Author Archives: Greg Moore

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About Greg Moore

Founder and owner of Green Mountain Software, a consulting firm based in the Capital District of New York focusing on SQL Server. Formerly, a consulting DBA ("and other duties as assigned") by day, and sometimes night, and caver by night (and sometimes day). Now, a PA student working to add PA-C after my name so I can work as a Physician Assistant. When I'm not in front of a computer or with my family I'm often out hiking, biking, caving or teaching cave rescue skills.

PA School: Studying

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To state the obvious, any grad program, but I think among them, especially PA school requires intense studying. In some ways, PA students will cover more in a semester than many med students in the same amount of time. Time is at a definite premium. As mentioned previously, for every hour we spend in lecture, we’re expected to spend roughly two hours outside of lecture on that same subject. So if we have a single hour on a topic like Inflammation, we should probably plan for two hours or more of studying on that outside of class.

Related to that though is some advice they’ve given us very early in the semester and that is to a point, grades don’t really matter. Obviously they do, there are some program minimal requirements and the like. For example, to continue to the next semester or next year will require a minimum GPA of a 2.70. In order to be eligible for the overseas service trip requires a GPA of 3.0. But, for an individual subject, they’ve told us if we get a 70% or better on it, we should be OK for the PANCE. That said, I think everyone wants to do well and to do better than “just enough.” I know I do. But, we don’t have class ranking and we’re not competing for residencies, so honestly, they’re right, beyond a certain minimum doesn’t matter.

I say this because it does impact my approach. I mentioned in a previous blog how I had a major test on Tuesday (Medical Terminology) and hoped to do well. We were all nervous about it and several of us, including myself, had dreams about it. Mine was particularly weird. But we all took it. I don’t think any of us required the full amount of time. They’ve warned us that often tests will take several days to grade (there’s a complex process to it, even though the tests are given electronically). But today, it only took a couple of hours. I’m proud to say I got an 89.69. Yeah, just short of a 90. But I’m ok with it. Yes, I’d have loved to have gotten higher, and honestly where were two questions I know I got wrong that I probably should have known a bit better. But, the reason I’m ok with it is, I based on the amount of time I spent, I got a grade I’m happy with. I was hitting a cost/benefit ratio on time. Had I spent another 5 hours studying, I might have gotten those two right. Another 10 hours, perhaps four more right. But, in the end, there were a couple of terms that I honestly never would have thought to study, so it’s unlikely I would have gotten a 100% on it. And I’m ok with that.

And that leads me into my part of this post. HOW I am studying. For medical terminology, one of the approaches I took was to ensure I knew a number of Latin roots and prefixes and suffixes. This meant that if I encountered a term I had not studied for, I had a better chance of figuring them out. Sure enough there was at least a few terms I had not specifically studied for, but that I was able to figure out. I’ll probably talk more about the “language” of medicine in a future post.

Now, that said, the medical terminology exam was a critical one to pass, but honestly, I didn’t think it was hard to study for. Coming up tomorrow is our first major exam in a class called Mechanism of Disease. This has been far harder to study for.

Below are two pictures of some of the things I’m doing to study. I’m going to work on this process over the coming months as I realize what works and doesn’t work.

Since I started taking my prereqs, I’ve gotten quite adept at using Microsoft’s OneNote for taking notes and outlining things. Here I’ve taken all the objectives from various lectures that are covered in this first exam and put them in one place. I’m slowly going through and color coding what I feel very comfortable with (green), only moderately comfortable with (orange, or not at all comfortable with (red). Black is for stuff I haven’t reviewed yet. This images is from Tuesday night.

Using this will hopefully allow me to decide where over the next few days I need to focus my limited time. If it’s already green, I’ll spend very little time on it. If it’s red, I’ll definitely spend time on it, and if it’s orange, I’ll have to determine how much time to allocate to it.

You’ll note that I don’t have any actual comments within the objectives. That’s generally elsewhere in my notes on other tabs.

But I also have a second thing I’m looking at. That’s the whiteboard shown in the following photograph. This is definitely something I’m going to be changing over time as I find out what works and doesn’t work.

I’ve broken out each lecture that will be covered on this exam. Then below it I’ve put several items (and this is the area most subject to change). Here, the colors mean nothing. They’re simply the markers I had available.

