Musings of a Mind on Medicine

During my first year of PA school, I gained a reputation with my classmates as someone who is “tech savvy.”  My classmates would come to me with their computer problems, and when people started considering hand-held devices for clinical rotations, they’d ask me what I thought about various platforms.  Yes, I had a reputation as somewhat of a tech geek.

Hey, that’s okay, because it’s kinda true!

Because I couldn’t afford the service costs associated with an iPhone, I bought an iPod Touch for my clinical rotations, and I have LOVED it.  The medical programs I use most often are Epocrates Essentials, Skyscape OCM, and now Medscape.  Other fun ones are eponyms and Diagnosaurus.

Some of these apps were free, but others like Epocrates Essentials are quite pricey.  I was lucky and found a 50% discount code, but unfortunately, it is no longer active.  (Students – check with your school to see if they have a group discount.)

I have neither the time nor the expertise to do a thorough review of each of these applications, but I’m just sharing that these are my favorites for clinical rotations.  If you want full reviews on medical applications for the iPhone/iPod touch, please visit iMedicalApps.com.

Until a couple of days ago, I had been a content user of Apple’s Safari for web browsing.  I had no idea why people thought firefox was so cool until one of my professors introduced me to the world of firefox add-ons.

Oh. My. GOSH.  How have I LIVED without this?? 

Specifically, my professor sent out a link about a free program called Zotero, which is a research tool.  Instead of butchering it with my own feeble explanation, I’ll let them advertise for themselves:

[Click to watch the demonstration video on their site.]

I haven’t started actively using it yet, but when I think about the tedium and research that my thesis is going to require, I get excited by the idea of something this helpful.  I whole-heartedly plan to use it to write my thesis paper.

What are your favorite medical applications, reference sites, and research tools?  Please share!

One of the fun things about WordPress is their stats page.  On it, I can see how many people visited my site, how they got to me, and what links they clicked on.  As you might guess from my underwhelming number of page visits (below) it’s generally not all that interesting.  I know I don’t exactly have the most massive readership… I just wish I knew why I get 80 page visits some days and only 14 on others.

Occasionally, people will find my site by typing something odd into their search engine.  One of my all-time favorites is “I suck at psych rotation.”  I still haven’t figured out what exactly this person was trying to learn by googling that phrase, but it made me smirk.  There have been other similarly amusing search phrases, but I can’t remember any offhand.  I should keep track of these and occasionally share them.

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I’m antsy to get back to school.  My temp job is not exactly thrilling, and I feel like I’m slipping further and further from the clinical rotations lifestyle and the clinical frame of mind.  If the Behavioral Advisory Committee approves my request to return for the rotation starting mid-March, I’ll be leaping right into orthopedics on March 22nd.

I decided that although reading the pharmacology book is good, it probably won’t be the best preparation for my ortho and surgery rotations which I’ll be doing early-on when I get back into school, so now I’m trying to devise a different plan.  My Boards and Wards book spends a disappointing four pages on orthopedics, so I need a better source for review.  Time to bust out the powerpoints, methinks… I just have to figure out how to make them portable because I don’t want to print thousands of slides.  Maybe I should just take my laptop to work with me and review them during my lunch break.

From what my classmates have said, orthopedics and surgery are two of the most grueling rotations.  It makes me a bit nervous that I’ll be doing those up-front, but on the other hand, the good news is that I’ll be getting them out of the way early on.  The other thing that makes me nervous is that I’m going to have NO breaks in my clinical schedule for about seven months straight.  I’m definitely concerned about burnout, but I’m hoping that I’ll be able to develop some coping habits and work through it.

I got a bit of bad news on Friday when I learned that because I won’t be continuously enrolled throughout the semester, I won’t qualify for any federal financial aid until July.  Ouch.  Now I get to find a cosigner so I can take out a few thousand dollars in private loans.  Not fun.  I’m still waiting to hear back on my health insurance situation.

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I have a confession to make: I don’t actually read all of the new posts for all of the blogs I list in the right column and claim to follow.  The ones I do check are the student blogs, StorytellERdoc, and Medical Moments in 55 Words.  I prefer the more literary-style sites, and I hope to practice my creative writing skills a bit more once I’m seeing patients again!

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Finally, I have to give you the update on my fish tank!

I went into NYC today for a church thing in the morning, and afterward, I went to a betta breeder in the city to pick out a fishy for my little tank.  $10 later, and I now have a young red delta tail betta swimming around my aquarium!  He won’t exactly hold still for a picture (even when I ask nicely), so this is the best I’ve got:

He’s picked at the shrimp a bit, but none of them have died yet, so that’s good.  Let’s hope he gets bored with them soon.  As I type this, he’s chasing one around.  Punk.   He’s certainly active!

