I'll Sleep When I'm Dead

little ditty about Jack and Diane

2010-01-09T12:20:00.004-07:00

Well, I have decided to come out of the rock I've been hiding under since my last post and finally get back to blogging. To be honest, things have rolled on as usual, I just got caught up in school and life in general, and this blog became the exercise bike that ends up becoming a coat rack.

Hope everyone had a great Holiday season -- thanks to everyone who sent me birthday wishes on my Facebook page in late Nov!

So rather than ramble on endlessly trying to fill in the blanks since my last post, I'll instead just fill you all in on something rather specific. As a lot of you know, my roommate has a deaf pitbull named Jack, who is quite the character. We have been thinking about getting another dog so Jack has someone to burn energy with and just hang around when we're not home, and my roommate finally pulled the trigger. We tried a cat first, although that didn't work out too well, so we had to give the cat away:

But when I came back from my Christmas trip, there was a new dog who greeted me along with Jack at the door. We have tentatively named her "Reagan" until we can figure out something better. We had Jack for about a week before his name surfaced -- sometimes you have to just see how they act and an appropriate name pops up (can you imagine if humans did that though? I wonder if I acted like a "Daniel" when I was a kid). She was another rescue dog -- someone found her lost and trembling on the freeway. We figure she is maybe a year old. She's pretty emaciated right now, but we'll put some meat on her bones and get her in fighting shape.

The amazing thing is how quickly she settled in and how she bonded with Jack right off the bat. Jack is one of those dogs who just loves to play, almost to the point of being obnoxious, and so I think he was just happy to have another dog to run around with. He never really got too jealous or territorial -- there was just the tiniest bit of sorting out the pecking order. Jack of course retained his dominance, but she is not afraid of him at all like other dogs have been, and even in her malnourished state, she can give almost as good as she gets. So without further ado, I present you with a video showing the 2 of them clowning around the house and becoming fast friends. All of this footage was gathered in the 1st week of her being here:

This will be our new sign on the gate for would-be thieves (let's hope they are literate criminals):

Happy New Year everybody

I Never Cry

2009-09-07T00:32:00.003-07:00

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

2009-09-06T23:13:00.006-07:00

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

2009-07-20T14:48:00.003-07:00

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

2009-07-08T14:43:00.006-07:00

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

2009-07-06T03:16:00.002-07:00

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

2009-07-02T21:44:00.008-07:00

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

2009-06-15T23:46:00.006-07:00

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

2009-06-10T00:51:00.011-07:00

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

2009-05-29T02:50:00.003-07:00

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

2009-05-12T03:07:00.017-07:00

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

2009-04-07T00:10:00.005-07:00

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

2009-03-28T00:00:00.009-07:00

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

2009-03-17T21:38:00.014-07:00

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!

And The Healing Has Begun

2009-03-13T20:45:00.015-07:00

(Camera is static & far away with no zooms ... but the performance itself transcends)

Well, things are slowly going back to the way they were. I had to channel some Van Morrison as I've been listening to him quite a bit lately -- something about his music does seem to bring comfort in times of distress and melancholy. He's a poet with prodigious pipes. This song is from his 1979 album Into the Music, and the title says is all. It's amazing how good Van the Man sounds 30 years later...

I just want to take a quick minute to thank all my friends and family for their support and condolences in the last week. It was amazing to see everyone rally to offer their assistance in a very somber time for me and my family, when we needed it most. You all are amazing, and I'm lucky to have you in my life...

Now it's time to take a deep breath, regroup, and get busy living. Gramps would surely have wanted it that way.

I have just completed my 1st week of my last didactic quarter. I suppose a description of my load this quarter is in order...

First, a couple of continuing classes:

Clinical Medicine III: Part 3 of our "bread-and-butter" class. This go-round, we are covering endocrine disorders, infectious diseases, GI problems, seizures/strokes, and many other various and sundry disorders, afflictions, maladies, endemics, and sicknesses. We have the small group case studies once a week as well, where we are presented with a new patient each time and work collaboratively to do the history and physical exam, formulate a diagnosis and plan, and then write up the SOAP note, complete with prescriptions.

Lab Medicine II: Part 2 of our lab class. This quarter we are covering thyroid tests, liver function tests, tests for infectious diseases & rheumatologic disorders, blood cultures, radiology, diabetes, arterial blood gases, heart sounds, and pulmonary function tests.

Pharmocology II: This quarter we are covering CNS drugs (sedatives, hypnotics, antianxiety, antidepressants, antipsychotics, opiods, Alzheimer's/Parkinson's drugs), antibiotics, chemotherapy, antiepileptic, corticosteroids, contraceptives, GI drugs, asthma/allergies, migraine/gout, & analgesics.

And now for the new classes:

Emergency Medicine/Surgical Procedures: This class is going to cover all kinds of procedures that you would come across in the ER & surgery. Some of the topics include: airway emergencies, trauma, shock, altered mental status/drug intoxications, wound healing, chest pain, neurologic emergencies, metabolic emergencies, orthopedic procedures, and burns.

Psychiatric Principles: This is going to cover all of the major DSM IV diagnoses like psychotic, cognitive, personality, depressive, anxiety, somatofrom, eating, sexual, and bipolar disorders.

Pediatrics: You know, for kids.

ACLS: This class will get us certified in our cardiovascular life support skills. One of the new techniques coming into favor is CCC or continuous chest compressions, as opposed to the traditional CPR.

Medical Spanish: This is an elective but I figured it would come in quite useful. I have picked up quite a bit of colloquial Spanish over the years just from living in Arizona, but this class is more focused on terms/phrases I'll use in practice. I have a cousin who teaches Spanish as well as an aunt from Venezuela who works as a Spanish courtroom translator, both of who have been encouraging me for years now to brush up on my linguistics. I've considered trying the Rosetta Stone software as well and never got around to it. Maybe at the end of the quarter, I can try making a blog entry en Espanol.

I also have some other infrequent or independent study classes this quarter as well, such as my Clinical Master's Track course (going to focus on my clinical specialty and start building my portfolio this quarter), Interdisciplinary Core class, and the PCP or Preparation for Clinical Phase classes. I do think it will be somewhat easier than last quarter, as there is only 1 hardcore science class and more practical medicine courses. That being said, it's still going to be a breakneck free-fall to finals.

Today's Tomfoolery:

Cheers to a new quarter!

I Still Can't Say Goodbye

2009-03-05T04:55:00.012-07:00

I lost my grandfather Ruben yesterday afternoon. He truly was my hero, and taught me everything there was to know about being a good person -- working hard and diligently, being a devoted husband, keeping the faith, getting involved in the community and neighborhood, spending money wisely, developing a keen sense of humor, becoming a shrewd Euchre player, and so much more. He was the pillar of the family, the toughest man I've ever known yet gentle and kind, and had many nicknames over the years -- Mitz, Kenobi, and Redwood just to name a few. He also was responsible for the nickname of myself and my 2 brothers -- aka "The Hoy Boys." This came about because when we would visit my grandparents (who we lived next door to growing up and saw nearly every day), my grandpa Ruben would greet us with "Hoy!" rather than "Hello." Somewhere along the line, the family came to know the 3 of us as the "Hoy Boys" and the rest is history ...

Here is a picture of my brother Peter's license plate, in honor of that nickname that has stuck for over 30 years now:

My grandfather was also a carpenter by trade and kept quite busy after retirement, working in his workshop in the back of his garage, creating all kinds of projects for friends and family. He had a remarkable knack of looking at something and figuring out how to make it in his head -- it always amazed me how talented he was at that. One summer my grandpa, my dad, my 2 brothers, my Uncle Dave, and myself built a 2 car garage with attic and workshop in our backyard, basically from the foundation up. Grandpa and the rest of us even built the trusses for the roof -- although I'm not nearly as handy as my dad or my grandpa was, I will say that I learned a lot about blood, sweat, and tears on that summer-long project. I also remember one school project I had asked grandpa to help me on -- we had discussed it the day before, and the morning he was going to help me, I woke up and walked over to his workshop around 6:30 a.m., figuring he would be getting the wood together and waiting for me. To my surprise, he had been up early and finished the project all by himself while I was still sleeping!

He made many varieties of birdhouses, and the one that my parents mounted on their back deck was a famous haven for all of the many cats we had over the years. Here is a good example of that birdhouse in full use:

I think the hardest part of the last week has been the fact that I wasn't able to go back to Michigan to say goodbye to my Grandpa. When I got the news that he was sick and had inoperable cancer, I was just preparing for my 2 weeks of finals. By the time finals were over, he was very close to the end. I am grateful that I spent almost all of my 2 week Christmas break back home and had many great visits to him. And over the last week, I was able to talk to him on the phone and let him know how much I loved him. I'll never forget the last words he spoke to me -- he told me he was proud of what I was doing in college and wanted me to keep working hard.

There is so much more I could say and yet it's hard to find the words right now too. He was a role model for myself and my brothers and I really miss him. Somehow I think he is still watching over his family...

They say a picture is worth a thousand words, and so I'll end with this video I made tonight with some of my favorite pictures of my grandpa. I want to thank all of my friends and family who called and contacted me after getting the news to offer words of comfort and support -- it really means a lot to me.

I'm Good Now

2009-03-02T00:21:00.008-07:00

Well, the dust has finally settled and I find myself surviving the toughest quarter yet. The last week of finals was a endless parade of semi-consciousness and went by like a blur. One of my professors even commented that I looked like I was sleepwalking. I think I slept for almost 14 hours straight following my last final. It feels extremely odd to wake up in the morning and not head immediately for the book bag. I find that I almost don't know what to do with the free time.

For the meantime, I suppose I will just be thankful for making it through another quarter. Performance-wise, it was a bit of a mixed bag; I didn't get as many A's this go-round, but on the other hand I passed all of the 20+ tests and don't have any C's either. In other words, I'll take it! Success these days is measured by being able to move on to the next semester rather than letter grades.

