2014 EMPA Graduates

Looking at your newest class of Emergency Medicine trained Physician Assistants.  It was a loooong grueling 14 months, but absolutely worth it.  Overworked and under-payed, dedicated to expanding our knowledge base and building our confidence to improve patient care.  2 months spent at community hospitals and 5 rotations including Orthopedics, Surgery, Internal Medicine, OB/GYN, and Pediatrics.  I finished my last shift on December 29th and have been working per diem at Arrowhead until I start my new job on March 1st in... Arizona!  Looking forward to the next adventure!

Job Interviews

With only a few months left of my fellowship, it was time to start the search for a real job!  In the ER, of course.  My job offers:

1) Arrowhead Regional Medical Center | Colton, CA

My program director offered me a job to stay at my current hospital, which was a huge compliment to me.  However, working at a county hospital, which is also the third busiest ER in the whole state of California, was not an easy feat for the last 14 months.  Spending time in 2 other community hospitals during my fellowship was like night and day.  If possible, I would like to move to a community hospital that was much less chaotic.  Don't get me wrong, it was a FANTASTIC place for learning as I will unlikely see again what I saw there.

2) Western Medical Center | Santa Ana, CA

This is a very small hospital close to Orange County, which is one place I've really wanted to live.  However, my company was just taking over the contract and lots of new changes were going to be implemented.  Not to mention, it's a very small ER seeing only 75 patients a day.  I would get to work with one my classmates there, though.  I just felt it would be challenging initially to start here.

3) Dominican Hospital | Santa Cruz, CA

I really like this ER!  This was probably my top choice.  Not to mention it's right on the beach!  However, I don't think I could afford to live in Santa Cruz, or even if I did it would be social death (no dating).  So the alternative would be to live in Palo Alto, which has a large mid-singles scene, but commute an hour each way.  I just had to decide if that's what I wanted to do...  Not to mention I would be much more isolated from friends and family.

4) Chandler Regional Medical Center | Gilbert Mercy Medical Center | AZ
What can I say?  This feels like home.  I grew up in AZ, but haven't lived there in 11 years.  Shocking, I know.  I have a good friend who works for this group (staffs 2 ER's) who recommended me for the job.  We took all of our pre-req's together at EAC back in the day.  He's had good things to say about the group and has been there 4-5 years.  Not to mention it's the highest paying job of them all AND the cheapest cost of living.  Oh, and did I mention it's home?  The only down side is that a doctor HAS to physically see every patient of mine AND I don't get to see any high acuity or do advanced procedures.  Say whaaaat?!  I get to do all that stuff now and the doctors in my fellowship don't even set eyes on every patient of mine.  So I would be losing some of my autonomy, but also decreasing my risk which is a good thing in Emergency Medicine.

5) University of Utah | Salt Lake City, UT
My dream location!  I have always wanted to live in SLC.  Although this was not technically a job offer, the lead PA basically told me he'd like to hire me if they had a position open but will keep me in mind for future openings.  This ER is similar to Arrowhead where I completed my fellowship in that I would continue to work with medical residents.  It would be an easy transition.  Granted I wouldn't see high acuity, traumas, or do advanced procedures but I would still have autonomy in the patients I do see.  Pay is lower (to be expected in Utah), but location is second to none and pension awaits you after putting in so many years.

6) Sanpete Valley Hospital | Mt. Pleasant, UT
24 hour shifts, one PA on duty at a time, no attending physician except by phone or present for traumas.  !5 minutes from my parent's house.  Perks: I get live in Utah where the great outdoors flourishes.  Downfall: no doctor available in house if I have a question.  Yes, I just completed a 14 month fellowship and am adequately trained, but I am still new and will always have questions.  I probably didn't feel comfortable enough until I have a few more years under my belt.

LOTS of options to weigh.... job announcement coming...

Work Conferences

Back in September I had a couple of work conferences, one in San Diego with all of my colleagues and a few in Palm Springs, including one where I helped teach suturing to other PA's.  It feels great to actually be in the position to have something to bring to the table and teach others some of my skills. This fellowship has truly been remarkable in my learning curve.  Anyway, it was fun to be back in San Diego and I even got to catch up with my previous roommates!