But to decode it:

  • Notes – Have I reviewed my notes (or in a few cases, even made them!)
  • PPT – Have I reviewed the PowerPoint slides. I’ll be honest here without naming names, but some professors make better PowerPoints than others. For example some will include notes with the slide. This can be very useful so that I can put the contents of the slide in context.
  • Book – Have I read the assigned chapters in the book? If not, I need to go back to it. Sometimes the book will explain things the lecture didn’t cover or explain it differently which will help.
  • O – Outline – have I outlined notes and organized them in a readable fashion.
  • AAR – Alternative Academic Resources – did they provide a link to a video. Are there videos I need to read.
  • Quiz – Have I made or looked for a Quizlet? To be honest, I find this hit or miss because if someone else is making them, they put in topics I don’t need to know or alternatively not put in stuff I do need to know.
  • LTT – This is the critical one and ultimately the only one I’m going to care about at the end.
    • Learn – Do I feel like I’ve learned the material? This will be true when I have all, or perhaps mostly green in my OneNote outline.
    • Teach – Do I feel like I can teach the material to someone else, or even better, have I. If I feel comfortable teaching it, then I’m going to be comfortable that I’m ready for the final T
    • Test – How did I do on the test? This of course is the ultimate metric.

For the whiteboard, I don’t necessarily plan on or hitting every single mark there. They’re more of reminders. “Hey, you’re having trouble with this topic, have you tried all these ways of learning it?” The only one I really care about is being confident in the LT portion of LTT.

The combination of these two resources will hopefully help me make sure I don’t go down a rabbit hole of a particular lecture and forget to study for another. For example, if I wake up Sunday morning finding I’m green on almost everything, but perhaps orange on two things and red on one, I’ll focus on the red topics first, so I can at least get them to what I consider an orange level.

What’s this translate to in the end? I can’t put hard numbers on it, but my thinking is something like:

  • Everything green – I feel like I should walk into the exam expecting something solidly in the 90s.
  • A majority of green with a few oranges – ok now I’m talking solidly the 80s, perhaps approaching 90.
  • Mostly oranges but no reds – I’ll start to worry. I’ll probably pass, but not solidly in the 80s.
  • Mostly oranges with some reds – I’ll be in panic mode. I’ll have to spend more time.

But, this is a feedback. If I think I’m green at that amount of effort and I’m getting a much lower grade on tests than I expect, that means in the future I’m going to have to increase my study time, or change how I study.

Alternatively, if I find myself in the orange a lot because I ran out of time, but doing really well on tests, then perhaps it means I’m overestimating how much I don’t know and need to revise.

I started this blog Tuesday night and am posting Sunday night. At this point, I’m green on most items and I think I’m ready to go. But we won’t know for sure until tomorrow!

PA School: First Impressions and Grades

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“It’s like drinking from a fire house.” Before classes even started, I heard that expression a lot and frankly, used it a lot. It’s true.

The first week started off a bit easy. The first day was orientation. That was easy. And we had two classes postponed to the following week. That made that week easy. Of course it meant that much more work last week! By my count we had 16 class lectures, plus a lab and four other scheduled events. It was quite the firehose. I still haven’t caught up on my note taking!

But this week is in some ways where the rubber hits the road.

For one thing, our first “student led lab” was today. In these, we are broken down into three groups, and each group has two student instructors that we rotate through over the next 7-8 weeks. This means everyone at some point will lead a lab. You can guess who, by sheer coincidence get assigned not only to lead a section for the first student lead lab, but the first session of the day. Ayup, myself and a fellow student. So since there are three sections each week, each having two student leaders, that meant that six of us got together on Sunday to setup what are called “presets” on the Anatomage tables and work out our presentations. That took at least six hours. Then on Monday, I spent at least two to three hours doing additional prep and run through. Tuesday, I had to lead my section. I wasn’t quite as well prepared as I would have liked, but I got good feedback, and my fellow students seemed to appreciate my efforts. The TA that graded the section gave me my grade a bit later the same day. 100%. I’m of course happy with that. BUT… that ends up being like just a few percentage of my entire grade. There’s a lot more grades to come.

Speaking of which, Wednesday was one of the bigger tests for another class. It’s big in two ways. For the class it’s in, it represents 20% of the grade for that class! For another, it’s sort of a make or break exam. If you fail it, you actually have a chance to remediate it before the end of the semester. This is great, but if you fail that, you’re dismissed from the program! Reportedly no one, at least in recent memory, has ever failed it twice. So that was reassuring.