Doubt I'll be getting into too much trouble this week -- have a lot of odds and ends to catch up on and need to go look at some apartments for my upcoming clinical year. It's starting to really warm up already -- high of 89 tomorrow so perhaps a little pool time is in order.

I've had Curb Your Enthusiasm in heavy rotation lately -- here is one of my all-time favorite LD moments, where he does what he does best -- beating a dead horse and prolonging an argument by repeatedly insisting his point of view and refusing to "let it go" in the infamous "Doctor's Phone" segment:

Well, I'm off to enjoy my brief down time and recharge for my *last* didactic quarter, which hasn't really sunk in yet and doesn't seem possible.

"Life is never made unbearable by circumstances, but only by lack of meaning and purpose" -- Victor Frankl

I'm Going Slightly Mad

2009-02-26T03:14:00.014-07:00

Well -- one more final to go. It's hard to believe this juggernaut of a semester is almost over. In light of today's title, which is not much of an exaggeration to be honest (sleep deprivation and mental overload), I thought I'd highlight Brian May, a true renaissance man who is not only a iconic rock star but a full-fledged scholar as well.

Prior to his rock band fame, Brian was an aspiring physicist, studying at the Imperial College London, and graduated with a Bachelor of Science Degree in both Physics and Mathematics. He then proceeded to make his way towards a PhD, but abandoned his scholastic endeavors when Queen started to become successful. 30 years later (and an estimated 300 million worldwide albums sold!), Brian returned to his research and completed his PhD thesis, officially graduating at a ceremony held in the Royal Albert Hall in May 2008. He also became the Chancellor of Liverpool John Moores University in April 2008, taking over for Cherie Blair, the wife of former British prime minister Tony Blair.

Brian in guitar hero mode:

Brian in full academic regalia:

In a word -- Brilliant!
Here's to you Dr. May...

Honorable mention goes out to Tom Scholz, guitarist and founder of the band Boston. Tom attended M.I.T. on a full scholarship and graduated with Bachelor's and Master's degrees in Mechanical Engineering. He went on to work for Polaroid and has 34 patents to his name. While still at Polaroid, Tom recorded virtually all of the first Boston album in his basement -- an album that went on to sell more than 16 million copies, which I still believe holds the record as the best selling debut album of all time.

Tom the guitarist:

Tom the tinkerer:

I'm off to do my last minute cramming. I've been pulling all-nighters all week -- don't see any reason to stop now. My last final is in Physiology, over the GI unit. Some fun facts:

We produce 1-2 liters of saliva a day
the stomach is capable of expanding to 30x it's empty volume
the cells of the stomach lining are replaced every 3 days

And one of my favorite terms all quarter -- one of the procedures in diagnosing GERD (gastroesophageal reflux disorder) is abbreviated as a EGD -- I doubt many internists use the full name -- esophagogastroduodenoscopy!

How my head feels at the moment:

(Got Me) Under Pressure

2009-02-25T02:18:00.009-07:00

Another quickie as I'm in the midst of another all-nighter after a few hours of sleep this afternoon. On a positive note, I did rather well on my Laboratory Medicine final this morning. A small triumph considering it's not as many credits as the rest of the classes I have finals in, but a triumph nonetheless.

Studying tonight for my Microbiology final in the morning. Lots of pictures of bacteria, trophozites, etc. to memorize as well as 3 clinical correlate lectures. This unit covered malaria, measles, lyme disease, infectious mono, herpes simplex, chickenpox/shingles, parovirus, variouis bacterial skin infections (acne, impetigo, erysipelas, cellulitis, gangrene, etc) and dermatophytes/cutaneous mycoses aka all of the "tinea" infections -- ringworm, jock itch, athlete's foot, fungal nail infections, and finally the lovely ectoparasitic infestations like scabies and pubic/head lice.

Microbiology and the related conditions are pretty fascinating, although the class tends to make you a bit obsessive-compulsive as you start to think about and eventually become completely preoccupied with all the microscopic bacteria and organisms that you took for granted before. I feel like I could end up like Tom Waits as Renfield in the Bram Stroker's Dracula movie, picking and scratching at imaginary bugs while slowly descending into madness. This should be the intro to any Micro class:

Statitician's Blues

2009-02-24T04:05:00.003-07:00

Have to make this post short and sweet, but figured I may as well put something up. It's now past 4 a.m., which is my cutoff threshold for the all-nighter: no point in going to bed anymore as my next final is at 9 a.m.

Had to interject some Todd Snider -- not that I'm doing much number-crunching in PA school, but as I'm knee-deep in the sludge of a nasty finals week, I can relate to the chorus:

Too much to think about
Too much to figure out
Stuck between hope and doubt
It's too much to think about

3 finals down (EKG, Clinical Medicine, Pharmacology)
3 to go (Laboratory Medicine, Microbiology, Physiology)

Current status of my brain:

Splendid Isolation

2009-02-21T00:30:00.004-07:00

In case you haven't noticed by now, I'm a huge Warren Zevon fan (my blog title and an earlier post title this week are all from Warren). I have to hole up for the weekend and every night next week to do the finals cram again, so it seemed appropriate. I could also extrapolate the notion to life since PA school too in some regards. I decided to move close to school for my didactic year as I didn't want to deal with traffic and a long commute -- time is one resource you can never get back. As a result, I've been a bit more "cut off" from friends out here -- not that I have spare time anyway, but between living where I do and the massive amounts of time spent with my nose in the books, I think this is the most time I've ever spent by myself. Of course, I'm a loner of sorts by nature, so I tend to fend for myself normally, but it's even more pronounced these days. And it's not necessarily a bad thing -- I am quite capable of entertaining myself and I almost need the separation right now to focus on my studies. It's also harder now that my brother is in Dallas as I don't have any family now in the state, but I made the choice to move out of Michigan years ago and it's one of those things that seems wrong at some times and necessary at others.

I probably won't have much to post until the dust settles after finals. I have a lot of info to squeeze into my noggin and can hopefully organize it all and recall it when needed. Back to the science for me ...

And remember to enjoy every sandwich!

I Fall To Pieces

2009-02-20T04:03:00.004-07:00

Well, took my 2nd final this morning feeling pretty confident and ended up falling flat on my face, kinda like this guy, sans yarmulke.

I didn't fail the exam, but as I somewhat predicted, I did blow my A in the class. I was hoping to be a bit more Einstein than Homer Simpson, but them's the breaks sometimes.

Think I'll fire Stuart Smalley as my motivational guru -- my daily affirmations are not working as I clearly am not smart enough. Well, I suppose it also didn't help that I forgot to bring my EKG calipers to the test ...

Nothing to do now but take it like a man, dust myself off, and prepare for some more chagrin next week when I take the final four finals (is that an odd phrase or what?)

On a positive note, had our last Therapeutic Skills lab on Wednesday -- we did skin punch biopsies on the cloven hooves of pig feet and some more suturing. This time we learned the subcuticular suture, where the stitches (dissolvable) & knots are all hidden "beneath" the wound. I have to say I was a little confused about it until I actually sat down and then it made more sense. I am actually looking forward to doing some stitching on actual human flesh now -- any volunteers?

Poor Poor Pitiful Me

2009-02-19T01:02:00.008-07:00

Well, I thought I had my Clin Med final licked -- it covered the Renal unit and I walked out thinking I had aced it -- turns out I did worse than I thought. And as this test was all about the kidneys, seeing my score felt a bit like this:

I shouldn't really feel too bad -- I still got a solid B. It just seems to always happen that I do worse on the tests that I think I nailed, and better (usually) on the ones I think were disastrous. Not sure why that happens, but it's definitely been a pattern I've seen again and again since PA school.

No time to cry over spilled milk though -- have my next final -- EKG -- in the morning. I'm hoping to fare a little better on this one.

I need to stay positive going into this one. I need to convince myself that it's just 1 more test among many more that I'll take, and that I've put in the proper study time, so it should be no problem. What's the worst that could happen, right? I blow my A maybe. Life goes on. Of course, being that cool, calm, & collected is easier said than done sometimes for me. Guess it's time for my daily affirmations.

Your Nervous Heart

2009-02-17T01:03:00.007-07:00

Today's title comes from an excellent track by my brother-in-name Rhett Miller from the Old 97's, my favorite band to come out of Dallas. And why was I nervous today? This morning I had to give a shirt-and-tie 30 minute oral presentation to my class and 4 of my teachers, as part of my Master's track class. I had a nice 40-slide PowerPoint made up to put up on the massive projection screen (we have a large auditorium-style classroom, with theater-seating for about 150), so it wasn't like I had to just give a monologue with no props, but it was nerve-wracking nonetheless, as we are expected not only to be captivating but on a graduate educational level. Jerry Seinfeld summed up the fear of public speaking pretty well in this clip:

Jerry also demonstrates the response my presentation received:

Actually, it went just fine -- everyone was pretty attentive, asked questions, and a few told me afterward that they enjoyed the presentation. Of course, I stumbled a time or two -- though not as bad as old Admiral Stockdale:

I will likely have to do another one next quarter, so the practice is good for me.

Last week, in Therapeutic Skills lab, we learned about casting/splinting and even got to practice putting arm and leg plaster of paris casts on each other. Each of us got to apply both of the casts, and got each one put on us. As you might envision, it was a fairly messy lab -- water buckets, wet plaster, tape, ACE wraps, etc. -- but a ton of fun. For some reason I kept thinking about Smykowski.

Well, finals are on me once again -- I have my 1st one -- Clinical Medicine -- in the morning, so time to put on my War Face.

