new classes. This semester has some classes which only have a midterm and a final -- I'm used to all of my classes having 4 or at least 3 tests per quarter. So it looks like there will be some short bursts and flurries this quarter, followed by periods of relatively laid-back weeks. Granted, there will still be plenty to keep me busy, but it's nice to know it won't be another all-out blitzkrieg like last quarter.

Going to the state PA conference later this week, which should be interesting. I've done OT conferences in the past, but this will be the 1st big gathering of PA's I've attended. Our school is having an alumni get-together, so it will be nice to see exactly what/how past graduates are doing out in the "real world" aka the work force. I have to say that as much I gripe and moan about how rough this program is, and as eager as I am to get back into working myself, I think a part of me is going to miss living in the relatively safe & sheltered cocoon of academia.

Today's Tomfoolery: today's image is an inside joke of sorts for my brother Aaron -- I refuse to let this die just yet!