That’s all, folks!

I found out which three rotations I’ll be starting off with WHEN (not if) I return to my coursework mid-March.  The sequence:

1. Orthopedics
2. Psych (NOOOOOOO!!  ;)  just kidding.)
3. Surgery

What I really want to know is WHERE I’ll be doing these rotations.  I’m reeeeeallyyyyy hoping that I won’t be having to drive to queens for any of them.  It’s an hour drive without rush hour traffic.  No student needs that, especially me.

I don’t dare ask this faculty member where I’ve been placed until I have the green light to register, hopefully next week, maybe the week after.

On Tuesday, I got the note from my psychiatrist saying he thinks I’m fine to go back.  I’m hoping that’s enough because the psychologist called in sick yesterday, so I don’t have a note from him yet.

However, I found out the other day that that February 12th deadline doesn’t actually apply to me, and I can register later without penalty.  That takes some pressure off, but I’m still going to push ahead because I want the assurance of knowing that everything is taken care of.

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In completely unrelated news, I decided to go ahead and try putting shrimp in my little aquarium.  I had to order them online (they’re shipped with heat packs), and they’ll be arriving probably while I’m at work today.  Yay!

My sister has requested that I name a fish after her, but because the only fish, the betta, will be a male (and I’ve already picked out the name Buford), I’ll have to name the biggest, reddest female shrimp after her.  Then, of course, I have to just hope that Buford the betta doesn’t decide to eat Allison the shrimp.  :)

PS – Happy Birthday to my big brother, Dan!

I learned today that the registration deadline is February 12th, so even though I’m not planning to return to clinical rotations until March 15th, I need to get the approval from the right people to allow me to register.  I have two weeks to make it happen.  EEK!

I’ve been spending more time studying lately.  I decided that my pharmacology textbook would be my best friend for the next few weeks, and I’m basically just reading it and hi-lighting the heck out of it.  I can’t say that I’ve retained a ton of the information on the 200+ pages I’ve read, but I also bought some nice pharm flash cards that I need to start using.  I don’t expect myself to learn everything that I’ve missed, but since the pharm book reviews physiology and pathophysiology before talking about the drugs and their mechanisms, I figure it’s a decent place to start.

In other news, I got a job through a temp agency, and I’ve been doing clerk/secretary type stuff at a small insurance agency for about three weeks now.  I’m vastly underpaid (especially for the area), but I think it will be enough to make ends meet, which is all I really need.  It was kinda funny – one morning I was wondering to myself whether any of my faculty were clients of the agency, and that afternoon, one of my faculty walked in to sign something.  That answered THAT question!

On the home front, I’ve been moderately obsessed with my small fish tank.  An old roommate had been keeping it for me in Utah, but since the fish that had been inhabiting it finally died, I took the tank back to NY with me after Christmas.  I’m now impatiently waiting for it to “cycle,” or grow the ammonia- and nitrite-eating bacteria that I’ll need before I can safely add any fish.  I’m planning to get a show-quality betta from a breeder in NYC when I go into the city on the sixth.  Red cherry shrimp also sound like a fun addition, but rumor has it that they would end up being an expensive snack for the betta.  I’m still deciding whether I want to try it.

For your viewing pleasure, here is a picture of my little tank!

I think that’s all for now.  I’m hoping to be back in school and writing about school and medical things soon!

Before my medical leave of absence, I had heard about the passing of Michelle’s Law.  Named after a student who, for the sake of keeping her medical insurance, maintained full-time student status while battling colon cancer, this law requires that group insurance plans continue coverage of students who must take a medical leave of absence.

I was under the impression that this meant I would not lose my student insurance through Aetna.  Unfortunately, Michelle’s Law apparently does not apply to student insurance plans… only to family plans.

Although the law helps those students who are still covered by their family insurance, it is of no assistance to the many students who have opted for the school-provided insurance option.  These students are faced with the same dilemma as Michelle: they must maintain full-time student status, or lose their medical insurance coverage.

It still baffles me that a student can even lose medical insurance while on a medical leave of absence.  Could there be any worse timing??

I’m glad Michelle’s Law passed, but it does not meet the needs of many of the students it was designed to help.  Provisions must be made for students utilizing their school’s insurance provider to be able to retain coverage while on a medical leave of absence.