Blue Valentines

2009-02-15T02:09:00.009-07:00

Can't think of a better time for one of my favorite Tom Waits tunes. Waits is my all-time favorite songwriter & right up there with Dylan when it comes to expressing a tortured soul lyrically. Tom's wife once famously said that he writes 2 kinds of songs -- Grim Reapers and Grand Weepers. This one is definitely one of his best Grand Weepers. With Tom Waits tunes, I can usually pick out a few killer lines from every song, but this one is genius from start to finish:

In school news, I pulled it together somewhat on my last Physiology exam. It was one of those "ehhh..." performances. If you don't know what I mean by that, then allow Mr. Larry David to demonstrate the proper use of this expression (here is the set-up if you've never seen this episode -- Larry, Ted Danson, and some other celebrities are opening up a restaurant. Ted wants to use his personal chef as the restaurant's head chef, so he brings over Larry and Jeff to sample one of his meals. This was Larry's reaction after the meal -- when later pressed for more details, he responds very matter-of-factly with "a little too saucy", nearly reducing the chef to tears. You have to love the absolute lack of tact that is LD):

And just for completion's sake, here is Larry explaining very casually to the chef why he didn't like the meal:

So, in one respect it was still satisfactory, as I have been struggling recently, but only slightly so, as obviously everyone likes to do their best. Who knows, maybe that was/is my best. Or maybe I have my sights set too high and should lower my bar a little. One more representation -- the half-hearted Al Bundy thumbs up:

I guess it's like the old saying "Nothing worthwhile comes easy." If that's the case, than PA school must be really, really, really worthwhile. And on that note, I need to get back to the books.

Kicked in the Teeth Again

2009-02-09T23:51:00.027-07:00

I had to channel some Angus Young riffage after another rough Microbiology test this morning to soothe my shattered soul. For some reason I just can't seem to lick that class -- after getting an A on the 1st test, it's been a struggle to keep my head above water. To borrow a quote from President Barack Obama:

I guess that's been the theme of this quarter -- a series of highs and lows, defeats and victories.

Today it was more like this:

Granted, I have yet to fail a test (well ... this semester at least), but as I've mentioned before, if you're someone who is used to excelling academically, it's a blow and bruise to the ego to be pulling C's or getting below the class average for an exam. I'm know I'm not alone in this and everyone in my class feels the pressure to some degree. I do know that I can at least say I'm putting forth an honest and concerted effort -- if I was blowing this off or doing it half-heartedly, then it might be more understandable to see my grades slipping, but if that were the case, then I don't belong in the program anyways, right?

I bet that those of you following my blog who haven't been to grad school (or even if you have) must sometimes get a kick out of my unabashed drama. I'll be the first to admit that when it comes to throwing a pity party, I can sing the blues and dish out the "woe is me" song-and-dance with the best of them. You know how every circle of friends or family has one person who can always seems to notice the touch of grey in every silver lining? In my crowd, I'm that guy.

Hey, if nothing else, if you're feeling down yourself, then you can come here and listen to my latest rant about how tough of a time I'm having, how my head is going to explode if I have another test, how little sleep I'm getting, how I feel like I just can't get it together for one more day, etc. and then you can assure yourself "at least I'm not as pathetic as this guy -- what a sour grape! Like Mickey Ross once said in his Pyramid of Pain infomercial, "Let my psychosis work for you!"

I know it probably looks ridiculous at times, but much of the reason for starting this blog in the first place was to capture and make a record of the emotions and struggles of taking on such a significant step as PA school. So far it's by far the most challenging obstacle I've faced, and also one of the most rewarding. And at least I have so far accepted my setbacks with as much dignity as I can muster, a certain amount of kicking/screaming/whining, but most importantly, without losing my sense of humor. Once you lose that, then you're really in trouble... life it way too short to spend too much time feeling miserable or sorry for yourself like the tormented Chris Farley below:

As crestfallen as I can be sometimes, I'm also too stupid and stubborn to know when to quit trying. I'm a pessimist by nature, but a closet optimist.

On that note, here are some quotes I like about the whole idea of rolling up the sleeves and toiling away:

“Opportunity follows struggle. It follows effort. It follows hard work. It doesn't come before.” -- Shelby Steele

“I have had to fight like hell and fighting like hell has made me what I am.” -- John Arbuthnot Fisher

The Test for Leprosy

2009-02-08T19:04:00.013-07:00

I had to reach into the deepest recesses of my hippocampus to come up with today's title, the 1st song off the 1st album by Christian metal group Tourniquet. I seem to remember reading that one of the band member's father was a physician, which explains some of their bizarre, medically-related song titles such as:

Somnambulism
Impending Embolism
Pathogenic Ocular Dissonance
Ruminating Virulence
Spectrophobic Dementia
Gelatinous Tubercules of Purulent Ossification
Vitals Fading
Phantom Limb
Broken Chromosomes
Stereotaxic Atrocities

How can you not love a band with song titles like that? At any rate, the title is indeed appropriate as tomorrow morning brings another Microbiology exam, and Mycobacterium Leprae is one of the flavors in the smorgasbord of diseases covered in our latest section.

We also had a huge section on TB, and other diseases spread by respiratory droplets. I was hoping to find a clip of the classic scene from Michael Crichton-penned flick Oubreak where a movie theater patron sneezes and you are treated to a slow-mo clip of the sputum disseminating throughout the room, landing in the popcorn buckets and gaping mouths of unsuspecting patrons. Alas, I could not find that particular scene, so instead, here are some stop-motion photos of actual sneezes, which should make you flee in abject horror the next time someone engages in an involuntary personal expulsion of nasopharyngeal mucosa in your immediate vacinity.

I also found this pretty fascinating & scary -- a diagram showing how the 2003 SARS outbreak supposedly spread so rapidly:

(if this is too small to read the print, click on it to enlarge)

This post was conceived as a result of having all sorts of bacteria, fungi, protozoa, and other sorts of nasty germs on my mind as a result of studying for Microbiology. I'll try to make the next post less ... unsettling. Until then, I'll be locked up in my apartment, munching on some popcorn and awaiting the next great pandemic, which as one of my professors reminded us, we are sorely overdue for. In the words of a fellow Arizonan:

Some say the end is near.
Some say we'll see armageddon soon.
I certainly hope we will.
I sure could use a vacation from this

I Want a New Drug

2009-02-02T00:02:00.016-07:00

I thought I'd be taking it on the chin again on my latest Pharm test this morning

However, this time around I secluded myself for the weekend (who am I kidding? All I do is study these days), forsaking the SuperBowl (well, the 1st half anyways) and immersed myself in the world of Autonomic Nervous System drugs. The section on Diabetic agents and Anticoagulants was fairly straightforward, but the ANS material was fairly complex and voluminous -- not only knowing what the effects were, we had to know if it was a full or partial agonist, which receptors it worked on, whether it was direct or indirect, selective or nonselective, side effects, indications/contraindications, etc. I won't bore you all with any more of the details; needless to say, I was fairly nervous about the test but the studying paid off as I surprised even myself by how well I did.

What else have we been doing in school lately? Well, we started a 2 week suture lab that has been a blast so far. We are working on fake skin that looks quite similar to this:

So for we've just done the simple interrupted and uninterrupted stitches. This week we'll be working on the horizontal/vertical mattress stitches for deeper type of lacerations. And then we'll be doing skin punch biopsies on pig's feet. I'm having a lot of fun with this and they sent us home with a knot board to practice our square knots. I kind of feel like I'm working on the Navy docks with all the knots I've been tying.

In Microbiology, we've moved on from leprosy to sexually transmitted organisms (always nice to see some of those manifestations in full detail on the jumbo projection screen right before lunch!) In Clin Med, we're about to have a test over the pulmonary unit: Asthma, TB, lung cancer, interstitial lung disease, etc. In Physiology, we finished with the endocrine unit and are moving on to reproductive and finally the GI unit. In Pharmacology, we're starting diuretics. In Clin Lab Med, we covered fluid and volume balance today, going over the standard IV compositions for replacing fluid and electrolytes. I'm starting to put together my Power Point presentation together for my Master's Class. Other than that, not much else new to report on. As you can imagine, I've kept busy.

I'll leave you with my favorite anti-methamphetamine ad (a sympathomimetic drug that we covered in our last Pharmacology unit on adrenergic/cholinergic drugs and the ruin of many a life)

I Forgot More Than You'll Ever Know

2009-01-28T01:58:00.006-07:00

Had to go with a Dylan title this time as he's been on heavy rotation. School has been rough lately, and in this fire-hose type education, there is a fear that:

a) I'll never learn everything I need for every new test
b) Supposing I accomplish a), that I won't be able to recall it when my rotations start

Hence the blog title -- I almost went with "Idiot Wind" -- it was kind of a toss-up. If you couldn't guess by now, I'm a big fan of self-deprecating humor. I figure no matter how bad things get, you should always look for the funny side of things, even in yourself.

On that note, my performance on the last round of tests have provided some classic facepalm moments. Below are some recreations of me checking my test scores online:

I'm still hanging in there though -- I don't know if it will get any easier.
But there is one thing I DO know -- my primitive brain is being pushed to its capacity. After all, I'm just a simple caveman.

The TB is Whippin' Me

2009-01-17T15:40:00.012-07:00

No, I don't actually have tuberculosis, or "the consumption" as it was known back in the day when Doc Holliday died from it. However, it was the topic of one of our recent pulmonary lectures, and in my recent corny attempt to name all of my posts after relevant song titles, this one fit the bill. The song actually goes back quite a way to country legend Ernest Tubb (probably best known for "Walkin' the Floor Over You"). At any rate, I first heard this tune from my favorite Chicago band, Wilco. Their cover version, done with Syd Straw) was actually their 1st single. They have gotten quite a bit less twangy since then, but the song has some great Tele licks -- check it out here if you haven't heard it: streaming version of Wilco's "The TB is Whippin' Me" (click on the link and then look at the bottom of the page to see their integrated media player -- a bit hard to find if you've never been to this site before -- hit the little triangle symbol in the very bottom left to play).

This is my 1st post of 2009 -- had a nice Christmas break with the family and now it's back to the books. Hopefully I can get back to some regular posting, but then again, I seem to say that on every post eh?