San Gorgonio Memorial Hospital

Wow, I've been SUPER behind on my blog posts.  Here's my attempt at catch up...

I just finished my second 4 week rotation at another community ER, San Gorgonio.  Again, I LOVED it.  This ER was even much smaller than Pomona and only 1 year old.  It was even better since it was just me and one doctor on shift at one time and I got to work in the back seeing higher acuity patients.  The schedule was a little insane-- 6 pm to 4 am, five days a week.  But it actually wasn't too bad since I'd sleep in till noon and still have plenty of time to go to the gym, cook dinner, or get other things done.  I definitely prefer the 10 hour shifts.  Plus, the house supervisor would bring us soup every night at midnight AND every Saturday night one of the nurses would go get us In-N-Out.  The nurses were super great as well.  It was a much more chill place to work.

GOAL: GET A JOB HERE ASAP!!

Diabetic Camp

We got home from Havasupai on a Saturday and then on Monday I left to work as medical staff at a diabetic camp in the San Bernardino Mountains, about an hour drive from my house.  It was a full SEVEN days and it wouldn't have been so bad, had I just not spent 4 days hiking and camping at Havasupai.  I think I was a little camped out.  Fortunately we got to stay in cabins and 2 of my other classmates from fellowship were also there.

As medical staff, we were each assigned a cabin of 13-17 year olds to monitor blood sugars and dose insulin 6 times a day-- before breakfast, before lunch, before dinner, at bedtime, midnight and 3 am.  The rest of the time was free time to spend sleeping, doing activities with your cabin, etc.  It was a fun week, but also exhausting.  We each had to spend one night in the infirmary (our version of the ER) to take care of kids coming in in the middle of the night.  

Normal blood sugar is 70 - 100.  Most of the kids had insulin pumps, which I had zero experience with so I definitely learned a lot that week.  We had to make sugar the kids' blood sugars didn't get so low they had a seizure or went into a coma OR so high they went into a coma.  It can go either way.  My one success of the week was on the last day when a girl in the cafeteria was feeling "low."  Turns out her sugars were in the 30's so I gave her a shot of glucagon, glucose tabs, and juice.  She could have easily had a seizure.  There were a few problems with kids getting dosed insulin and then not getting their food on time due to the long food line.  So I always stood in line with my girls and dosed them just before they got their food.  More work for me, but safer for them.

We also got to do some fun things, like a few hikes, campfires, an overnight campout in the open, and I even got to go canoeing with my cabin.  

BUT... I was super excited to be back in my own bed at the end of the week with a hot shower.

Pomona Valley Hospital

Beginning in May, I did a 4 week rotation through the ER at Pomona Valley Hospital, a small community hospital.  WOW!  It's nice to know not all ER's are as crazy as Arrowhead's, where I'm doing my residency.  People actually have insurance and a primary doctor to follow up with.  And the nurses set up all the materials you need to do suturing and other procedures.  It was an eye opener and I LOVED it.  Not to mention there are no medical residents so you don't have to fight for procedures.  All the doctors, PA's, and nurses were so nice.  Can I go back please??  On my last day the lead PA told me they would definitely like to have me work there (lots of positive feedback from the other staff for me), AS LONG AS there is an opening.  I definitely want to work at a community ER that's for sure.  County hospitals are just a bit too crazy for me...

Sheriff Ride Along

A while back I did a 10 hour sheriff ride-along, which I was supposed to do way back in November along with the ambulance and helicopter ride-alongs.  Better late than never I suppose.  And I really wish I had written about this immediately after the fact because it was SUCH A COOL DAY.  It was very intriguing.  My brother is in law enforcement and Stephen is going into it as well so I had a heck of a time time telloing them both about it.