Under Michelle’s Law, I am losing my student insurance, but I can be covered through my mom’s insurance until I turn 20-something* in March.  At that point, I can only hope that I’ll be back in school and eligible for student benefits again.  If not, the options are grim.  I, and others like me, need a Michelle’s Law for the rest of us.

As it is, it’s good, but it isn’t good enough.

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* Sorry, I’m not disclosing my age for security reasons.  Different group insurance programs have different age limits for dependent students, so the point is just that I’m going to lose coverage again because I’m about to hit the age limit for my mom’s insurance company.  Hence, older students are also not benefited by Michelle’s Law.

I had an interview with and was hired by a temp agency today.  My agent (ha) is looking into a clerical position for me, and if all goes as planned, I’ll be working full-time by the end of the week.  If not, then the agent assures me that he can find something else very soon.

Perhaps I should be more excited, but the feeling is bittersweet.  It isn’t what I wanted.  I wanted to be back in my clinical rotations and moving on with my life, not in an indefinite holding pattern, watching the world go on without me.

I can’t tell you how much I hate having to explain my situation to people.  When a friend or relative asks “How’s school going?” I would love to say “It’s great!  I’m loving it, and I can’t believe I’m almost done!”  I try to find some pleasant and concise way of explaining that I’m on a leave of absence, but it’s hard and awkward.  I feel like this happens every day, and every time, it’s like salt in the wound.

Yes, employment is a step in the right direction, and a move I would have made MONTHS ago if I could have predicted the future, but I hope you can understand if I don’t really feel like celebrating.

2009 Review: A thoroughly bumpy year.

2010 Outlook: More steep and rugged trail lies ahead.

New Year’s Resolution: Tighten my boot laces, take a deep breath, and venture onward!

On Tuesday I learned that I will not be returning to clinical rotations in January as I had hoped.  I waited to say anything about it here until I had more details.  Unfortunately, nothing is written in stone or even clay as much as I’d hoped.  I wanted to hear dates and deadlines and specifics, but things are still as much in the air as they had been previously.  I have only the resolution of knowing that the answers I sought do not actually exist.

Extending the leave of absence creates a huge wake of difficulties in my non-school life.

Because I am not enrolled as a student, my health insurance will expire mid-January, and I’m not sure what I’ll do in the meantime.  A medical leave of absence is a very bad time to be uninsured.  There is a possibility that I can be on my mom’s plan until I turn 26 in March, but they might require proof of enrollment.  Another option is medicaid… and that idea makes me cringe.

Losing my insurance also means that I will likely have to switch psychiatrists in a month.  When it comes to determining the timeline for my return and my readiness to go back, the only opinion as important as the psychiatrist’s is my own (or at least that’s what I understood when I met with the faculty yesterday).  If I am having to switch providers, it could take a while before that person feels he/she knows me well enough to certify me as being ready to go back to school… thus possibly delaying the process unnecessarily.  That makes me nervous.

Extending the leave of absence also means that I will not qualify for any financial aid.  Loans were my sole source of income, so I suddenly find myself completely broke.  Obviously you need money for frivolities like rent, medications, food, and so forth, so I’m now in the process of job hunting.  However, it’s hard for me to look for jobs when I’m not sure how long I’ll be working or even what hours.

I asked the faculty if I could sit in on the first years’ lectures while I’m on the leave so that I can learn/relearn/review some of the subjects where I feel my knowledge is weak… which is most of them.  :( Their response didn’t leave me with much optimism, but I still hope there’s a chance.  If they’ll allow me to do that, then an evening job would be better.  I wish I knew.

I don’t know if I’ll be going back to school in February or September or anywhere in between, so although I know I’d be a “temp” employee, I don’t know how temporary I’d be.  I’d hate to commit to something and then have to pull out early, or wind up in a job that ends too soon.

There are two main options I’m considering for work… one is the possibility of working for the 2010 census.  That idea is promising because it pays really well, has flexible hours, and is temporary… but I’d likely going door-to-door pestering people, which is not really my thing.  The other is that I’m hoping to find work in a clinic somewhere as an MA/Receptionist/Records Clerk.  It’s what I’d done for years before PA school, so I doubt it would be too hard for me to slip back in, but it doesn’t pay as well, and most places are going to want to hire someone permanently.

We’ll see.  I re-did my resume, I’ve put up a work wanted ad on Craigslist, and I’m checking the job listings regularly.  I need to call a census office to ask what months I’d be employed if I worked for them.  I have to figure out my insurance situation, and I need to find a new psychiatrist who can see me soon.  On top of that, I’m supposed to go out of town tomorrow, but we’re expecting a blizzard around the time of my flight, so that could cause some problems… I’ll clean and pack anyway.