We have had some fun times in our Therapeutic Skills lab as of late. The last 2 sessions have included giving/receiving shots (sub-Q, IM, & ID) to eachother, as well as venipuncture/blood draws and starting IV's. Since I actually like the blood & guts of medicine this was no problem for me and I actually enjoyed it. And luckily I was able to remain calm and prevent a hulkout.
(I'm sure you all remember this infamous hulkout from old TV series with Bill Bixby: Receiving a lethal injection, and then having the person say, "Oh. I just gave you a lethal injection. Sorry, David.")

In honor of that stupendous TV series, here are some more classic, and frankly, hilarious hulkout moments that actually occurred (courtesy of this webpage). It must have been quite a challenge for the writers to find new and inventive ways to make David *really angry* every episode, and as you can see below, the thinktank well often ran dry.

How to provoke a Hulkout:

Dealing with a pesky operator in a phone booth ("I DON'T HAVE TWENTY-FIVE CENTS!!!")

Being stuck in a cab in New York rush hour traffic - "You don't understand, I have to be there by 4:00!" - "Hey, mac, it's rush hour, we ain't gettin' there til five, so relax." - "BUT I HAVE TO BE THERE BY FOUR!!!"

Being tied up and fed soup by an elderly Japanese woman who doesn't understand words like "You've GOT to cut me loose!"

Falling through a rickety staircase while trying to get to the drunk girl who is about to jump off the roof, and then finding that she's locked the rooftop door

Being placed in a dumpster by the two garbagemen who think he's a thief, and who don't believe him when he says "Hey! There are rats in here!", and then being bitten by the rats to add injury to insult

Getting his jacket caught in the printwheels at the newspaper printing room, and then inexplicably sticking his hand into the rollers

Having a large wooden beam fall on him, and then having a heavy boulder fall on the beam

Falling into the churning water of a boathouse, and then inexplicably being repeatedly carried over the paddlewheel

Having his friend tell the New York "syndicate" that David has their money, so that their enforcers chase David back to his apartment, and then having all his neighbors close their doors on him rather than listen to him saying "Please! You've GOT to let me in!!!", and then being beaten up and thrown over the balcony into the smelly trash cans by same enforcers

Helping Ray Walston out with a magic trick by allowing himself to be chained up and put in a tank of water, only to find that drunk Ray has forgotten to leave the escape key inside the tank

Locked in a drunk tank with a crazy person who insists he is Ernest Hemingway and then beats the stuffing out of David

Somehow getting himself into a belfry and then realizing that a bell is there, just as it strikes the hour

Being put in a strait jacket because he's seen the videotape that proves that the sanatarium doctor is performing unnecessary lobotomies on the patients, and then thrashing around so much that he bangs his head on the floor

Wandering into an Army dump to get the deadly canister of army nerve gas that has blinded his friend, only to be caught by a mean MP who knocks his gas mask off and throws him back down the hill, knocking the canister open so that David can frantically try to put his mask back on before looking up to see that the MP has somehow brought in a crane and is dumping two tons of garbage on him

Trying to run away from the nasty prison work camp, only to fall through a rotted bridge, and then being bitten by a rattlesnake

Beaten up by all the other prisoners in the work camp, in the middle of the night while he is trying to sleep, when he emphatically told them not to beat him up that particular night

Making the High Priest of the Baba Yaga voodoo cult so angry with him by challenging a perfectly normal ritual sacrifice that several of the Priest's minions are obliged to beat the stuffing out of David and throw a cloak over his head

Being mistaken for mob boss Mike Cassidy, who looks exactly like him, and who everybody wants to beat up, so that David is repeatedly beaten up for no reason

Beaten up while trying to keep the incoherent man from stabbing the woman who accidentally locked David in the closet, and then having same man attempt to close the door to same closet on David's head

Being hit by a car and knocked twenty feet so that he tumbles down a conveniently open manhole

Coming to the aid of the gumshoe in the garage who is being beaten up for not minding HIS own business, and getting beaten up himself, kicked under a low riding sportscar that has been jacked up for repairs, and whose jack is removed so that the car can fall on David. Gumshoe's reaction, in voiceover narration: "It was a big green thing, and it definitely wasn't happy about something."

Being caught at the old studio backlot with same gumshoe, by same nasty bad guys, and trying to run away so as not to get angry with them, only to have them pull a heavy old scene facade down on top of him. Gumshoe's reaction: "It was that green thing again, and it still wasn't happy."

Having several clay pots broken over his head in the middle of the now-burning room (why is the room always burning?), and then knocking an entire case of same clay pots onto same head, and then, while lying very still and struggling not to get angry, having his pants catch fire

While paralyzed for the episode, somehow getting caught in the middle of a barroom brawl, and while trying to quietly wheel himself out of the room, being hit by a flying body and knocked down the stairs (what David is even doing in such a situation goes unexplained)

While still paralyzed, trying to drive a car to the bank to stop his friend for the episode (who is going to try to obtain an immediate loan by robbing the bank), only to drive so slowly that the big guy in the truck behind him keeps yelling "Hurry up! Learn to drive!", and then getting so caught up in watching his friend wheel into the bank that he forgets to look both ways before entering the intersection, crashes into a car trying to cross in front of him, and gets rear-ended by the big guy in the truck, who remarks as David begins turning into the Hulk: "You IDIOT!!"

And I'll leave you all with the infamous "tire change" hulkout, which incidentally was the very first TV series hulkout:

She Blinded Me With Science

2008-12-23T00:42:00.005-07:00

One of my Microbiology professors did a lecture on controlling microbes in the clinical setting, and she dispensed some really neat historical biographies on a couple of very famous scientists/physicians who had an impact on the world through their discoveries, saving millions of lives in the process. So, I thought it might be neat to share their stories -- I'm a sucker for stuff like this (one of my favorite parts of the recent Body Worlds exhibit, which features "plastinated" human bodies in a very tasteful and artful display, was the historical information on all of the famous early anatomists. For example, did you know that in centuries ago, the church considered it immoral and unethical to dissect the human body, and outlawed it for over 1,000 years? Galen, the famous Greek anatomist, created the foundation of modern anatomy in the second century by working on pigs and monkeys. During the Renaissance period, cultural ideas and social taboos started to shift, but the famous artists like Michaelangelo and his rival scholar Leonardo di Vinci actually had to rob graves in the dead of night in order to perform dissections and further scientific study of the human body). And so, I will now present to you the story of two of the most prominent figures in the field of Microbiology, with a slight twist. I'm going to try my Paul Harvey impression while doing so (this one's for my Grandma). So don't say you've never learned anything by reading my blog!

Hello Americans, I'm Paul Harvey. You know what the news is -- in a minute, you're going to hear... the rest of the story.

In 1846, a Hungarian physician named Ignaz Semmelweis was assigned to the first obstetrical clinic at Vienna General Hospital. He became alarmingly aware of a higher death rate due to puerperal fever among delivering mothers at his clinic, which was staffed by medical students, than at other wards in the area, which were run by midwives. Puerperal fever, also known as childbed fever, can develop into sepsis, a whole body inflammatory state caused by infection that is life-threatening if not treated. Semmelweis did his best to make sure the procedures were being carried out the same at his clinic as they were elsewhere, and still the unusally high mortality at his ward persisted. After a fellow colleague of his died from sepsis following a scalpal cut during an autopsy, Semmelweis then came to realize that the diseases were the same and rationalized that the medical students were somehow infecting the mothers. You see, there were no Universal Precautions back in his day, and when his medical students were between childbirth deliveries, they went to work on cadavers.

Semmelweis then enforced a strict handwashing policy using chlorinated lime and subsequently nearly eliminated death due to puerperal sepsis in his clinic. However, as is often the case when new scientific discoveries are made, his ideas were not readily accepted in the medical community, and his methods were not widely practiced, despite Semmelweis repeating his results in other hospitals and clinics. Later in his life, he became mentally unbalanced and his mind deteriorated, and some speculate that he had contracted syphillis, which was common among obstetricians at the time, and can lead to neurological symptoms such as dementia, mania, psychosis, and depression. In 1865, he was committed to an asylum, and in a case of cruel irony, he died of sepsis following a beating from the guards .

Ignaz Semmelweis (1818-1865)

Around the time of Semmeweis's death, French scientist Louis Pasteur developed the germ theory of disease, which gave a theoretical basis for what Semmelweis had been working towards. Semmelweis is now held in high esteem in the medical and academic world and often referred to as the "Savior of Mothers." However, the story does not end there ...

Louis Pasteur (1822-1895)

Page Two

In the same year that Semmelweis died, Joseph, an English surgeon made his first great success in Glasgow using carbolic acid to sterilize surgical instruments. Back in this time, the prevailing theory of diseases like cholera and the Black Death was the miasma theory, which maintained that diseases were spread thorough a noxious form of polluted air. Joseph was not convinced that wound infections were caused by miasma, and inspired by Pasteur's germ theory, he began to experiment with using carbolic acid, which at the time was used to treat sewage. He eventually came up with a formula that could be used as an antiseptic for treating wounds and handwashing as well as a disinfectant for surgical instruments. His ideas were initally met with skepticism, but were eventually accepted in his lifetime, and he was knighted in 1883. He is now known as the "Father of Antiseptics" and the "Father of Modern Surgery." You may recognize him by his full (knighted) name -- Sir Joseph Lister, and by the product later developed in 1879 and named in honor of him, Listerine.

Sir Joesph Lister (1827-1912)

And know you know ... the rest of the story.
Paul Harvey ... Good day.