The exam itself is “Medical Terminology”. I’ve been studying for it off and on over the past few weeks and 3 of my fellow classmates did a study session for it late Tuesday afternoon. In addition, my Council of Moore has reassured me that I’ll do great given my background (but of course they weren’t the ones actually taking it now, were they?)

So I’ll admit I was not OVERLY nervous but I’d by lying if I didn’t admit that I had been a bit trepidatious about it. Turns out I did “well enough.”

Around here, they reassure us that any grade over an 80% is good enough

Monday morning, I have my next exam. That one honestly, is MUCH harder than the Medical Terminology one, but as long as I pass, I don’t have to worry about being kicked out of the program!

So, wish me luck. I’m confident, but will always take a bit of luck!

PA School – Update

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I’m going to start with the fact that I absolutely should be studying right now. But I’m consciously choosing not to. I’ll get into why in a moment.

So it’s been an interesting week. Tougher in a few areas than expected, perhaps easier in some than expected. And note, this post will be a long one.

When I got down here, my housing situation was still in flux. I was torn between two places and had basically settled on a place in downtown Wilmington, but still needed to figure out the paperwork. That took until Thursday before I could move in. So for three nights I slept in hotels. Not great, but doable. Thursday I was finally able to move in and unpack the car.

First the good:

  • It’s a beautiful building. Marble floors downstairs, etc.
  • It has a great gym, though I haven’t gotten there yet.
  • It has a great balcony on the 12th floor for cooking out and the like.
  • It’s small, but perhaps better described as cozy.
  • I was able to get a great deal on it given the location and quality.
  • The commute isn’t nearly as bad as one might expect.
  • For a small fee, it has a great co-working space in the building with free beer on tap!
  • It has a concierge service and wonderful package receiving room.

Now the issues

  • I had looked at a 1 bedroom at this place on a previous trip and that’s what made me interested in the place. But I couldn’t afford it. Then I realized they had some studios. I decided, given the other facilities in the building, that would be workable. So, I agreed to take one, without actually actually seeing it until I started to move in. A bit of a mistake. Turns out the studios overlook the central area, not the streets, so I’m looking out at a wall. Granted, it’s probably 50′ away, but well, to a country boy used to seeing the sky all the time, it’s quite depressing. But I could probably get over that in time.
  • I mentioned I’m a country boy at heart. I’m definitely not a city person. I got thinking perhaps being in a walkable neighborhood and all would be great. But I’ve realized, I’m probably NOT going to have the time! This will be a reoccurring theme.
  • Bicycling: simply the logistics of hopping on my bike and going for a ride is far more complicated than I expected it to be. And takes more time (between getting the elevator, etc.)
  • Time: given the workload I have, I realize, I’m probably not going to have the time to make use of the facilities, including the co-working space
  • Socialization: I may be a country boy at heart, but that doesn’t mean I don’t like having folks over. Between this place being a bit smaller than I expected and the logistics of parking and all for guests and letting folks in, I can’t see myself organizing successful study group meetings here. That’s grating on me. It’s definitely not an issue I thought would be a problem until after I thought about it this weekend.
  • So, overall, I’ve come to the conclusion that I should have taken the other space. I’m currently exploring options to see what I can do. Worst case, I suck it up, bike less, and make this work. I mean in many ways, it really is a nice place and if it was a different situation, I’d probably love the space.
  • But if you know anyone looking for a great studio space in downtown Wilmington, reach out to me.

The other issues

Simply settling in. I mean this would be true anywhere. But I’m lacking some basic necessities. Amazon for the most part is taking care of this. But the thing that nearly sent me over the edge today was that UPS failed to deliver my bed from Amazon! I’ve been sleeping on hotel beds and now a leaking air mattress for a week. Between that and stressing about my apartment choices, I have NOT been getting good sleep! All weekend I was looking forward to my bed being delivered so tonight I could sleep well. Alas, UPS failed and claimed “no one available to receive package”. Did I mention the building has a concierge service? Not only that, but if that person stepped away from the desk, there’s two glass-walled offices right next to the doors that overlook the concierge desk. I received packages over the weekend, including Sunday. I have NO idea how UPS could mess this up. Two calls and numerous attempts to contact them resulted in “A regional manager will reach out to you within the hour.” That was 3 hours ago. So much for that.

So, as a result, I’m completely off my game. I’m in no mood to study. So right now I’m writing to get my brain back where it needs to be.

Speaking of studying

That is the main reason I’m here. I mentioned last week I have 16 credits. This is spread across 6 classes right now.