So I show up to the station and get assigned to an officer for the day.  Turns out he's the husband of one of the PA's I work with!  Day's off to a good start already!  So the first thing we do is prepare for a search warrant.  There's only 1 or 2 of those that come through every couple weeks, so luck is on my side!  The officers plan their route of attack so as not to be seen arriving.  And off we go in 3 cop cars and 2 under-cover cars.  Our target: marijuana plants in a 2nd story apartment building.  Everyone gets out of their cars and draws their guns.  I'm told to hang back until it's all clear.  Now the adrenaline is going and I'm thrilled yet frightened at the same time.  Up the stairs they go with another officer on the ground to watch the back window making sure no flee attempt is made.  And there I stand.... all alone.

After 10 minutes or so, I'm given the clear and invited up into the apartment, where there are 2 people handcuffed on the couch.  One of the officers takes me into the back bedroom and a potent smell hits me.  There's a 3 level wire shelving unit with 15 or so marijuana plants, lined with aluminum on all sides to reflect the light from the bulbs hanging up top.  Never have I seen such a thing.  BUSTED.  Well..... not so much.  Turns out someone in the house has a medical marijuana card.  WHICH, I had no idea meant that you could grow your own.  Turns out you can.  BUT, we did make a detention center stop to drop off the handcuffed victims for other crimes.

After that, it was all sorts of fun.  There was a limping dog in the middle of the road that we stopped for, called animal control, and waited until they came to pick him up -- the dog was an accident risk.

Then we got a call saying someone suspicious was seen close to the McDonald's so we pulled an "area check," but nothing was to be seen.  Except for a quick pit stop at McDonald's.

Next, we caught someone driving with a suspended license.

Then, without a license plate.

Then we got a call for domestic violence.  The victim was in the ER with a busted lip.  So we went to hear the story, make some notes, then went back to the apartment to take pictures for evidence.  So again, I hung back while the officer drew his gun and searched the apartment before giving me the clear.  And back to the bedroom he went to snap photos while I waited in the living room, all the while SUPER nervous the perpetrator was going to walk through the front door and say, "Hey, who are you?!"  Of course, the wind blowing the blinds was unsettling my nerves.  Off we went and the officer put out a warrant for the arrest.

Let me tell you, it was an EXCITING day.  Much more so that I can do justice here.  I learned a ton too.  Apparently it's illegal to hang anything from your rearview mirror.  It's also a misdemeanor to sit on the side of the road with a sign saying "homeless" asking for money.  It's also a misdemeanor if anyone comes up to you in the parking lot asking for money.  From most serious to least: murder, manslaughter, mayhem, assault with a deadly weapon, domestic violence.  Mayhem is defined as any physical disfigurement.

The officer was running license plates left and right on suspicious cars while he was driving.  It will pull up where the car is registered, if registration is current, and who the owner is.  Sometimes, he says he recognizes names that way of people that have warrants out for their arrest.

The other part that kinda scared me during the day was that the officer told me any time we pulled a car over, I was to take my seatbelt off and crack my door open.  That way if any shooting started taking place, I could book it.  "I'm 99.9% sure that's not going to happen, but just in case."  What did I get myself into?? Good thing his 99.9% guesstimate proved correct!

Just wish I could do another day....

Meet the Crew

We make a great team of PA Fellows - serious talent, intelligence, and enthusiasm.

24 Hour Christmas

Wow, I'm SUPER behind on my blog, but there's no time like the present to catch up!  Speaking of presents... let's talk about Christmas.  But first, let's talk about holidays in general.  I think I missed EVERY significant holiday in 2013.  Let's start at the top... long distance relationship for Valentine's.  Boo.  In Honduras for Easter.  Boo.  Working the night of July 4th.  Double Boo (one of my favorite holidays).  Moved to CA 2 days before Halloween and didn't know anyone yet.  Boo.  Working on Thanksgiving.  Boo.  Working on Christmas.  Extreme Boo.  Working New Year's.  Boo.  What kind of profession did I go into anyway?!

So the point of all that was to tell you that I DID actually get to go home to Arizona for Christmas, but only for 24 hours the weekend before.  Well, there was plenty of time for some shaved ice, the temple lights, and.... that's about it.  My parents sent me home with a WHOLE suitcase full of presents.  So opening them Christmas morning before heading to work was just fabulous.