Paul Harvey (1918-present)

Takin' Care of Business

2008-12-21T18:09:00.005-07:00

Well my winter break starts today, and before I whisk away to a snowy Christmas far away from here, I thought I'd give a round-up of what my quarter looks like. Here are the classes I have:

Clinical Medicine II: This is part 2 of our "bread and butter" medicine class where we study various groups of disorders, their signs/symptoms, pathophysiology, and the current treatments, including medications. We are starting the quarter off with various and sundry cardiac conditions: hyperlipidemia (aka high cholesterol), endocarditis/pericarditis, ischemic heart disease, valvular heart disease, heart failure/pulmonary edema. From there we move to pulmonary conditions: embolisms, deep vein thrombosis, peripheral vascular disease, chronic obstructive pulmonary disease, bronchitis, pneumonia, asthma, tuberculosis, coccidiomycosis (aka Valley Fever), lung cancer, and insterstitial lung disease. Then it's on to kidney disorders: urinary tract infections, pyelonephritis, glomerulonephritis, polycystic kidneys, actute/chronic renal failure, benign prostatic hypertrophy, and incontinence and then wrap up the class with some genitourinary disorders -- prostrate cancer, etc. and finally some endocrine and adrenal hormonal abnormalities. Part of this class included a weekly small-group case session where we follow a hypothetical patient throughout his/her life -- each week represents them coming to see you with a new set of problems, and we have to brainstorm the possible diagnoses and then write up a SOAP note, complete with prescriptions on a "real" prescription pad.

ECG -- this is an entire course designed on being able to analyze and interpret ECG strips. You wouldn't believe how much you can gleam from these. Very detail-oriented stuff -- luckily for me, I have my trusty ECG calipers to help me wade through the intricacies. Even the heart rhythms can be tricky -- not only can heart beats be irregular, but they can be regularly irregularl or irregularly irregular (kind of like how the Detroit Lions are having the perfectly imperfect season -- one more game to go until infamy! Just when you think they've hit rock bottom, they dutifully don the miner's hat and plumb the depths a little further. Here is a pretty good synopsis of the misery that is being a Lions fan: they are 31-95 over the past 8 seasons & have won just 1 post-season game since Henry Ford's grandson purchased the team 44 years ago! The only salve for that kind of pain is that the Pistons have done reasonably well in the last decade, and Detroit is home to the NHL's greatest franchise in the Red Wings, an organization from top-to-bottom that is the complete antithesis of the chronically hapless Lions)

Microbiology -- this is more of a medical-oriented Micro -- no wet lab, though most of us have already had that experience as an undergraduate, which was a great lab -- taking all kinds of swabs and then growing cultures overnight. This class is very practical, and so far we've learned about the various gastrointestinal disorders (in other words -- any of the viruses or bacteria that cause an involuntary fluid loss from both ends, if you catch my drift) and now we're starting to explore various parasitic worms. We also got a good lecture on how the various classes of antiobiotics work -- some attack the cell membrane (penicillin), some disrupt nucleic acid synthesis (rifamycin) , some inhibit protein synthesis (tetracyclines) , and some act as antimetabolites (sulfa drugs). And then there are the antifunglas and the antivirals ...

Physiology II -- part 2 of Physiology -- in this course we are starting off with Renal function and acid/base function, moving into GI function, and finishing with a whirlwind tour of the endocrine system, covering all of the various hormones. Luckily for me, Dr. G gave me really good preparation for this course.

Clincal Laboratory Medicine -- not to be confused with my regular Clincal Medicine class listed above, this class covers all of the various diagnostic tests we will be expected to order and interpret once we start practicing. We started off with the CBC or Compete Blood Count, with differential -- basically studying abnormalities in red blood cells, white blood cells, and platelets. Next is Urinalysis and then the CMP or Complete Metabolic Panel, which includes glucose, electrolytes, and BUN (or Blood Urea Nitrogen). We actually have homework in this class where we receive various lab reports and have to come up with possible diagnoses.

Pharmacology -- this will likely be the hardest class for me. The first section was not really about any drugs in particular, but rather an exploration of pharmacodynamics & pharmacokinetics, which in a nutshell includes how drugs act on the body as well as how the body absorbs, distributes, metabolizes, and excretes them, all in painstakingly great detail. Very heavy on biochemistry, although now I think we are going to move into various classes of drugs which should be a bit easier for me to tackle.

Therapeutic & Diagnostic Skills -- well, each quarter we have a "fun" class, and this one fits the bill this go-round. This is a lab class where we learn various skill-based medical procedures. So far we have had an eye lab where we practiced removing foreign objects, using eye flushes, and using fluoroscein dye to look for corneal scratches and abrasions. The second session involved going to the anatomy lab and learning how to scrub in for surgery. We had an local heart surgeon (Israeli-born who trained in England for 10 years, practiced in Europe, and eventually came here to consult and work) explain the do's/dont's of the OR, and then we actually scubbed in -- did the nail scrub, handwashing, and put on surgical gowns, masks, hats, gloves and got a rundown on surgical instruments. Some of the future sessions include practicing venipuncture and administering shots on eachother, as well as learning sutures and surgical knots (we will be practicing on pig ears!)

Clincal Track -- Independent Study -- this is basically for the Master's component of my degree. While we only meet for a few session over the quarter, there is a project involved that we need to be working on our own, turning in various parts of it over the quarter. We got to choose a topic and then we can either do a 10-page paper or 30-minute presentation on it. I chose the presentation as I have written my share of papers over the years and think getting up in front of my peers and practicing my public speaking will be more beneficial. Thanks to a suggestion from Rachel, I will be doing my presentation on CTCL -- Cutaneous T-Cell Lymphoma -- a very serious disorder which often gets misdiagnoses early on as it resembles more benign skin conditions like eczema or psoriasis. The presentation includes making handouts and developing a Power-Point program.

Interdisciplinary Core -- this is the only class that I have to just show up for. It only meets every other week, and it's meant to just expose us to the various disciplines. Each week a different program is highlighted -- Dental, D.O., P.A., Nurse Anesthesia, Cardiac Perfusion, etc.

In case you weren't counting, that is 9 classes (well, Core class is not really a "class", but attendance is mandatory). I think I counted up 20+ tests alone this quarter, along with my Independent Study presentation, homework for ECG/Clinical Lab, and Clin Med small group write-ups. In other words, I am busier than ever, if that is possible. The program director only half-jokingly said that most students mentally break down in mid-January to early-February, and that we should come to them or see the school counselor when, not if, that happens. I have to say, if I didn't love what I'm doing, it would seem insurmountable.

I'll reward you with some funny for wading through that academic diatribe...

A White Sport Coat ...

2008-12-07T23:52:00.007-07:00

...And A Pink Carnation

(Hopefully some of you catch the Marty Robbins reference, or at least the later version by Arizona's own Meat Puppets -- go here if not)

And what am I blathering about now? Well, this Friday the school had its annual White Coat Ceremony. It's a fairly new tradition which originated at Chicago's Pritzker School of Medicine in 1989 but is now observed in over 100 medical schools. It is a formal event in which students are "coated" by their program directors and Dean to symbolize a student's entry into the professional phase of their education.

The event was fairly large, as all of the school programs were included: the College of Osteopathic Medicine, the College of Dental Medicine, the College of Pharmacy, and the College of Health Sciences. By the way, Midwestern is starting a School of Optometry next year, so if anyone has thought about pursuing that field, let me know and I can pass on more information and tell you about the program.

Back to the event -- it was held in the brand spanking new auditorium, which has a half-circle stage and seating for 2,500. Lots of friends and family were in attendance, and the venue was definitely full. The President of the University gave a short speech, and each of the Deans also made some brief remarks. Following the actual "cloaking", we took the following oath:

As I embark upon my course of study, I will:

Enter into a relationship of mutual respect with my teachers and my colleagues to enhance the learning environment and gain the knowledge, skills, and attitudes of a good health provider.

Accept responsibility only for those matters for which I am competent, maintain the trust expected of a health care provider, and never take advantage of the patient-provider relationship.

Respect the patient's right to privacy.

Value the knowledge and wisdom of the health care professionals who have preceded me and endeavor to contribute to their tradition.

Recognize my weaknesses and strengths and strive to develop those qualities that will earn the respect of my patients, my colleagues, my family, and myself.

Continue this learning throughout all the days of my life.

I was still a little under the weather, having caught a cold a few days earlier, but it was a nice ceremony and I did feel proud to be up there with all my fellow students. Here are a few pics of the event:

So does that make me look official or what? Before long I'll be joining the ranks of these famous and esteemed white-coated professionals:

Here I Go Again

2008-12-01T02:54:00.014-07:00

Today I start my 3rd quarter of PA school. The last quarter had a few struggles and yet I came out with a 3.45 GPA which was higher than the 1st quarter, so at least I'm hanging in there. According to the teaching staff and former students, this one will be the most challenging -- I'll post more on the course load during the week. I've enjoyed the last 2 weeks of break but am ready to get back to the grindstone -- this may sound preposterous, but I found that I almost don't know what to do between quarters -- it's hard to get out of the "MUST STUDY" mode and relax.

I did complete my "November experiment" again this year -- shut off my air/heat in the apartment for the entire month. That might sound remarkable but it's not really -- the weather here in Phoenix is nearly perfect this time of year -- days are in the high 70's/low 80's and the nights get down to the mid 50's.

So what did I do over my break? Well, for starters, the timing was impeccable as my birthday fell on my break. I did quite a bit of hiking -- didn't get out to Sedona or Mexico this time but there are plenty of good hikes in town. I decided to do a birthday hike on Camelback Mountain. For those not familiar with Phoenix, Camelback Mountain is part of Echo Canyon Park, right in the middle of the Valley, just south of Paradise Valley, just west of Scottsdale, and northeast from Phoenix. It's about a 25-minute ride from my apartment. There are 2 trails leading to the summit, both about 1.5 miles long, with an elevation climb of about 1200 feet, with the summit having an elevation of 2,700 feet. It makes for a good workout and there are a few spots with handrails that are good scrambles. Some people find the desert landscape to be drab and dull, but I think the desert has a beauty of its own, and I much prefer to get out and exercise outside than run on a treadmill in a gym like a hamster on a wheel. Here are some pictures:

And I also enjoyed a nice Thanksgiving feast courtesy of the Marshall clan, who have taken me in for many a holiday in the years I've been here in Phoenix. 2 of the Seven Deadly Sins were engaged in -- 1st gluttony, and then sloth as ravenous maws were stuffed full like bears getting ready for winter hibernation, leading to bloated bellies and the onset of a food-induced coma. There were 2 birds this year -- an 18 lb roasted and a 22lb deepfried. That is 40 lbs of turkey for 15 people, not to mention flowing wine & all of the usual side dishes including the infamous Marshall family "Slickers" which are succulent homemade noodles and a staple of their holiday meals. My own contribution was the infamous Miller family Olive salad. Here are some pics of the fantastic vittles we gorged on:

Hope everyone else enjoyed their Thanksgiving!

