The Road

Quote for the day...

"What appears to be the end of the road may simply be a bend in the road."
- Robert H. Schuller

Journey

This week I had a meeting with the classmates I will be working and living with in Cambodia. It still doesn't seem quite real that I will be leaving three weeks from today. Three weeks.... So much still needs to happen in my life before then. We also received our contract from Mother's Heart, the organization we will be working for, which outlines our responsibilities and their expectations of the work we will be doing. All of which I am very excited about. We will be performing a needs assessment in an area the organization would like to expand its services to. This area houses several factories and beer gardens where many women and girls work. These are the women we will be interviewing and conducting surveys with.

In the coming three weeks I will be:

• completing my last clinical rotation
• traveling back to California for callback week on campus
• taking my last end of rotation exam
• completing an OSCE (objective structured clinical examination)
• giving a case presentation to my class
• completing and turning in my CV for review
• finishing all my travel vaccines
• packing for summer in Cambodia
• leaving for Cambodia! 

"It is good to have an end to journey toward; but it is the journey that matters, in the end." 

 -- Enerest Hemingway 

Experience

Today as I sit in a coffee shop in Austin, well not just any coffee shop, but my favorite coffee shop, I am working on my CV. As I am writing about all of my clinical experiences from the past year, I am reflecting on what a crazy year it has been. I am excited to be completing my last clinical rotation this month, but I am also fearful of what this means. In less than six months I will be a graduate of Touro University and preparing to sit for the PANCE (Physician Assistant National Certifying Exam).

Here is what I have been up to for the past few weeks.

I moved to Austin for my last clinical rotation with Dr. Fullerton, the physician I worked for during the two years prior to starting PA school. I had the luxury of having a week off for Christmas, which was really nice. I have been gone from Texas long enough that I forgot how big Texas skies are, I love every sunset I have watched over the past three weeks. They are just stunning. I am so proud to call this place home.

I am also preparing for my public health field study, which will be from February to mid March. I will be traveling to Cambodia to work with an organization that provides crisis pregnancy counseling. This will be my first trip traveling abroad and I am so excited! It is certainly proving to be expensive to prepare for, but I know it will be well worth the experience. I am also hoping it will be the first of many trips abroad for public health and medical missions.

I applied for graduation! Which makes it a little more real that I am nearing the end.

A quote I find appropriate as I continue to realize how little I know about medicine, but am excited by the prospect that medicine will always be teaching me more.

"Experience: that most brutal of teachers. But you learn, my God do you learn."
  - C.S. Lewis

Snow and the business of skiing

Today was crazy in the emergency room. I have been asking myself why and have come up with several reasons.  1. the ER is unpredictable, you never really know when you are going to have a rush of patients.  2. It is Sunday, most urgent care centers are closed.  3. There hasn't been much snow to accumulate on the mountains, many ski resorts are making snow because they were determined to open by this week, but the snow it is like ice instead of a nice thick bed of powder. Ice = injuries!  Today I saw three patients with vertebrae fractures, two of which had to be transferred to nearby trauma centers for emergent surgery. One patient should have been paralyzed after viewing his images but his motor and sensory neurological exams were still intact.  For many reasons I am hoping for some snow while I am here, one of them being I have some exposure to ortho cases other than spinal injuries.

Lake Tahoe

Distance

Home

Last week I experienced for the first time what it feels like to need to be home, to be with my family during an emergency, but have no easy way to fill that need. This need makes one feel alone. This need makes 2,000 miles seem like oceans away. This need makes one desperate. However, as a student I have learned to put my needs aside, and I was in the process of doing this when my clinical coordinator, stopped me in my tracks. She told me to stop preparing for my next move to Truckee (where my seventh rotation is), pack my bags and book a flight home. Which is exactly what I did with the help of many.  During times of crisis, when you are most vulnerable it is astounding the people who are supportive in so many unexpected ways.

Thank you Bruce for booking me a flight home with a few minutes notice and acting like its no big deal. Geoff and Kat for dog piling/bear hugging me while I finally processed all my emotions from the week. Becky for sitting in the hospital with my family before and during Gary’s surgery on Saturday, after she had been in a hit-and-run accident, it also happened to be her birthday. Kasie for being as available as possible while in the middle of nowhere with no cell reception. Tracey for “momming” me and telling me I need to go home now, instead of later. Makani, Donovan, and Sedona for making me special dinner with kale, surprising me with Its Its,  letting me have another sleepover, keeping my belongings in your guest room, taking me to and picking me up from the airport. Katisha and Kaitlyn for keeping my arrival a secret so I could surprise my mom and Gary. Michael for being my rock and understanding why I have been a bit absent these past two weeks. And last but not least all the people who have reached out to my family and I to show support.

This past week my success was measured in laughter, and meals, instead of my medical knowledge, bedside manner, physical exam skills and test taking ability. An odd, but welcome change of pace. My goal for the week was to fill in the gaps where needed.  One of these gaps was food! I put 14 meals in the freezer over the course of four days, to ease one of my moms responsibilities over the next few weeks. If you know me well, you know I love cooking.  I love finding exciting ingredients and creating meals. I hate measuring spices and following recipes (unless I am baking), instead I like to eyeball and taste test to determine what a recipe needs. I love the lack of control I allow myself in the kitchen and I love that a dish comes out different every single time. When cooking for myself, I eat about 95% vegetarian. It is a rare occasion that I buy and cook meat. This week I cooked a lot of meat and a lot of cold weather, hearty meals. This week my teacher was not a patient but instead the kitchen. I thought after a day of planning and three epic days in the kitchen I would feel burned out, but mostly I feel energized to keep it up.

One of my goals for the next five weeks is to get back into shape and keep a clean diet. I have found a yoga studio close to the apartment I will be living in that has a great deal for new students. I am looking forward to the new found energy exercise brings and to the soreness.

Callback week

Last week I was on campus all week for testing and lecture. During this week there were many indicators that I am nearing the end of my education at Touro. We took our practice board exams. Which, to say the least was enlightening. It defined my strengths and weaknesses, and highlighted the areas and I need to spend some time studying. We also started to have discussions about graduation. Every time I think about graduation I get emotional. I am looking forward to celebrating my accomplishments with my friends and family. With the people who have sacrificed and supported me through this journey.

With two rotations remaining, the time to decide what I would like to do for my public health field study has arrived. This is the only component of the MPH I have remaining, and I have decided I will be going to Cambodia. I am awaiting my placement on a project I will participate in there. More details to come on this…

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.