continuing on

WOW.  Well year two is well under way, and it is a whole different game than didactic was.  In good, amazing, awesome ways and crazy, overwhelming, slightly terrifying ways as well.  I tried not to think too much about what clinicals would actually literally be like, and this is because of a variety of things.  Obviously I was busy right up until the last day of the semester, and spare brain space was a bit lacking at that point.  In Jamaica I actively suppressed any thoughts of the near future because when I did it made me feel physically ill, margaritas on the beach definitely aided the active suppression of scary thoughts, but that’s a whole other post! 

In any case, I had my first day last Tuesday, and most of my classmates started that Monday.  As you may imagine, I spent the better part of that Monday alternating between pacing my apartment, mindlessly flipping through textbooks at an impossible-to-read pace, wringing my hands and checking and rechecking my phone for news from classmates.  I talked with my friend Julia during her lunch break while she was hiding in her car eating and delivering her report of the day thus far while I tried to calm her nerves and reassure her that she would undoubtedly, or at least most probably, survive her first day in the emergency room relatively unscathed.  When Tuesday morning came I wasn’t actually as nervous as I thought I would be, I think I just needed to get the first day over with, because anything was better than the agony of my imagination.  

My first rotation is in Portsmouth, NH which is about (exactly) 51 minutes from my house.  I am doing my Internal Medicine rotation in the Intensive Care Unit (ICU).  My schedule is a bit insane, and adding my commute time makes it a bit more insane, but so far I have survived.  I work ten hour shifts rotating a little between day and night, so for day shift I get up at 5 in the morning to make it there for 7:00 rounds. 

The advice we were given from the class a year ahead of us was that on the first day, no matter how many dumb things come out of your mouth, or how many things you have never even heard of, just try to say one thing that is even marginally intelligent.  Gotta keep that bar high, eh!? I definitely bit my tongue the entire day to keep the illusion of intelligence at least somewhat existent, and my mind blanked out on basically everything I learned last year especially when I was being asked a question, but my one marginally intelligent thing was asking if they should do a bladder scan on a patient that had all but stopped producing urine and we were getting extremely concerned about her kidney function.  It turned out her foley was kinked, and after the scan it was adjusted, no need to worry about the kidneys at all! PHEW.  Marginal intelligence RESTORED.  

Now I’ve got a week and a half under my belt, and things are starting to get a little more familiar.  I had some delusions that this year would be less busy then last year, but so far it’s been just a busy if not more!  After my shift I have to log all my patients into this tracking system that my school uses to make sure we are seeing enough patients, doing enough and learning enough.  I know it will get easier with time, but right now it’s the slowest process in the world to try to figure out the ICD or CPT codes, and then recall what exactly we prescribed and what labs we ordered.  There are a million drop down menus and they are all kind of vague so it often takes me ten minutes just to find the section I am looking for.  Oh well, at least it is the same system for the entire year so soon I will master it and it won’t even feel like that much work.  Right? Right.  

So, that’s what I am up to lately.  Adjusting to working weird days and nights, standing and walking for ten hours instead of endless days of sitting and staring at powerpoints (thank god!), and figuring out the home dynamic as we move into this next phase of life.  Aside from all the moments of stupidity and overwhelming feelings, I already know that this year is going to be absolutely awesome.  It’s an incredible feeling to put the textbook down and actually see all the things I learned about!  I did a million physical exams on my classmates, all of whom are healthy, so it’s amazing to put my stethoscope to a patient and hear a murmur in their heart or crackles in their lungs.  Don't worry, I’m working on controlling my rubber face so that my eyes don't subconsciously open real big with my eyebrows raised all the way up and my mouth doesn't smile large when I hear something pathologic, which is probably not the best face to have just before I tell someone they have bilateral pneumonia. 

can you even believe it?!

Year one is DONE. DONE. DONE!  We had our last exams yesterday in surgery and while I was out with classmates having a celebratory and congratulatory lunch, grades were posted and just like that my didactic year was 100% officially completed!   I'm still in a bit of a daze, and I swear this morning when I woke up naturally at 8:30 instead of unnaturally early to an alarm blaring into my ear, I had a mini panic attack in my head about how late it was and how behind I must be!  Old habits die hard I suppose.  But for now: Sleep! Food! Drinks! Friends! 

I can't remember the last Saturday that I didn't go to campus and sit in a stuffy room cramming knowledge into my head until my eyeballs wanted to jump off my face and roll off the table into the garbage can.  Instead, this morning I took a long walk in the morning rain with three of my favorite beings and enjoyed a big cup of coffee at the kitchen table with my fiancee across from me and our pups at my feet.  Nothing like a grueling didactic year to remind you how important is it to appreciate the littlest things! 