  • Professional Practice I – 1 credit – This will be an “easy” course. No real tests, just a few projects. I think some of my classmates may think it’s a “trivial” class and it probably is in terms of getting a good grade, but honestly, in some ways it’s one of our most important.
  • Medical Interview Counseling Skills – 2 credits – We had our first lecture in this today, partly covering billing and coding.
  • Human Gross Anatomy – 5 credits – Both an easy class and a hard class. I’m finding some of it simply review from my prereqs. But it’s vitally important and we’re still covering what I consider the basics. It’ll get harder as the semester goes on. A lot of stress though and where I’ll be spending a lot of my study time in the coming weeks.
  • Biomedical Science – 3 credits – We have not had this yet
  • Mechanisms of Disease – 6 credits – Due to two different professors being sick two lectures got moved from last week t o tomorrow. So we didn’t even have a full week last week! Tomorrow will be a busy day. Right now this is causing the most stress among our cohort because next week we have a “must pass” exam on medical terminology. I say “must pass” because if you fail, you have to sign up for an online course and take the test again by the end of the semester and if you fail that, you’re out of the program totally. I’m not overly stressing, in part because of the studying I’ve done so far reinforces what I picked up over the years and working as a tech and my background in Latin has given me a leg-up. I’m still working on learning more though. Just to be sure.
  • Pharmacology & Therapeutics I – 1 credit – We haven’t had a lecture here yet.

Today the Director of Didactic Studies met with our cohort to give advice on how to study and what to study. He also went in depth on how they grade and validate the tests. It’s far more complex than simply “ok, you got these questions wrong”. They look into how many students got them right versus wrong, and when they got them wrong, which wrong answers did they pick. This gives them some insight into if they’re teaching the right things or perhaps something got missed in a lecture.

After every test, the system eventually generates a Strengths and Opportunities report. Strengths are things you did well on. Opportunities are areas you need to work on. For example, if it’s a test in Anatomy and you get most of the questions on the skeleton correct, but got most of the ones on the nervous system wrong, you’d be advised not only to study more on the nervous system, but possibly what areas specifically (perhaps you understand where they go, but not what they do.) I really like this because I think it’s a key part of what will help me do well.

He also emphasized they’ll do different types of questions:

1st Order – basic and absolute knowledge. For example it might be a diagram with “identify this muscle?” Or a multiple choice for “what is the definition of hypoglycemia?”

2nd order – a question about something related to what is shown. So the diagram might point to a muscle but instead of identifying it, it could be more like “what type of motion does this muscle help with?” Or a multiple choice for “Which of the following numbers might be indicative of hypoglycemia?” So you have to know the definition of hypoglycemia and what numbers are associated with it.

3rd order – to be honest, I’m still trying to come up with a good example.

But the point here is to NOT just remember facts, but causes and effects, and to have a deeper understanding of the subject matter.

80%

One thing they keep stressing is, 80%. If you’re getting over that, don’t worry about it. Their own reporting shows that as long as you’re doing that, you’re very likely to pass the PANCE on the first try. Of course I hope to do better, but it also means I won’t stress to much either. As they point out, at this point, the competition is over. We’re in. As long as we all pass, we’ll graduate. We’re not really competing for spots for anything. This is reassuring.

That said, let’s say I got a 70% or below. That simply triggers a meeting to go over what concepts I missed and perhaps learn why and how to do better the next time. 75% or below you can ask for one, but it’s not mandatory.

He also went into Bloom’s Taxonomy a bit which was useful in understanding how to learn and achieve that 80% or better.

One thing I’m really like about this program is that they feel compelled to go beyond simply “we’re teaching you stuff” to ensure we’re actually learning stuff and able to pass the PANCE. I think it’s one reason their PANCE pass rates are consistently well above the national standard. (for example in 2024, the Christiana Campus had 95% of their students pass the PANCE on their 1st try, compared to 93% nationally. The Glenside Campus had 98% pass on their first try. 100% eventually passed.)

I had one classmate rejected from a program much closer to home for her, but she didn’t feel bad because their PANCE pass rates were in the 60%-80% range.

So in Closing

The bed situation will resolve.

The apartment situation I can live with.

But most importantly, the school situation will be VERY difficult, but I have a school that I feel like is really backing me. I actually feel very confident that no matter how hard I find the academics at times, I’ll make it. That’s reassuring.

I’m Oriented

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Day One is in the books.