Oh bother ...

2008-11-20T16:31:00.007-07:00

So, I'm sure everyone at some point in their life has been compared to, or felt like, a cartoon character. For me, that character happens to be Eeyore. Personally, I find Eeyore to be a bit chipper and upbeat for my tastes, but I've been given the comparison by friends and family too many times to refute it at this point. And so, as Eeyore would say, "Thaaaanks for noticin' me."

Some Eeyore fast facts: Eeyore's Birthday is celebrated every year in Austin, Texas.
Here is the official site and the Wiki entry

After all, what are birthdays? Here today and gone tomorrow -- Eeyore

Before I sign off, I should probably answer the burning questions going through your skulls right now:

Yes, that post DID just happen
Yes, the above post was made by a fully grown man
Yes, I am crazy. Like a fox.
No, I don't think I need to up my Prozac dose.

take a deep breath ...

2008-11-19T21:20:00.011-07:00

Well, I'm officially on break. We get a nice 2 week break before the next quarter, which starts Dec 1st. And then we have a break just a few weeks later for Christmas, so the end of the year is actually not too bad. Not exactly sure what I'll be doing over break but even doing nothing is nice sometimes.

Musical point to ponder:

Sad Sack Song Titles

There are a lot of contenders, and certain songs here and there stand out. Every band or artist has a sad song or 3. You could argue that pretty much all of the blues and the lion's share of country music deals with hardship and heartaches. However, there are some artists who seem to thrive on anguish, to wallow in wretchedness like a pig in mud and embrace it almost willingly. Look at Chris Isaak for instance -- he's made a career on wistful woe. And there are sad songs, and then there are sad songs with equally gloomy and bitter titles. I'm talking about ones that you can just tell are going to be "fetch a length of rope and a wobbly 3-legged chair" from the get-go. If I had to pick the King of Pathetic Woe-Is-Me miserable tunes, it would have to be the melancholy Morrissey, AKA "The Pope of Mope", both in his solo career and with the Smiths. Here are a couple of gems showcasing his sorrow and suffering:

How Can Anybody Possibly Know How I Feel
Angel, Angel, Down We Go Together
Now I Am a Was
The More You Ignore Me, The Closer I Get
We Hate It When Our Friends Become Successful
I Am Hated for Loving
(I'm) the End of the Family Line
Sorrow Will Come in the End
I Don't Mind If You Forget Me
What Difference Does It Make
Girlfriend In A Coma
I'll Never Be Anybody's Hero Now
Unlovable
Oh Well, I'll Never Learn
Satan Rejected My Soul
The Boy With a Thorn In His Side
The World Is Full of Crashing Bores (actually I'm with him on this one)

and my personal favorite:

Get Off The Stage (sheesh, apparently he thinks even his fans despise him)

Honorable Mention goes to Ryan Adams for cheery classics like:

Excuse Me While I Break My Own Heart
I Taught Myself How To Grow Old
Clearly Destroyed
I Hope It Rains At My Funeral (For Once, I'd Like To Be The Only One Dry)

and some truly tormented album titles like:

Love is Hell
The Suicide Handbook
Faithless Street
Cold Roses
Those WEREN'T the Days

If anyone else has some truly bleak additions, leave them in the comments please.

And since I hate ending the post on such a dreary note, here is something guaranteed to make you smile:

The (Van) Damme Dance!

<-- I have no idea what is going on in this picture, but I'm thinking maybe some popping and some locking

the hits just keep on coming ...

2008-11-17T15:55:00.003-07:00

Well, I did survive the end of my finals, though I did not escape unscathed. After a string of A's on the midweek finals, I took another beating at the end of the week on my Women's Health final. This was me leaving school that day:

Yes, it is a pathetic sight to see a grown man crying. I know I need to cut myself a little bit of slack and remind myself how lucky I am to even be in the program -- there are many, many, many who apply every year (and sometimes year after year) and don't get in. Still, it's a blow to the pride when you fail an exam, regardless of the consequences. I'm one to be especially tough on myself, so I have a hard time rolling with the punches sometimes, but I'll get over it. I think you do learn a lot from your mistakes (and let's just say I learned a lot on this last test).

So, later that evening, after seeing my score online through tear-stained eyes and doing some quick math, I found out I was still going to pass the course. Needless to say, that lifted my spirits in a hurry, and my demeanor quickly changed to:

Ah how the tides can turn. And after doing some more quick math, it looks like my GPA will actually be higher this quarter than last, so I'm at least doing something right. What an emotional rollercoaster ride so far -- though now I have a nice 2 week break to rest, relax, and refocus before heading back for what I have been told will be the toughest quarter yet. Rachel, does this all sound familiar to you?

the Final(s) Countdown

2008-11-12T01:29:00.011-07:00

James, I hope you enjoy the Europe reference -- had to throw that in there since it's your all-time favorite song... get a webcam and this could be you:

Yes, I am indeed in the throes of a crazy finals week -- I did get 2 of them done last week (Clinical Medicine & Epidemiology) but this week I have 5 more -- one each day. How am I faring, you might wonder? Let's just say sleep is nil, stress is high, and I'll be ready to collapse when this week is over. I am feeling more and more like a hermit these days -- it's hard to find a balance when you feel there is *always* something you could and should be studying. I don't mind the studying; I love what I'm learning. I guess I'm just saying I struggle with finding that balance between school and the rest of life. Put it this way -- when you start thinking things like "Hmm if I cut down my showers to every other day, that would give me an extra 30 minutes of study time a week" then you know things are a little off-kilter, although I don't think PA programs are designed to give you much free time. I think the decision goes something like this: figure out how much coursework and material would most likely kill them, and then back if off just a little.

And to top if off, I folded like a pizza box on my 1st exam on Monday. The Dean of Student Services warned us during orientation that everyone should be prepared to fail at least 1 or more exams along the way, and to not let it get you down. And the school actually does take the stress levels generated by the program seriously -- we fill out Beck depression inventories every quarter, and there is free anonymous counseling available to all students. That being said, failing an exam still slaps the taste right out of your mouth. Rather than drone on any more, let me illustrate my performance via images:

Now, I should probably say that I still ended up with a B in that course overall -- one good thing about our finals is that they are weighted the same as a regular test. The other good thing -- nowhere to go but up from here! And with that, I think I'll get back to the books ... my next post will probably be after my last final on Friday, providing I haven't assumed room temperature. And if I do somehow make it through, I plan on sleeping straight through my break -- someone make sure I wake up before the next quarter starts, ok?

A mathematical paradox

2008-11-06T18:26:00.005-07:00

Today was my last day of lectures for the quarter. My how time flies! And today's was a doozy: a 3 hour barn-burner Physiology wrap-up on the Respiratory system that turned my grey matter into a puddle of primordial goo. I know it had something to do with ventilation, perfusion, PAO2, PaO2, the A-a gradient, PACO2, PICO2, PaCO2, and laws by fellows such as Boyle, Hentry, Dalton, LaPlace, Fick, and Poisseuille but after that it gets kind of hazy ... though I do have all weekend to figure it out. So far, I've taken 2 finals so far -- Clinical Medicine and Epidemeology. They mercifully split our finals up so they wouldn't all be on finals week. That being said, I have a final every day of the week (Mon-Fri) next week and my meta-analysis paper the following Monday so it's going to be a long haul regardless.

Thought I'd shift gears a bit and talk about Math today (is this the nerdiest blog you've ever read or what?) This is something I picked up from Dee -- she is taking a graduate level statistics course, and so the bulk of the material in her class is beyond the grasp of my pre-Calc intellect. After all, I'm just a simple caveman. However, there is one thing I do know! And that is the strange case of Simpson's Paradox, which I will now present to you in a hopefully coherent and understandable manner.

Imagine 2 colored urns, one black and one white. Now imagine there being a mixture of red and green balls in each urn. Finally, imagine a game where you must select either the black or white urn, and then draw a ball at random from that urn. If you happen to pick a red ball, you win $1,000,000! Sounds simple enough so far, right?

Okay, in the 1st round, the black urn contains 5 Red balls and 6 Green balls. The white urn contains 3 Red balls, and 4 Green balls. Which urn do you pick to draw from, the black or the white?

Let's look at the probabilities of picking a red ball:
black urn - probability of red ball = 5/11 = .455
white urn - probability of red ball = 3/7 = .429

So, as you can see, you would likely pick the black urn, as the percentage of getting a red ball is higher.

Now let's consider 2 more urns. In this case, the black urn contains 6 Red balls and 3 Green balls. The white urn contains 9 Red balls and 5 Green balls. Again, which urn do you pick to draw from?

Here are the probabilities this time of picking a red ball:
black urn - probability of red ball = 6/9 = .667
white urn - probability of red ball = 9/14 = .643

Once again, it should be apparent that the black urn would be the one to pick, as it has the better odds of yielding a red ball.

Now, we will consider a third choice. Imagine if we combined the balls from the 2 black urns used in the previous examples. We also combine the balls from the 2 white urns. Now which urn would you pick to draw from? Since in each example, the black urn had the higher probabability of a red ball pick, you would no doubt pick the black urn once again.

(Right about now is when I lean in and whisper -- this is where the story gets w-e-i-r-d!)