I have my work cut out for me.

Tonight I learned that one of my high school classmates, Justin Key, died suddenly of the H1N1 virus yesterday.  Although we were never really “friends,” he and I spent a lot of time together in the band program, from jazz band at 6:30 every morning through marching band rehearsal ending at 9:00 at night.  He was nice, funny, and I’ll even confess to thinking he was rather cute.

Although we didn’t keep in touch these seven years since graduation, pictures on facebook and a website of his indicate that he had been healthy and very active with business school and world travels.  His death was truly a shock to his family and all those close to him, and my heart goes out to them.

To my knowledge, he is the first person who I’ve known personally to die of H1N1.  I knew him.  He was my age.  Now he’s gone.  I’m not well-acquainted with death, so events like these come to me as an abrupt reminder of the fragility of life and of our mortality.

Rest in peace, Justin.

There are a few questions I’ve been asked a lot lately, especially since some of the things I’ve divulged on this site have caused me a bit of awkwardness or heartache in real life.  These questions are: Why do you have a blog? Why don’t you make the site private? Why not just keep a journal?

I do keep a journal… actually, two.  Each serves a different purpose: one is the life stories and religious thoughts I’d hand down to posterity, and the other is basically a throw-away heap of rants and ruminations that I needed to get out of my system.  As open as I’ve been with my life on here, there is plenty that I don’t tell you.  This site is not a journal.

Also, I do have a semi-private blog for my family and friends.  Because all of my family lives in the Western US (Arizona, Utah, Washington, Texas…) it’s quite the adventure for me to be living by myself on the opposite side of the country for two years while I go to PA school.  That page is, I suppose, my student equivalent of a “mommy blog.”  Its purpose is to help me keep my family and friends updated on the adventures and happenings in my life, in a fun way.  (I try to keep the heavily medical stuff off of there.)  I have had a family/friends-style blog continuously since November 2003.

But then there is this page, the source of the controversy.

Stumbling across Dr. Rob’s Musings of a Distractible Mind sometime in the late summer of 2008 was my introduction to the world of medical blogs.  I was entranced by the stories, delighted by the humor, and impressed by the keen perspectives.  I was hooked.  Within a few months, I had developed a list of PA student blogs and began following their posts too.  Some of them told stories about school, most ranted about crazy schedules and incessant studying, and some used their sites as a platform to offer advice to pre-PA and younger PA students. What really impressed me though was the sense of community that I saw in the comments section of many posts.  I wanted in.

My actual ranking, 1024. Very impressive. (ha)

I’m still trying to decide if I have anything really worthwhile to add to the conversation.  I won’t delude myself into thinking that I’ll ever be in the eDrugSearch.com’s top 100 medical blogs because I’m not interested in discussing policy or politics or miracle cures.  There are plenty of people out there addressing exactly those topics in a manner much more professional than I could muster, so I’ll leave it to them.

Instead, I consider myself more of a storyteller (who is currently lacking her primary source of inspiration – clinical experiences).  I write about the poignant scenes and life lessons that tumble through my mind.  I explained the nature and purpose of my stories in this post, shortly after my faculty discovered the site and questioned my HIPAA compliance.  The key point appears in this paragraph:

The stories aren’t about the characters; the characters are fake.  The stories are about the human experience, as I encounter it on my clinical rotations.  That is what I am trying to express and convey when I compose these tales.

But why so publicly, you ask?

I really enjoy reading the story-style posts of other medical bloggers.  This past week I discovered a certain StorytellERdoc who tells stories both delightful and moving.  I am interested to see how others handle and rationalize the sorts of difficult situations that I sometimes face as a student, so I hope that there are others out there who feel the same way about my tales.

Also, when I write something, I am always interested in hearing my readers’ feedback.  If I were to put these stories in a closed journal, they would rapidly sink into lonely oblivion.  I want them to be conversation topics.  I want people to point things out to me and challenge my thinking.  That way, I can not only learn from my own experience, but from my readers’ insights, too.  (For example, the comment on this post forced me to reconsider my approach to the severely demented patient.)

Finally, I mentioned a desire to be a part of the “community” that I saw via the comments section on on the writers’ posts.  The kinds of experiences and thoughts I share here aren’t really the sort of things that are of great interest or relevance to the people I am closest to in ‘real life,’ so I can appreciate the collection of like-minded people online who are interested.  I suppose it’s a bit of a virtual social circle that perhaps fills some gap for me…

So there you have it.  That’s why I write, and that’s why I write publicly.  Do my reasons make any sense?

For any other bloggers out there (medical, or not), why do you write?