As noted in my previous post, I couldn’t sleep, so I made sure to get into the classroom early. I was probably one of the first 10 or so to arrive. I was able to identify a few of my fellow students in the lobby by the look on their face. I’m sure it matched mine. Not exactly scared, but nervous and excitement mixed.

I picked up my packet and mug at the book of the room. I then picked the seat I had selected last time I had visited the campus and I think it’s going to be my seat for the year. We’ll see.

Two things I immediately noticed: for some reason my packet didn’t have my badge with it. Apparently a few didn’t get printed in time. They assure me I’ll have it soon.

The other thing I noticed was that last year’s cohort had left personalized cards at each seat. I read mine and am keeping it. It’s honestly a nice touch.

We started a bit late (as I expected) due to “technical difficulties” trying to coordinate Zoom between the two campus. Once that was resolved it was off to the races. Every professor introduced themselves and then there were various departments, such as security, health services, and more introducing themselves. A lot of useful information, but also a bit overwhelming.

We also did an ice-breaker where we broke into groups of two or three, did a very quick interview of each other and then presented that information to the class. For example, the person next to me came in 3rd place in a world championship in Texas. Nice detail.

Part of the day was spent talking about how courses are graded, exam policy, suggestions on studying, and other useful details to help make us be better students. It was fairly reassuring. The only really scary part was reminding us that for every credit hour of in class time we have, to expect to spend two (or more) hours outside of class. For the Summer Semester, that’s not too bad, we’re taking 18 credit hours. So if you do the math, that’s 18+(2*18), which means 54 hours a week for this semester. That’s doable.

Next semester is 25 credit hours. I’ll let you do the math on that one.

But, given the way they apparently teach the classes and coordinate studies, I think I’ll be all right.

That said, one thing I realized pretty quickly: as nervous as I am about the amount of materials I need to learn, I also love to be back in the classroom! I can’t wait to start my actual classes now!

All in the Same Boat

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Orientation starts in just under two hours, but I can’t sleep, so here I am blogging.

Last night, 1/7th of my local cohort, in other words, 7 of us, got together for a dinner I organized. The food was good, but the company was better. Our ages ranged from “just graduated undergrad two weeks ago” to me. We had the extrovert to the one that appeared to be more introverted. One of us has already completed the Public Health portion of her dual degree program. Another was from Connecticut and yet another had a background as an ED Tech like me. In other words, a pretty diverse group, even with just the seven of us.

But, we all had one thing in common: we’re all nervous as all get out! We’re about to leap into the great unknown and it showed. We talked a bit about our upcoming Medical Terminology exam on June 11th (sort of a make or break exam, if you can’t pass it on two tries, good-bye. But apparently no one has failed it in two tries.)

We all wanted to know what today, Orientation Day, will bring. Fortunately I was able to chat with my mentor via text after dinner so I got some idea.

And we were curious how classes will work. Our schedule gives us some clue. Many are local but some are remote via Zoom with the Glenside campus outside of Philadelphia. That’s the mechanics, but the zeitgeist is still a bit up in the air. I suspect for the remote classes, many of us will still come to the classroom in order to stay in “student” mode and not be easily distracted back at our apartments or homes.

I have to say I had a feeling of relief after dinner since it was nice to know I wasn’t the only feeling like I did yesterday morning.

So in two hours, the great adventure begins.

My only regret is that I failed to get a group photo. Maybe in two years we’ll get the same group together for a good-bye photo.

Holy Frack! Less than 24 Hours

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In just under 24 hours from the time I’m writing this blog I’ll be starting orientation with my fellow cohort of students at the Christiana campus of Arcadia University’s PA program. I can’t believe it. Everything I’ve worked for in the past 2 plus years is about to bear fruit.

That said, in the last 24 hours I’ve had two dreams.

The one two nights ago had me starting class. Strangely, one of my classmates was my wife. While she loves medicine and enjoys hearing me talk about it, she decided years ago that my path wasn’t for her. Still, it was an interesting subconscious take on where I’m headed. What’s interesting is we decided we’d sit in completely different parts of the classroom. You’d think we’d want to sit together, but we realized (at least in my dream) that our learning styles were different enough that we’d be better of separated. In any case, in that dream, things were going smoothly and I felt confident and excited.

Contrast that to the dream I had this morning. In reality, last night, via GroupMe, I started to organize a get together dinner for my classmates tonight. So far it looks like 8 of us (out of 49) will be showing up. That much is accurate.

