Purpose

I have found a purpose. I have been doing a lot of processing trying to determine what about working with the Hoopa Valley Tribe brought me this new found inspiration. Though I am still not entirely sure, I do know many of the patients I saw need an advocate, they need someone to care for them, to embrace their flaws, someone who will give them their best work because they care. I CARE A LOT. I am feeling incredibly sad, a little heart broken, to be leaving this rotation and it is because I know I did good for the patients here. I have done more good in the last six weeks than all my other rotations combined. I am incredibly grateful for the opportunity I had at K'ima:w medical center and hope to one day work at an IHS clinic again.

Pay day

There is a phenomenon that occurs on pay day, social security day, and welfare day. All the ails of the patients that are seen at K'ima:w seem to disappear for a few days. I have experienced this a few times, but today the contrast was undeniable. For the past two weeks the clinic has been crazy busy. It's cold season, we are approaching flu season and there has been a GI virus making its way through the community. But today in the nine hours I was at work, I saw seven patients in the walk-in clinic, only two between 1:00-5:00 pm. I had time to catch up on Typhon data entry, do reading for public health and socialize with the nursing staff. To say it was slow might be an understatement.


Tomorrow is my last day at K'ima:w Medical Center and I am really quite sad about it. I feel like I became apart of the team here. I am about to make move number seven this year and community is what I am longing for all the time. I have been excited for this rotation since it showed up on my schedule 10 months ago, but I never imagined what an impact this tribe and medical center would have on me. It has inspired me and I really hope that I can find work at an IHS (Indian Health Services) clinic one day.

Although I thoroughly enjoyed working with all the providers here, I bonded with one in particular. Susan Walsh is a Family Nurse Practitioner who has worked at this medical center for 12 years. She never treated me like a student, she treated me as an equal. She had high expectations and challenged me to make assessments and plans for my patients, but was always open to discussing these things if I was unsure. She cares about her patients, wants to do the best for them, and is willing to put in extra hours to achieve that. She is also upfront and straight to the point, knows her limitations and isn't afraid to ask for help. All of these are qualities I admire about her.

And the couple I lived with, Sonja and Dan, I will also miss. They are optimistic, happy people who really enjoy having PA students live with them. They looked after me, invited me to family dinners and made sure I had all I needed out here.

I am a bit emotional about this departure, but also so excited to spend the next week with my friends in Vallejo, which unfortunately involves exams! Then it is off to ER rotation in Truckee, which means I am a week closer to a visit from my parents, and then Michael for Thanksgiving. I haven't been home since early July and haven't seen Michael for six weeks... I am elated for both visits.

Joy and Pain

As I was studying in a coffee shop in Arcata this morning I was pondering ideas for this blog post. Then it came to me. In one 8-12 hour day in clinic I can experience complete euphoric joy and also intense emotional pain. Yesterday, was one of those days. I had several patients who, when I finished I felt I had helped, then at 3:00 pm I walked into a room with a couple I would spend the rest of my day with. As a provider it is incredibly frustrating to spend a lot of time trying to diagnose a patient, ordering xrays and labs, doing chart review, spending time obtaining a thorough history to have this patient, whom you have decided needs to go the emergency room via ambulance, decide to leave the clinic against medical advice to go home and come back in the morning, simply because they are tired of waiting. And although I have to go home at the end of the day knowing I did everything I could for that patient, I still fear that they will call an ambulance in the middle of the night and not make it to the ER in time or simply fall asleep and never wake up again. I feel guilt for the unknown outcome, but hopeful that this patient will indeed have an uneventful night and be back in the morning. Most days I can leave my work at work. I can shed the emotions when I take off my white coat, but yesterday I couldn't. I have wednesdays off, so I am anxiously awaiting tomorrow morning to learn how this patient is doing. Feeling these emotions is not particularly fun, but it confirms, for me, that I love what I am doing!

Fall

Here are a few things I have thoroughly enjoyed about living in the Klamath Mountains of northern California: 

• Watching fall paint its vibrant colors along the roadway. Everyday the painting is different and I look forward to my morning drive as the sun is trying to peak through the leaves, lighting them up as if they were under a spotlight. 
• The quiet of living in the mountains. 
• Sitting in the sun reading by the river. 