As for the next step, we've got lots of exciting stuff crammed into my ten days of summer vacation, every day of which JP will also be on vacation, what a guy!  Tonight we are starting off with a combo early birthday celebration for the boy and end of year celebration for the me at a fancy restaurant here in Portland courtesy of my parents!  Then we leave early, early in a car bound for Portsmouth to a bus bound for Boston bound for an airplane bound for JAMAICA!!  It's going to be a tough week for us I am sure, staying in a condo with a balcony overlooking Doctor's Cave Beach, but somehow we will find a way to push through.  I've got pictures to share from the past few months, and lots to tell you about my near and approaching future, but for now I am going to go bask in the beauty of time away from the daily routine. 

Thank you, all of you, for the love, support, belief, phone calls, encouragement, wise words and moments of laughter and tears that surrounded me and lifted me up as I waded into and survived (!) one of the most difficult and rewarding years I've ever experienced.  I am truly blessed in so many ways to be exactly where I am right now.  Well... and also in Jamaica.

And Emily?  I've only got two textbooks and some handwritten notes packed...they are small I swear!

runaway april

Yet again time has been slipping away from me!  I knew April was going to be a rough month in terms of school, but man did it creep, fly and creep on by.  I just finished my second patient simulation OSCE examination this morning, an experience that is very anxiety producing and a bit awkward, uncomfortable and funny at times.  I was thinking about my first one back in the fall, the difference was crazy.  I felt so much more prepared this time, and I even prepped less!  It's starting to feel like some of my knowledge base is gelling together finally.  Finally! Not all the time, and not even consistently within a day, or an hour, or a minute, but sometimes there is a real glimmer of smartness in there and it makes me feel like I may be able to do this! I feel more confident at thinking on my feet when I'm in an unfamiliar patient scenario, and am getting better at trusting that I know how to do a history and physical exam on a patient.  Even if I don't get the exact diagnosis or am waiting for labs or imaging to be done, I am at a place where if I can take a minute to collect my thoughts and look at all the information I've gathered and written down, I know that the diagnosis is there, and I can piece together reasonable differentials and rule out some big things.  That may not sound like a lot, but it's no small feat in this world!  Last month I was despairing a bit because I felt like everything I was learning was dumping out the other side of my brain, I was super stressed out and getting lost in lectures of things I'd already learned, even circled back around to randomly crying in the grocery store again, but it feels a lot better now.  I've been working on stepping away from the books more often and seeing the people in my life.  Imagine that!  I've been back at the gym regularly, even upped my membership so I can do group fitness classes.  That way I don't even have to think, just follow and kickstep around.  It's made a huge difference in my energy and focus, and I'm sure it doesn't hurt that there is finally sun shine (and spare moments to enjoy it) back in my life again.  SUN SHINE! Oh how I missed you.  We are sliding into finish at this point, three weeks to go, some exams and papers and presentations, but it's getting close enough to touch!  And did I tell you that I'm taking JP to Jamaica for his birthday?! Sooooooo close! And, because no post feels final without at least one picture, here is a blurry one of my brother Joe and I showing some friends how to waltz.  It makes me happy.

I said YES!

I wasn’t sure I would survive the final drag down week of school before spring break, but on a rainy, windy Tuesday night my best friend got down on one knee and asked me to marry him!  I may have blacked out what he actually said, then cried and squealed and hugged him for so long he had to peel me off of him to put the ring on my finger, but in the end we were officially engaged!!  I’ve basically been on a cloud of smiles since then, which helped propel me through the long lectures and right into spring break.  We kept it a secret from his family and surprised them with the news when we got to Louisiana.  It was incredibly exciting to share the news with my family over the phone, and quite special to share it in person with his.  I feel so surrounded by love and support, and I am overwhelmed with excitement for this next step together!  He is my constantly supportive, nerdy joke telling, shoulder to cry on, kitchen dance partner, teenage mutant, computer fixing, fast scooting, card playing, puppy loving, whiskey drinking, scallop searing, creative, intelligent, ridiculous best friend extraordinaire, and I GET TO MARRY HIM!  What luck! 

Oliver cleaned up in style to help with the big proposal! 

In the hubub of vacation and celebration I somehow didn't take many pictures, but rest assured that family, sun, and crawfish were exactly what we needed for a little recharge before my final six weeks of didactic year.

ski bums for a day

We went skiing!  It’s kind of my secret and now I suppose public shame that I lived in Colorado for two whole years and never went skiing.  So lame!  I think I was just buried forever in a pile of crap-to-do, plus it was all kinds of expensive and yadda yadda, two years later I still hadn’t gone!  So it might be kind of sad that when we finally headed out for some mountain time, we went to the little baby slope of Shawnee Peak about an hour outside of Portland, but it was great!!