Well, lets go ahead and check the math on this, just to make sure we chose right. Looking at the combined urns, in the black urn there are now 11 Red balls and 9 Green balls. In the white urn, there are now 12 Red balls and 9 Green ones.
black urn - probability of red ball = 11/20 = .55
white urn - probability of red ball = 12/21 = .571

What you talkin' bout Willis? I'm sure those of you who have made it this far are left scratching your heads a little. This one fooled me too. However, there is a rational and reasonable explanation for this, which can be found at this link: The Secret of Simpson's Paradox

Considering the quantum leap in racial equality made 2 nights ago in the U.S. presidential election, I will leave you with a fittling mosaic. (for full effect, look at each block close up and then back away from the screen -- not that you probably needed me to mention that, but that's why my friends call me Capt. Obvious)

Loves me some sarcasm

2008-11-02T23:59:00.018-07:00

As far as school goes, I am in the eye of the storm of the quarter. I do have my clinical medicine final in 7 hours -- the last unit was mostly on musculoskeletal disorders -- neck and low back pain, knee problems, carpal tunnel, plantar fasciitis, and a huge unit on hypertension, which is the #1 cause of office visits in chronic conditions. Not the most difficult unit for me as a lot of it ties in to the etiologies I treated as an Occupational Therapist, but there are still some tricky things, like remembering the difference between spondylosis, spondylolysis, and spondylolithesis. One thing that I really like about this course is that they are teaching us the various meds for each disorder -- it's like sticking your big toe into the water in preparation for diving into Pharmacology class next quarter. Hypertension, in particular, can get pretty tricky with the med adjustments -- when to use or not use ACE inhibitors, beta blockers, ARB's, calcium channel blockers, central alpha agonists, alpha blockers, and the various diuretics. There is nothing like pushing yourself beyond what you thought you were capable of, and it boggles my mind when I look at my folders and contemplate just how much I've learned in such a short time.

That being said, and getting back to the title of this post -- I also happen to be a huge fan of sarcasm (it was first embedded in my psyche by Razortongue herself , nurtured and fostered by my fellow Hoy Boys and fellow appreciator Phil, and then polished to a fine point over years of exchanges with my equal in satirical cynicism, James) and so I now present you with some fine bits of biting sarcasm dealing with college. There is one random picture and the rest all come from the fascinating mind of the Simpsons creator Matt Groening. As most of you probably know, he wrote a series of cartoons and books under the umbrella of "Life in Hell" and these particular exerpts are from the hilarious and yet all-too-true book "School is Hell", which can be purchased here (my legal team thought it would be prudent to include the link).

Hope you have as twisted of a sense of humor as myself and can appreciate these:
(if you're having trouble reading some of the text, click on each picture to see a larger version)

What's in a name?

2008-10-25T13:19:00.009-07:00

Not too much to report school-wise -- had a big Neuro exam on Friday and now I'm holeing myself up for the weekend to study for a big Physiology exam on Monday. This unit is all about the cardiovascular system; anything you can imagine is covered: the cardiac cycle, EKG readings, cardiac measures, blood pressure, peripheral circulation, hemodynamics, and how the system responds in exercise as well as various states of failures. There are 3 pages of mathematical formulas alone to measure. One thing about PA school -- you can never be caught up, you just do your best to prepare for the next big test. I think if all I had was Physiology, or say Neruoanatomy, I would feel really comfortable in any one area, but there is no way you can master it all when you have 8 classes.

I thought I'd go into names a little bit. How many of you have thought about your names, and what they mean? I happen to have a very common name, but it's one I'm rather proud of.

Let's start with my first name: Daniel. I was named after the Biblical Daniel, a prophet as well as an interpreter of dreams and known as a wise man (for clarification: wise man -- not wiseguy). In Hebrew, Daniel means "God is my judge." In the Bible, Daniel is perhaps most known for his courage in the "Lion's Den"

Did you know that Daniel is portrayed in Michaelangelo's famous painting on the Sistene Chapel? Needless to say, Daniel is a quite a popular name worldwide -- many young parents pick this name (and who could blame them?)

But just how common is it? It depends on the source, but here are some of the data I found:

In the U.S., Daniel is the 5th most common given name, overall. You can break it down further and look at states and years -- for example, in California in 2007, Daniel was the most popular given name, and I won't belabor you with all of my findings, though here is one curious one: according to the 2000 U.S. census, Daniel is also the 380th most common surname! Suffice it to say, there are a few of us Daniels around. Here are some links in case you want to research your own name: U.S. links or a more general site

Now let's look at my last name: Miller. As you probably know or would guess, this is incredibly common as well. According to the last U.S. census, it was the 6th most common surname, behind Smith, Johnson, Williams, Brown, and Jones. Another way to look at it: Millers account for about 0.5% of the U.S. population. Here are some links for last names: a nice NY Times scrolling chart and a whitepages.com breakdown.

And finally, my middle name: Ruben. My middle name came from my paternal grandfather, a man who I greatly love, admire, and respect and who I am proud to be named after. My grandfather, as my family well knows, has many legendary nicknames, though that is a tale for another day. Ruben, incidentally, is the 20th most common given name in Spain, and by its alternate spelling, makes for quite a tasty sandwich. To quote the great Miracle Max: "Sonny, true love is the greatest thing in the world. Except for a nice Reuben sandwich, where the corned beef in nice and lean, and the sauerkraut is fresh."

Hopefully I made you all think a little bit about your own names, if you've never been curious enough to do that in the past. I'd love to hear some comments so feel free to share some stories about your own names and any other interesting related trivia. I'll never forget the time my uncle David lived on a street where there were 2 other David Millers within a few miles. As you can imagine, their poor keystone-cop-like mailman never could get their mail sorted just right.

One more interesting Dan Miller bit: as some of you know, I'm a fan of all things martial arts, including the recent MMA movement. Well, there is an upcoming fighter from Jersey named Dan Miller, and of course, I am a huge fan. We Dan Millers have to stand up for each other, you know? He fights tonight at UFC 90 -- let's hope he does the rest of us Dan Millers proud. Apparently he is a pretty good grappler and submission artist, though I notice he still lacks a nickname. Which reminds me of a converstation I had with my friend Derek, where we tried to come up with possible nicknames for ourselves were we to become MMA fighters. Derek came up with "The Red Herring" which is even more fitting as he has red hair, and I figured that he should hail "from parts unknown." So any suggestions for a good nickname would be appreciated. Here is a link to his bio: Dan Miller's bio & professional record

Carlin of the day:

The wisest man I ever knew taught me something I never forgot. And although I never forgot it, I never quite memorized it either. So what I'm left with is the memory of having learned something very wise that I can't quite remember.

Somehow I'm still afloat

2008-10-22T23:45:00.002-07:00

Had quite an interesting experience on Monday -- had to perform a Well Woman exam on a standardized patient. This included a breast exam as well as a full pelvic exam, including using a speculum to visualize the cervix (I did not actually take a pap smear, though it would have been a simple thing at that point) and a bimanual exam to feel the uterus and ovaries. As you can imagine, this was a fairly nerve-wracking experience, especially for the guys in the class. Thankfully, the patient was very relaxed and helpful and they made the whole experience as non-threatening as possible. It ended up being a lot less stressful than I had anticipated, and hopefully I'll be more prepared now when my Women's Health rotation comes around next year. I won't go into any more detail about the experience (for all of your sakes) but it was probably the most invasive thing I'll have to do until my clinical year, and I'm glad they included it in the curriculum -- it's one of things you can't just read about but have to actually do to appreciate.

I'm keeping this one short as I have a big Neuro exam to study for.

In closing, let me present you with proof positive on something I have long suspected: Tom Cruise is indeed a Sith Lord:

I'm on a roll here ...

2008-10-13T22:17:00.000-07:00

Had a shorter day than usual at school -- in Neuro, we reviewed upper and lower motor lesions involving the vestibulospinal, reticulospinal, rubrospinal, corticospinal, and corticonuclear systems as well as discussed what is going on neurologically in decorticate and decerebrate postures that you might see in comatose patients. In Women's Health, we started the Obstetrics 1/2 of the class. Our teacher for this section is actually a OB-GYN D.O. who graduated from our school in 2004. I've found that quite a few of the PA faculty are past graduates. I think someday I would enjoy teaching a class here or there. Though first, I need to *pass* and complete the program. Then, get some years of experience under my belt (and hopefully pay off my sizable college loans in a decade's time.) Then, and only then, I will hopefully try my hands on the other side of academia.

In other news -- it's FINALLY cooling off here -- 72 tonight and the 1st night I've had the windows open at night. I shouldn't complain as I do like the heat for the most part and seeing the sun every day -- although I love a nice cool night with the breeze blowing in through the window screen.

I'm getting a rare break this week and going to see Bob Schneider play on Thursday night. Normally, I wouldn't even consider taking a night off (sounds absurd but sadly it's true), however I will have a brief reprieve following a big test on Wednesday and I'm seizing the opportunity as I may not have another opportunity until the semester ends. And when Bob comes to town, I help out by playing roadie or selling merch and so the show is free. Free is good when you have no real income.

I have a few quotes from Mark Twain for today:

Action speaks louder than words but not nearly as often.

Forgiveness is the fragrance that the violet sheds on the heel that has crushed it.

When we remember we are all mad, the mysteries disappear and life stands explained.

What's this? A new post?

2008-10-11T00:57:00.000-07:00

And it only took me a month and a half. At this pace, I'm sure I've lost the interest of the few people who might actually check this blog out. However, I am compelled to push on and maybe if I get in the habit of posting something, *anything*, at least once a week, it will become habit and this blog will actually serve the purpose I set out to accomplish with it. At any rate, I'm starting to ramble, as I'm wont to do, and I know no one wants to suffer through that, so I digress...

As you can see, I changed the title of the blog. I'll probably keep the same address but tinker with the title to reflect my current mood. After a really tough week or more all-nighters than I've had in a while, I decided to switch to my new motto and one of my favorite Warren Zevon tunes (I know he didn't coin the phrase but his song is legendary to me).