I was recently speaking with one of the providers about the patient population in the clinic, although I see Native Americans all day, they are no different than any other patient population I have seen. Each day I spend a lot of my day educating patients about caring for themselves, either for an acute condition or for a chronic condition, that if not managed can drastically change their life. Each day I feel I truly get through to only a few patients, but those patients are the fuel most practitioners need to do the jobs we do. I recently spoke with a 17 year old, who was being seen for cold symptoms, he wanted to go to Oregon State but wasn't sure the best way to do it, we spoke for at least 10 minutes about the different resources he has available to him to make that happen. If he does in fact attend college in his future, he will be the first in his family. Although I will most likely never know what will come of his future, I like to think that the support I offered him will bring him a little bit closer to attending college. These types of conversations bring me peace when a patient is yelling at me because I dont think they need a Toradol shot, or antibiotics, or xrays, or whatever it is that they are wanting, or simply because I am a student and they want to see the doctor. The nice part about being a student is when I am being yelled at, I do my best to calm the patient down and if I can't, I can always get the provider who is supervising me for the day. Unfortunately, this luxury will no longer be available when I am working as a PA, I will no longer be able to use the excuse of being a student. In the same way that fall is changing my drive to work everyday, the patients I see paint my workday each day.  

Burn out...Senioritis...Fatigue

Call it what you will, but as graduation is becoming closer, studying becomes more difficult. Actually, everything associated with school, except being in clinic and seeing patients everyday, is like trying to run through mud that is knee deep, its exhausting. Packing my car, moving, Typhon data entry, minimum requirements, studying, studying, STUDYING are exhausting.  At this point, I find reading my abbreviated medical texts easiest when studying. I am so tired of reading my notes, but ultimately these are the most helpful to me at this point. Tonight I was chatting with a friend who is considering going to graduate school, she is currently taking an online course and spending hours studying, and seems really excited about. It reminded me of my excitement and fear when starting PA school over two years ago. As I was reflecting, I tried to determine when the shine of PA school wore off, and I realized that each new stage of PA school is like polishing tarnished silver, the shine comes back. Though I am lacking luster on occasion, I know I am constantly working towards the end and a new stage will start soon!

The date for graduation recently became official. Pending a few more months of school and exams, on May 23, 2014 I will receive the two masters degrees I have been working diligently to obtain. We are in single digits people, approximately 7.5 months away from graduation.

Before starting rotation 6, our clinical coordinator warned us that rotation 6 and 7 are the most difficult, because the hype of the beginning is gone, the end is near but not near enough. This is the season of burn out. I have spoken to several classmates, most of who are feeling the same way as I am. The really amazing part is when I reflect on what I have done since starting rotations in February I can reach a state of complete motivation. I have lived in six places, worked with many providers, made a lot of new friends, I have learned so much (and forgotten a lot), I have failed and succeeded, but the greatest part is I continue to fall in love with what I am doing in clinic every single day.

I recently organized all my photos from the past couple of years. During the process I came across several of my favorite quotes I found while working at Dr. Fullerton's office in Austin. We had a daily quote board, which I loved, this is one of my favorite quotes...

"A mind that is stretched by a new experience can never go back to its old dimensions."
  - Oliver Wendell Holmes, Jr.

Site visit and sutures

Well after five and a half rotations I finally had my site visit. This consisted of one of my clinical coordinators visiting at my current rotation and evaluating my clinical skills. Julia, who is also my advisor arrived in Arcata Wednesday night where I met her for dinner. It was really nice to spend some time with faculty outside of the school setting. Thursday morning she met me at the clinic. She watched me do a history, physical exam and present to my preceptor. I was pretty anxious and it took me a bit longer to get into my rhythm with each patient. She gave me some great feedback and taught me a lot during our few hours together. I also saw herpes zoster, also known as shingles, for the first time clinically. It was textbook. The patient was in a lot of pain, the rash was in one dermatome, and did not cross midline on the patients chest or back.

Friday I sutured a person (not a fake skin, banana, chicken breast or pigs foot) for the first time! I was a bit nervous, but the patient was calm and happy to let a student suture him up, and I have practiced a lot on the materials mention above. I put two simple interrupted stitches in the tip of one of his fingers. He will follow up in about 10 days to have them taken out, at which time I'll get a better look at my handy work!

Today I drove into Arcata for the farmers market and a massage. When I drive west to Arcata I try to make a day out of it because the trip takes about one hour each way. At the farmers market they had a sidewalk decorating contest. There were some really great artists out there today. I visited the square again later in the day when the crowds were diminished and all the art was completed, here are some of my favorites.

Perspective

" Your best shot at happiness, self-worth, and personal satisfaction - the things that constitute real success - is not in earning as much as you can, but in performing as well as you can something you consider worthwhile."
  - William Raspberry