I think skiing in the Rockies always kind of terrified me a little, like my skills might turn out to not actually be “skills” per se when I was faced with a run that took an hour to get down.  Shawnee Peak was the perfect place to get back in the skiing saddle.  In fact, it was also the perfect place for JP who had never skied before.  (Side note, which I didn’t realized until my brother’s girlfriend mentioned it to me like weeks after, but technically JP’s first real time skiing was during that big ol’ snow storm after drinking whiskey and playing pinochle late into the night.  We slapped some cross country skis on JP and essentially pushed him down State Street.  HAHA, which is especially funny now that I realize that that was in fact his first introduction to skiing of any kind.  You can see blurry photographic evidence here.)

So, back to JP’s second first time skiing.  He had a lesson with a former Olympic skier, who even stayed after to take him down the Rabbit Run (a little steeper and longer than the bunny hill of course) a few times after his lesson ended.  

 And JP did great!  He pizza-d and french fry-d and pizza-d again!  My all-time favorite part of the whole day was watching him on the last run, coming down the pretty steep hill doing a sort of balancing dance move every time he switched back across the mountain.  It was absolutely hilarious and perfect.  When he got to the bottom he even asked “did you see my moves out there?!”  I did, I definitely did.   

The day was just so much fun, I had forgotten how great it is to be out in the snow enjoying the season! And mom, check out that buff keeping  my neck warm, what would I do without it?!

morning coffee

I’m doing something today that I just realized I haven’t done in a loooong while: sitting and drinking a fresh cup of coffee.  That’s it.  I mean, I’m not running to the car spilling half of it on my hand, or refilling in between lectures, I’m just sitting at my kitchen table thinking and drinking.  It’s funny how busy life becomes.  I spend every other weekend on campus for the bulk of both Saturday and Sunday while I prep for exams, and the ones in between I always have stuff to type for the next module, or pages upon pages of textbook to read, so I spend most of those sitting at either my desk or the table with breaks for errands and dog walks.  We are in a weird limbo time in school right now, and thus I have time to sleep in a little, and have a relaxing cup of coffee.  We finished a big section on Monday (really, they are kind of arbitrary and not really sections at all, it’s more just the title of the class, BUT technically we finished a class) and for the first time that I can even remember since starting way back in May, we have a month until our next exams!  To be honest, it’s really just a weird coincidence I think because spring break falls in the middle, and we are mashing two modules together in a muddled up pile (I’m sure you can guess how much I love when things aren’t in their separate little boxes!),  but whatever the reason, it is a really, really nice little breather.  I think I always underestimate the pressure of looming exams and deadlines.  I talk to my mom early on Saturday mornings when I am driving to campus to study and she always says “Where did you get your discipline, cause I know it isn’t from me!”, and I tell her that fear is quite a powerful motivator!  I’m joking, but it’s true, and I think that is one of the things that is difficult about being a PA student.  There is a big balancing act that goes on all the time between learning  as much as you can for  the long term, but also knowing that you need to tailor a lot of that towards passing a particular exam.  It’s pretty devastating to feel confident in the material, and knowledgeable enough that you aren’t terrified at the thought of seeing actual patients with the diseases you just studied, but then fail the exam because it focused a lot on tiny aspects that you had minimized when you were triaging information.  Luckily, that doesn’t happen often, and all that is to say that it is quite freeing to have some time to just learn and read without a close exam to make you push yourself too hard!  Which brings me to spring break.  In less than two weeks we are going to New Orleans to visit JP’s family and soak up some warmer weather and sun!  I am really excited to hang out with family and friends, eat amazing Cajun food and RELAX!  It is perfectly timed to correlate with maximum burn out from school, and I think it will be rejuvenating.  Nothing better than a pause to see just how close you are to the next big step, and to gather energy for a last big push!  Unfortunately I feel like I am in a free for all slide to the end and my mind wanders to mid May and day dreaming about our ten day break before clinicals start.  But, one day at a time.  When May 20^th finally rolls around, I know I am going to be shaking in my business casual shoes, wishing I could just go sit anonymously in the back of a classroom instead of being in front of real people in my short white coat.   Such is life!

the storm

 Well, the storm came and went, and it was glorious. 

 

We got dumped on, 32 inches of fluffy light white snow, and it was so beautiful!  

  

JP finally got to see how winter storms can be about community and helping each other bail cars out, 

waving to the only other person that you see braving the outside on a long walk, jumping into snow banks of freshly fallen snow, 

 

and of course how wonderful it can be to come back inside and warm up cozy to watch the wind whip the snow into even bigger drifts outside. 

 

It was just the weekend that we needed, no real responsibility to the outside world, an excuse to hunker down and hang with the pups.  

And on Sunday it was sunny and we got to tromp in the woods with Oboe, who was more than content to blaze his own snow trail.