And work was bearable ONLY because we wore our ugly sweaters and I got to stay an hour longer to do a procedure.  Which meant I was an hour late to my Christmas dinner invitation.  They were just to kind to wait.  Not sure they appreciated my ugly sweater though...

California

Can I just say I LOVE where I live?!  I'm SUPER glad I ended up in Redlands and not one of the other many ghetto cities around the area, such as San Bernardino (one of the highest murder rates in the nation and most poverty-stricken, only after Detroit).  There is a super cute downtown area complete with shopping and restaurants.  Every Thursday night they have a street market, which runs year long.  I went to it a few weeks ago and couldn't help but think of Portland - vendors and street performers.  The grocery store is just down the street.  The temple is 5 minutes from my house.  The mountains are 25 minutes.  The beach is 60 minutes, give or take.  And there's all kinds of fields filled with orange trees.  You must come for a visit.  

So I actually really like my YSA ward.  The Bishop's wife is a PA who actually used to work in my same ER for 6 years so she knows a lot of the same people.  I have a good group of friends in the ward who are older and involved in medical school, dental school, doctorate of anatomy, nursing, etc. (thank goodness for Loma Linda University nearby!).  I feel fortunate to have already made some good friends to do things with.  I've only been to church every other week due to trips to AZ and San Diego, so I have yet to get a calling, but I'm hoping that happens soon since I haven't had a calling in almost 2 years (life of a nomad and moving every 6 weeks).

As far as work goes, I'm working like a dog, about 55 hours per week.  Which doesn't sound like a lot, but I barely have time to grocery shop or pay the bills, let alone go to the gym (signing up this week!).  Night shifts include four 12 hour shifts plus 8 hours of lecture and Day shifts include five 10 hour shifts plus 4-6 hours of lecture.  There are 6 different pods in the ER (plus the trauma bay), based on level of acuity, or severity.  I've been rotating through them, working in a different pod each day.  I usually also work with a medical resident or PA, then have to present each patient I see to my attending physician.   It's been a little challenging trying to get used to the work flow and figure out how things work.  Some attending physicians and medical residents are better to work with than others.  I can't believe I've already put in 2 months and I've already seen HUGE strides in my patient management.  This was a smart move on my part.  Yes, it's exhausting and stressful, but it will be worth it.  I want to be a competent and confident provider for my future patients.  I'm liking it more and more as I feel more comfortable, just wish I was getting paid more.  But at least I'm getting to do lots of procedures (suturing, lumbar puncture, paracentesis, etc.).  There's no freaking way (excuse my language) I could have worked as the SOLE provider in Burley, Idaho.  This extra year of guidance is going to be invaluable for me.  

Plus, I got to do a ride-along with Mercy Air flying on the helicopter one day. :)  We were going to transfer a patient from Barstow to Loma Linda, which has pretty large mountains between.  The pilot flies by visual only and there was a huge cloud cover over the mountains, so you couldn't actually see them.  So the pilot was flying around for like 10 minutes trying to find an opening in the clouds, all the while verbally calculating how much fuel we had left.  So he finally found an opening and said MAYBE we could make it through.  WHAT DO YOU MEAN, MAYBE??  So the other flight nurse said there's was NO WAY we were going to attempt it.  Had the pilot not said maybe, she'd be all for it.  So we diverted to Palm Springs instead.  That whole conversation made me so nervous!  Helicopters also do not handle turbulence very well.  They shake quite a bit, but good thing I like turbenlence!

One more thing about work... I did not actually realize that the hospital was a county hospital so I would say 75-80% (or higher) are uninsured.  Thus, they do not have primary care doctors and do not take their medication as prescribed.  What do you mean you haven't taken your blood pressure medication for THREE YEARS??  Thus, I see quite a bit of end stage disease processes and organ failure.  Everything from amputated legs due to diabetic ulcers, kidney failure, hepatitis, HIV, and the list goes on.  It's definitely NOT typical of a regular community hospital and it's SUPER challenging sometimes, but at least I'm getting lots of great experience.  We also see the behavioral health and jail patients, so my education is very well-rounded.  Hope I survive another year!