One of the main purposes of this blog was to let everyone know what the experience of PA school is like. I still have to post about my 1st quarter -- the "breaking in" phase, if you will -- but I may as well talk about the current quarter.

A quick side-note for those of you not familiar with the structure of PA school: think of what 4 year medical school like, and divide by 2. The structure of PA school is in the medical model, so the 1st half is didactic (lectures, courses on campus) and the 2nd half is clinical (going out on various rotations.) In a lot of ways, I think PA school might be more intense than med school -- you don't learn everything a doctor does, but you also have half the time. And by the time I'm done, I'll be basically doing the same things a doctor does -- examining patients, ordering/interpreting lab and other diagnostic tests, writing treatment plans, prescribing medications, etc. It really is a unique profession that has come a long way in a short period, and is filling in the gap created by the current physician shortage and increasing demand for health care. One nice thing about my soon-to-be career: job security. There will always be a demand for it, and it's something that can never really be outsourced. Okay, I'm rambling again, back to this quarter ...

This is quarter number 2 (PA programs have quarters rather than semesters and you go straight through with no spring or summer break) and I have 8 classes. No, that wasn't a typo -- 8 classes! Here are each of them with a brief description:

Physical Diagonosis: This class, as the name implies, teaches us to perform a complete head-to-toe physical exam. We are taking this class with the podiatry students on campus -- it's neat to mingle with some of the other programs. There are lectures that talk about the technique and purpose of all the individual parts of the exam, as well as specialized tests and abnormal findings. A big component of this is learning how to use medical equipment such as a stethescope, otoscope, opthalmoscope, and vaious and sundry other instruments. There is also a lab section where we come in and practice the parts of the exam on each other. So far, I'm really enjoying this class as I'm really starting to feel like a clinician. Rather than just sitting in a lecture hall, we get to apply some of our knowledge. Our school has a set of clinical rooms set up just like your typical doctor's office room, complete with exam table and requisite "butcher paper" all the way down to the jar of long q-tips and tongue depressors. There are 2 sets of 3 rooms and in between these rooms there is a "monitoring area" where the faculty can watch all the rooms behind 2 way mirrors and even listen in via headphones when we do our tests. The tests are also videotaped and given to us on DVD so we can analyze ourselves performing the exams and see where our bedside manner, approach, and comfort/confidence can be improved. When it comes time for the exam, there are are standardized patients who come in and we perform the physical exam on them, with one of the faculty standing by and grading us. I just had the midterm exam and it consisted of the following sections: vital signs, skin, head, ears, eyes, nose, throat, neck, upper extremities, and pulmonary. We had 30 minutes to check over 70 individual items and had to work from memory, which was a little daunting, both in trying to remember the correct order and all of the various tests as well as being able to hustle and move quickly. However, you find that it tends to flow once you get over the nervousness. On the final lab exam, we will have an hour, but have to do everything on the midterm, as well as adding cardiac and lower extremities and adding other specialized tests such as a complete neurological exam and pelvic/breast exams. Basically, the final will be a complete and comprehensive physical exam.

Clinical Medicine: If Physical Diagnosis is part of the nuts-and-bolts of medicine, this is your bread-and-butter. This class is similiar to Pathophysiology, so you go system to system and study disease processes and abnormalities, but with the addition of treatment. We learn how to diagnose various disorders and also the medications and standart course of treatment with each. There is a small group breakout in this class where we are presented with a case and have to come up with the probable diagnosis & differential diagnoses (what else it could be) and then come up with a treatment plan. With each case, we do a full write-up as if we had just seen that patient in our office, and even write out their prescriptions on sample prescription pads.

Here is a sample of the content from our last test (which was this morning):

Hematologic conditions (all the various macro and microcytic anemias)
Oncology: Leukemias, Lymphoma, and Multiple Myeloma
Musculoskeletal/Rheumatology: Arthritis, Orthapedic Radiology, Gout, SLE

Obviously this is just a general idea of how we cover broad areas -- each section has many many more conditions than what I listed. Earlier in the year we covered Dermatology, Immune Disorders, Vision Loss and other eye conditions, ear infections, allergies, oral lesions, upper respiratory conditions, and more.

Physiology: This is tought over 2 quarters and is the natural extension after you make it through the juggernaut that is Gross Anatomy. In anatomy, you mainly just learn what and where all the various body structer are, and in Physiology you learn how they work. We started with some basic cellular stuff -- osmolarity, diffusion, equilibrium potential, the nervous sytem (action potentials, graded potentials, synaptic transmission) and such -- and moved on to the muscular system (one my faves -- the sliding filament theory) and now we are on a big cardiac unit where we study the cardiac cycle, EKG readings (what they mean and what abnormalities look like), circulation, blood pressure regulation, etc.

Neuroanatomy: Another extension of Gross Anatomy, this class focuses on the brain, spinal cord, and peripheral nerves with a focus on how various lesions present clinically. Very focused class as you might imagine -- so far we have covered a more comprehensive look at the anatomy of various brain regions -- medulla, pons, cerebellum, forebrain, cranial nerve nuclei, etc. and are now moving into systems: somatosensory (pain, touch, proprioception), visual, auditory, taste, olfaction, and upper and lower motor neurons and reflexes.

Women's Health: Somewhat of a challenging course for me -- I've been told on many occasions that I don't understand women, so I suppose I really need this class (though I'm convinced I'll never truly understand them lol). I won't go into great depth on this one -- the 1st half of the class covers gynecology -- we study the menstrual cycle and hormonal changes and disorders (amenorrhea, dysmenorrhea), birth control, sexually transmitted infections, ovarian, breast, and cervical cancer, pelvic organ prolapse, etc. Then 2nd half of the class will focus on obstetrics.

Epidmeology: This class looks at various ways to study and track disease processes and how to read and interpret various test measures. It's very heavy on statistics and calculations, but with a very practical focus, which I really appreciate. For example, if a woman tests positive on their pap smear, what is the chance they have cervical cancer? And what do you do next?

Evidence-based medicine: This is actually part of my Master's track and meets on Friday afternoons. In this course, we learn how to apply evidence-based medicine. The focus is on how to evaluate studies and research papers and use the current literature in our practice. The major "assignment" of this class is to come up with a clincial question, find all the current and relevant studies on your topic, and write up a review of the studies and disorder you are focusing on. The idea is that our final project will be suitable and ready to submit for publishing.

Interdisciplinary Core class: Finally, a class with no homework or tests! This is a very informal course that is designed to familiarize all of the students as to what each part of the health care team does. Each week, a different program comes up and presents on their profession. There are quite a few specialty programs here -- the dental school just started this year, and there are D.O.s, podiatrists, physician assistants, pharmacists, occupational therapists, nurse anesthetists, cardiac perfusionists, and other medical subspecialties. While this is basically a sit-back and relax class, there is a requirement to do community service as part of the course. The school runs a clinic and also does volunteer work at a few local homeless shelters, they periodically will do school physicals, and assist with fundraising events like the various walks/runs for various causes, so there really is a myriad of opportunity.

Well, in a nutshell, that is my current quarter. As you can see, I've been just a tad busy. Although I wouldn't trade it for anything -- there have been big groups of students already interviewing for next year, and the numbers keep growing and growing -- our school has had almost 1000 applicants already for only 80-odd seats, so I am truly grateful to have such an amazing opportunity and I do truly love it, even though I often feel overwhelmed and stressed. It's all part of the process -- and when else in my life am I going to be able to take 2 years and just learn...

Okay, if you're still with me after that massive diatribe, pat yourself on the back. I will do my best to post more frequently, and rest assured most of my posts won't be so long-winded and require you to schedule a 30-minute block into your day planners.

I'll end with a picture and a quote. The picture is a macrophage about to engulf a cancer cell:

And I'm not sure of the source of this quote, I just remember it from a plaque at my old kung-fu school in Michigan:

If we don't try, we won't do.
And if we don't do, then what are we on Earth for?

Let's get this ball rolling...

2008-09-01T01:34:00.000-07:00

Well, here we go. This blog is an experiment on my part to delve into the world of online journals, as well as a way for me to chronicle my journey through Physician Assistant school, a pivotal point in my ongoing and seemingly never-ending formal education. I'm planning to keep it informative so you all will have an understanding of what the PA educational process is like although I don't want it to be so dry and boring that no one will want to read it, so expect me to also try to keep it light and with appropriate doses of my patented dry and sarcastic wit. I'm hoping to include some pictures and other media, so if all goes well, it won't be as drab as it looks presently.

My intention was to have this blog started *before* school started, though predicatably I'm already a quarter behind, having just recently completed my 1st quarter, and am set to go back to the grind for the 2nd quarter on Tuesday, Sept. 2nd, 2008. Of course, most of you who know my penchant for procrastination are probably chuckling and nodding to yourselves that it is only right and proper for me to begin this little project already playing catch-up. The 1st quarter was a real eye-opener and quite an adjustment, and I plan to do a whirlwind summary of it later this week. However, I needed to get this blog started or it would likely have remained somewhere on my to-do list, never to see the light of day.

Which brings me to the title ... Yes, I realize it's more than a little corny, but I was pressed for time, and as I was brainstorming possible titles, this one popped in my head for some reason and at the time inexplicably seemed snazzy, so you know what? I'm going with it. The first person who saw it immediately erupted into a fit of laughter, as I'm sure some if not most of you did as well, but I've always said I don't mind being the butt of ridicule, so laugh it up jokers! Okay, I am starting to ramble so I think I'll sign off for now, but before I sign off for now, I'll leave you with a quote, and I welcome all comments, requests, and/or suggestions for future entries. Feel free to leave some feedback, whether it's your interpretation of the daily quote, random thoughts, or even just a quick jab at my hackneyed blog title!

Today's quote comes from Irish playwright George Bernard Shaw:

There are two tragedies in life. One is not to get your heart's desire. The other it to get it.