But in my dream, I had been sitting on a sidewalk in the downtown of some city (I’m going to assume it’s Wilmington) when a childhood friend (who now lives in Florida) shows up and tell me it’s 6:27 and I had promised to make the reservation for 6:30 so I really had to move. I started to follow her to her car and then lost track of her. Fortunately after turning around and taking a turn, I found my car. Which turned into a bicycle when I got there. Which would be fine, but I had a large box of items I needed to carry with me. So I figured I’d text or call my friend back but now mysteriously on my phone all her contact information was gone.

Some more hijinks ensued, but suffice to say I didn’t make it to dinner in time and was panicking.

So in 24 hours I had gone from confidence and excitement to panic.

I suppose this sort of mirrors the thoughts swirling in my mind. I’m excited, but I’ve got to admit a bit of panic running through my head. Can I cut it? Will my current knowledge help me enough to get through? Will my improved study habits make a difference? What am I forgetting to panic? Will I make friends? What will it be like being the oldest student in my cohort?

Well, tomorrow I will find out!

I’m Too Old!

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They say age is just a number. I wish that were true.

Otherwise my outlook sometimes wouldn’t be so blue.

The reality is quite mundane

One age and two is not quite the same

Ok, I give up, rhymed meter isn’t my thing.

But it’s still better than if I did sing.

Seriously now…

As the date of for starting PA school gets close (less than a week away) I have mixed emotions in my head. On one hand, I sometimes feel as giddy as I did when I first went off to college, or perhaps when I was in my twenties. For the first time in years, I intentionally won’t be earning an income. Instead, I’ll be paying good money for an education. I feel young in so many ways. In just over two years if all goes well, I’ll be starting a whole new career. I feel like I’ve got a whole new life ahead of me.

And I do.

But… the reality is, unless something changes, I have fewer days ahead of me than I have behind me. In fact, statistically, I have fewer days ahead of me than I have between when I finished college and now. My next career will certainly be far shorter than my previous one.

So I’m not too old to start school. I don’t feel all that old emotionally. Even physically I don’t feel too bad, though I’ll admit I’ve noticed the vagaries of aging in my body.

But I’m too old to mature in this career as much as I did my former one. Too old to do this career the justice I’d love to give it and then move on to something else.

But, I don’t care. I’m going to love and enjoy the heck out of the years I’ve got left and the career I’m moving into.

That said, if anyone has any secrets to longevity, reach out to me. Or heck, even if I could live to 200 or 300, that might do for all I want to do. Though I suspect at 150 or 250, I’d be wishing for more time to do more things.

So for now, my plan is to die young as old as possible.

Transgender

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Note, I started this about two months ago and only posting now, hence “yesterday”.

Yesterday I read that the National Park Service website for the Stonewall National Monument no longer references transgenderism or queerness and any references LGBT+ only reference LGB.

This is erasure plain and simple. Trans-women such as Marsha P. Johnson were a big part of the Stonewall riots.

In any case, this erasure is a good lead-in to a topic I’ve been wanting to blog about for awhile: sexual and gender identity

I’m going to touch on sexual identity first. This is in some ways the easiest to address from a purely factual point of view. There are plenty of posts elsewhere, such on Facebook that cover it, so I’ll keep this short. What you were taught in high school biology about sex being binary was a gross oversimplification. The whole XX=Female and XY=Male is not that simple.

The key words used here in a scientific sense are genotype and phenotype. Genotype is basically what genes you have, and phenotype is what you “see”. A classic example is eye color. If you have brown eyes, you may have both genes for brown eyes, or one each of the genes for brown and blue eyes. Brown “wins out” here. It’s the dominant gene. But if you have blue eyes, except in some very edge cases, both your genes for eye color will be blue. So if you see someone with brown eyes (phenotype) they could have both genes for brown eyes or one gene for brown eyes and one for blue eyes (genotype). There’s no way to tell without actually looking at their genes.

In a similar fashion, sexual characteristics have both a genotype and phenotype. Typically if you have XX chromosomes, as an adult, you will develop breasts, have a uterus, have gametes in the form of eggs and be capable of carrying a fetus. And if you have XY chromosomes as you mature, you will tend to grow more body hair, produce sperm gametes and not be able of carrying a fetus.

But Mother Nature is never that simple. It’s fully possible to develop characteristics where one appears to be male, but have only XX chromosomes. Or appear to be female and have XY chromosomes. Things can get very complex very quickly, including XO (no second sex chromosome) XXY, XYY, and more. (the only combination that doesn’t work is YO. There’s simply too many genes on the X chromosome that are required).

