Just.....bored.

So it's been almost three weeks since my last post, mostly for two reasons:

1) I go to bed before my 3 year old nephew because I'm up at 3:45am.
2) My apartment has no internet, so I'm typing as I eat my Panera sandwich.

The last three weeks have been exactly as it says in the title...kinda boring. Prior to this rotation I thought I would find surgery exciting, but as a whole I have been pretty disappointed. Surgery for a PA is a totally different experience than for a doctor. We make no final decisions and our voice is never the one the scrub tech is listening for most. Autonomy is one of the reasons I chose becoming a PA over a nurse or medical tech in the first place.

Clinic is even worse. 50% of my patients are here for one kind of bariatric surgery or another. Either that or they are follow-ups without complications, because any complications are usually dealt with in the hospital. All have been screened by primary providers for any serious conditions and almost none have findings on physical exam. Remember, this isn't an ER, it's scheduled patients. Gallstones don't schedule appointments. Not a single surgeon here carries a stethescope, only the residents. There are some minor procedures, and I try like mad to get in on those, but it's like feeding a starving man a saltine without water.


The only redeeming thing about this rotation is my Chief Resident and rounding. This is where I learn the most, get pimped the most yes, but it's all in the nature of teaching. Patients are sick, they are complicated, and they actually have findings on physical exam. Sure I have to get up early to do it and stay late to finish at the end of the day, but I think the trade is fair.

Just 3 more weeks....counting down...

Sucking the Government Teat....Or Just Sucking???

My time in Forks was up, so I hopped in the car and drove to my next Herculean Labor-surgery at an Army Medical Center. With it's many bureaucratic heads, very ugly visage, and the ability to leave a PA student feeling eviscerated, I figured this must be the Cerberus of my labors. In fact, I kinda wish I could just show up with a club and start bashing heads around. Working here is like swimming in chocolate pudding: very difficult, very slow, and at the end of the day you kinda look like shit.
Now don't get me wrong, there are many good things. So far I have performed some really cool minor surgeries. Several lipomas, cysts, and inflamed lymph nodes have fallen to my glorious Scalpel of Sterility (not the reproductive kind), and I have gotten to assist with some pretty cool stuff in the OR. However, the go-to phrase around here seems to be, "I don't deal with that". Problem: PA student needs computer access so he can review charts and see patients. Solution: A one week wait while the request is run through the "proper channels". Never mind that his Chief Resident is breathing down his neck to help carry the load, never mind that he is PAYING for this rotation. I have visited 6 different offices to try and expedite the process, only to hear "I don't deal with that" from at least 4 of them (the 5th was "out sick, sorry but nobody else here can help you", and the 6th was my preceptor. He actually called to yell at someone...to no avail).
Another interesting thing is defining "medical necessity". 46 year old male patient walks in with irregular, somewhat mobile, 2cm hardened mass in supraclavicular notch. History of smoking and family history of lung cancer. No other nodal involvement and no other indications for cancer, but the thing bothers him when he wears his packs. He wants it removed before he deploys next month, but somehow the doctor talks him into "watching and waiting" while he is abroad. I walked out of the room with my jaw on the floor. This man has some great risk factors, and the node is irritating him in the first place-why not just excise it and send it to pathology for shits and giggles? No follow up scheduled, no chest X-Ray, nada. After following this doc for awhile I realize this is a trend in his practice, so it must have worked out for him in the past. On the other hand, I have never heard of so many bariatric surgeries. Lap Bands, Gastric Bypasses, Roux En Y procedures...they do them morning and night, every day. it's damn near as common as gallbladder surgery. Whole different definition of medical necessity. Between rounding, clinic, surgery, pimping, running between computer offices like Forrest Gump after a blonde hippie, and more rounding; I am beginning to feel less like Hercules, and more like..dog food.




Anyway, dead tired after a 14 hour day and going to sleep...at 7pm...shit.