Flying High

My excitement for this week was the result of my preceptor, however, it did not take place in the OR, nor the hospital, nor the office. On Wednesday afternoon, Dr. Lanflisi, his practice manager, medical assistant and I took his plane on a flight. We flew down to Half Moon Bay, had lunch, then flew back to make it to the office in time for our afternoon schedule. On our way home, I had the opportunity to fly the plane from Half Moon Bay to Petaluma, where we landed changed positions so his practice manager could fly and took off again. I have never been in a small plane before, I was a bit nervous, but had a great time and managed to keep my lunch down despite a turbulent return!

 The plane 

 Mare Island

The descent into Half Moon Bay

The Count

I have seen over 1000 patients since starting rotations in February! It seems crazy to think I only have 3.5 rotations remaining and that I have seen so many people in such little time. Last week I was practicing knot tying with a classmate, this is basically an exercise in muscle memory, and allowed us to share stories. Skip to 2:44, this is almost full speed with a large string, it would usually be much smaller, and is done inside a surgical site.

 Diana is also doing a surgery rotation and we try to study together a few times a week. While knot tying we were discussing our proudest moments as students and I was reminded why I love medicine. As a student in surgery I do not have a lot of patient contact, I do some pre-op and post-op appointments but nothing like what I have had in my other rotations. Most of my patient time is spent in the OR while the patient is anesthetized.

Here are a few of the moments I have experienced with patients this year that have impacted me the most:

During pediatrics we had a 13 year old female who was brought in by her father because she was considering suicide. She was thinking of cutting her self the night before but decided to give the knife to her brother. Her family was in crisis mode and desperately wanted to do what was best for their daughter and sister. At one point during the visit I was alone in the room with the patient and having been a teenage girl, I remember how awful teens can be to one another. I asked the girl to answer a few questions for me about her friends, because this seemed to be the basis of her depression and suicidal thoughts. I asked her questions like: if you have a bad day who will you call your new friend or your other old friend who is making fun of you and spreading rumors, if you have a great day and want to share it with a friend who will you share it with, if you meet a cute boy and want to gossip about him which one would you call, etc... Every single question she answered with her new friend. I then encouraged her to think about her future. We then had a long conversation about being a teenager and how hard it can be sometimes, but that one day she will look back and realize how grateful she is for her true friends and family. By the end of our chat we were both crying. As a provider I have been taught to leave me emotions at the door, but in this case I think she needed some raw emotion. We laughed and cried together and I hope she walked away with a new motivation for life. She was also referred to a therapist and family counseling. She was such a beautiful young soul, I think of our conversation often and hope she is doing well.

During geriatrics I spoke with several patients about death, many of whom I have written about, but there was one day that I look back on often. I was checking in on a patient who was in his 80's and was a healthy man until he had a massive stroke. He was on hospice care and the family didn't want to prolong his life, but wanted him to be comfortable. He was NPO (no food by mouth), had been taken off oxygen but was being given morphine to keep him comfortable. For the first two weeks he was at the facility he was able to communicate by blinking or moving his head back and forth but was otherwise completely dependent on others for his care. He was able to communicate the he was comfortable, not hungry and agreed with the choices his family had made for his care. I was seeing him to check in with the family and confirm his comfort on the beginning of his third week in the facility. I walked into the room, introduced myself to his wife, daughter and son in-law, then started to ask the patient if he was comfortable. He was no longer able to respond via blinking. His wife was sitting next to him, she looked up at me and just started crying. I got down on my knees to be at eye level with her, held her hand and tried my best to provide the support she needed in that moment. Her question was "why hasn't he left us yet, I want him to stop suffering." I asked her if she had told him it was okay to go.  Often times loved ones hang on for the people they are leaving behind and if we tell them we will be okay, they will finally let go. I encouraged her to continue loving him, talking to him, touching him, and when she was ready to let him go, to tell him she will be okay. I look back on this day and hope my words were able to provide support the family needed in those moments, and I also realize that being with patients and their families as they are facing death is a role as a provider I truly enjoy.


Surgery is exciting and I am enjoying it, but I am always nervous, I study all the time but feel I never know the answer to the questions be asked of me, basically I am stressed out a lot. I miss having direct patient care and connecting with people. I miss it because I truly enjoy it, it is when I feel most confident as a student, and it is when I feel I am learning the most from my patients .

"The only people who can own social learning are the individuals who themselves are learning each day, from one another, based on their work and in the flow of work."
    -Marcia Conner

The life of a medical student

I have been in PA school for two years this week. As I teeter in and out of a state of burn out I am frequently reminded why I love medicine and why I am ready to be a graduate and no longer a student. 

Things I LOVE about being a medical student: 

1. I am always learning something new, this also means I am always unable to answer questions my preceptors have for me. Surgery makes this much more apparent. Basically all day everyday I am grilled about anatomy, physiology, disease processes, etc. My most common answer is "I don't know, but I will look it up." It seems that the more I learn the less I know and the less confident I am about what I know. However, I am learning that often times I do know the answer and I simply have to give myself the space to come up with it and trust myself and my knowledge. 
2. Interacting with patients. As Dr. Lanflisi (my current preceptor) said, the medicine stays the same, your white coat doesn't get any whiter, what makes this profession rewarding are the relationships you have with your patients. I couldn't agree more!
3. My classmates, who have become my family.

Things I miss from my life pre-graduate school: 

1. My family, friends, and Michael. 
2. Having time to commit to self care on a regular, almost daily basis (running, swimming, biking, yoga, massage, etc...).
3. Jezebel.
4. Cooking. Michael and I had this weekly tradition for a while, we would find something in the produce section we had never bought before and figure out how to use it in a recipe. It was exciting and fed my desire to create new dishes. I love being in the kitchen, learning to use new spices and ingredients. Although I still cook regularly, I pretty much stick to the things I know.

These are some of my favorite pictures from PA school and prior in no particular order: 

Summer

It still doesn't feel like summer. I was on campus last week for callbacks, exams, an OSCE (objective structured clinical exam- it is a practical exam with a patient that is a hired actor, I am observed by a faculty member and video recorded), and lecture. I spoke with several classmates about the concept of time during our clinical year. It seems like it is flying by and standing still. A few weeks ago I wrote the month as April several times, this has been happening a lot during rotations. It doesn't feel like it can possibly already be August. I feel there are many reasons for this... 

1. I am living my life six weeks at a time.  
2. I am moving A LOT.
3. I have yet to be in a place that was hot. For spring I was in San Luis Obispo, then I moved to Seattle (at its hottest was 80), and I just spent my last rotation in San Francisco (also not known for its heat!). 
4. I am consumed by working and studying, therefore being social is pretty low on the priority list. 
5. I have yet to wear a sun dress! 

Tomorrow I start rotation 5! I will be doing surgery in Vallejo, Fairfield, and Vacaville. I am excited to be in a place I know and be close to a few of my classmates. We have grand plans of studying together! I am also incredibly nervous about surgery. I have been in the OR many times since starting rotations, however I have yet to be scrubbed in and assisting. There are a lot of rules in surgery, and this makes me nervous. Also I will have my hands inside of someones body, kind of weird to think about!