Anyway, the point is, sex is NOT binary and short of looking at someone’s genotype (which most of us will never do) it’s basically impossible to say what’s going on at the chromosomal level.

Ok, enough about sex. There’s plenty of better posts on the topic.

Now I want to talk about gender, or at least gender identity.

I’ll start with saying that the scientific consensus on this is a bit less clear-cut. And for that reason and others I’m not really going to go down a deep hole based on facts. Rather I want to take a different approach.

I’m going to start by saying I identify as a cis-male. Some people seem to think that cis is meant as an insult. It’s not. In the field of science, cis and trans basically mean “on this side” and “on the opposite side” or “across”. Think about terms like “trans-Atlantic flight. It simply means flying across the Atlantic or to the opposite side. You don’t hear the prefix cis used as much, but one example in recent memory would be the term cislunar flight, from the Apollo missions. Often times in science one might skip using the prefix cis and assume that as the default and only use trans to highlight something that’s not cis.

So I could say simply “I identify as male” and that would be accurate, but adding the prefix cis makes it a bit more accurate. In this case my gender identity matches my phenotypical (and as far as I know genotypical) sex.

That said, if you still think that transgender isn’t a thing, or it’s somehow “wrong” or “evil” or “sick” I want you to do a thought experiment with me. I’m going to start with the assumption if you feel that way, you do not identify as trans. As started above that makes you cis.

Since I’m male I’m going to center this on male identify, but the exercise can work as well for a female.

“What makes me male?” It’s really a simple question. Right? I mean I could answer, “well I have XY chromosomes. But as illustrated above, that MIGHT not be true. (Though given the fact that I’m a biological father to both a man and woman tends to suggest it’s very likely to be true.) So let’s go a bit beyond that.

Why do *I* think I’m male. The more I think about it, the harder it is to answer.

Is it because I have a penis? Perhaps. But let’s say I was in a tragic accident and I lost that? Would I stop being male?

Is it because I grow hair on my chest? Perhaps. But if I shave it, do I somehow stop being male? Or if I lose it due to cancer or some other disease do I stop being male? Perhaps it’s fact that I don’t have breasts? Perhaps it’s muscle mass? But the truth is, as I’m growing older, I’m losing muscle mass. Does that mean I’m losing my maleness? What if I meet a woman who is similar in age to me and she has more muscle mass? Is she somehow more male than I am?

Hopefully you can see where I’m going with this. I can’t rely on any specific physical appearance to unequivocally state that I’m male.

Perhaps on certain actions? Long hair? Women in general are more likely then men to grow their hair longer. But that’s strictly cultural. And as someone who spotted a rat-tail or pony-tail or some sort of long hair for well over a decade, I don’t think that made me feel less male or somehow more female.

Perhaps it’s makeup? Well in some cultures, men very commonly wear make up (ancient Egypt for example).

Or is it shoes? I mean I’ll admit a woman in heels will make my head turn. But again, heel wearing is strictly cultural and in fact some of the earliest heels were worn by men, not women.

Many of the outward appearance we attribute to men or women are strictly cultural, not some innate part of the gender.

So, a few years ago, after giving this a lot of thought, I realized I couldn’t come up with a good set of criteria that clearly defined me as male. Now it’s possible I’m simply not creative enough to come up with a set of unambiguous criteria, but from talking to many others and giving it a lot of thought, I’m pretty convinced there’s no such list.

Ultimately like like Justice Potter Stewart’s famous quote about porn “I know it when I see it” I know I’m a man.

Just you as a reader probably deep down simply know, that you’re a man or a woman. You might not be able to articulate exactly why you know that, but you simply know that.

Now I want you to put yourself in a place of a transgender woman or transgender man. Deep down, just as strongly as you feel about your gender identity, they feel the same about theirs. The main difference is that their phenotype (appearance) simply doesn’t match what the feel deep down.

That’s really what it comes down to. It’s not a desire to sneak into a bathroom and perv on others. It’s not a desire to “mutilate” anyone. It’s simply (well partly not entirely simple) a desire to be able to express outwardly what one feels internally.

T – 1 Week and Counting

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Pardon the language, but “shit’s getting real!” Technically as I write this, it’s less than 1 week. Officially I start orientation at 9:00 AM on Tuesday the 27th. It’s about 9:30 as I write this and publish it. But I think I can say 1 week without being accused of lying.

But then again, technically classes don’t start until Wednesday the 28th. So there’s that.

Then I have my nervous breakdown scheduled for Thursday night on the 29th as reality hits me.

Seriously though, the time is coming fast. I’m finalizing my housing plans (yes, I waited longer than I had planned, that’s a story in and of itself). I’m starting to put together a packing list of stuff I need.

And, I’m trying to set up a dentist appointment because apparently I had a chip come off a tooth last night. Fortunately there’s no discomfort.

Oh and last minute paperwork and drug testing for school.

And projects around the house.

But other than that, I’m ready.

I think.

People have asked some questions, so I guess I should put together a FAQ. (by the way, technically the term FAQ predates my Internet introduction, but only by a few years. It was partially developed by Eugene Miya, a name I know well from my early days on Usenet.)

So, just the FAQs Ma’am, Just the FAQs

  • Is the family going with you? – Nope. Two of the three have local jobs, the third is looking. Besides someone has to maintain the family estate!
  • How long will you be gone? – Two years, but not really. It’s one year of didactic and then one year of clinicals. I have ten clinicals I have to complete in variations specialties. Most will be within 90 miles of where my campus is, but I can do several in other locations including at least one overseas rotation. So more like nine months of the second year I’ll be in Delaware, and if I can group the other three into a single block, I’ll be elsewhere, but not sure where yet. That will impact any apartment leases I book.
  • Will you come home weekends? – In most cases not. This is for several reasons. For one, since I won’t really be working, not coming home every weekend will save money. For another, I expect to be studying most weekends and wouldn’t have time for travel. That said, I expect often if I do travel home, it’ll be via train so I can sleep or study while in motion.
  • How hard is the program? – That’s a great question. One analogy I’ve been using and is told is accurate is it’s like drinking from a firehose. Another is that I’ll be sprinting a series of marathons. Imagine packing three semesters into one year for starters. The first semester is 18 credits. The second 25, and I believe the third also over 20. Basically I can count on a test every week. I’ll be learning in one year what many medical students spread out over a couple of years.
  • Are you nervous? – I’d be lying if I said I weren’t. There are moments where I completely doubt myself. But, as a member of my Council of Moore reassured me the other day when I asked for a confidence boost, that’s exactly the right attitude. It’ll keep me from becoming complacent. Mostly I think I’m nervous about the amount of rote memorization I’ll need to achieve. This is something that older brains in general aren’t necessarily as good at as younger ones. Most of my classmates will be half my age or even younger, so they’ve got me beat there. On the other hand, just because of my experiences in general, including working in the ED, I am fairly confident that understanding systems, pathophysiology, and physiology in general are strong. I’ve always been good at the “big picture.” I even noticed this, to brag a bit, in the ED when sometimes an attending would be quizzing a medical student or even a resident about a case and while I might not know some of the details, I was often able to understand the overall picture better than the student or resident.

    I also worry that my student habits from my BS will resurface. But that said, I proved my study habits in my prereq classes worked and I’ll of course be using them again. I’ve also built a good support system for myself.

    So yes, there will be moments where I doubt myself and even moments where I might not do as well as I’d like, but overall, I think I’ll do fine.

    But ask me in two years.
  • Are you excited? – Overall yes. But ask me in a week. Right now I’m just stressing about all the final prep.
  • Isn’t this costing a lot? – Honestly, yes. One reason I had hoped to get into a local program (there’s really only two that are considered local) was to save money and be home more. But alas, that’s not what happened. And honestly, I’ll be trading two years of income for two years of spending. And even when I graduate, I’ll probably be making less than if I had simply stuck in IT or even teched in the ED for those two years. But, ultimately I’m pretty confident I wouldn’t be as happy or as fulfilled.

    Years ago in either Dear Abby or Ann Landers, I recall someone writing in who was I believe like 46 asking if she should spend four years going to college or if it was a waste of time. The response was, that either way in four years, she’d be 50, so she should do what she thought would fulfill her the most. That’s my attitude. In two more years I’ll be 59. So I might as well be 59 with a masters in something I believe I have a passion for than 59 without that masters.

    Now, that said, if anyone wants to give me money, let’s talk šŸ™‚
  • I like PAs, can you be my PA after you graduate? – I’ve already had one person ask this. I pointed out my goal is to work in the local trauma center. Do you still want to see me at work? šŸ™‚
  • Will you keep blogging? – Definitely. I’m actually surprised and appreciate how many people (i.e. more than one person) actually appreciates to hear about my PA journey. It’s also my way of venting and keeping sane. Thanks for reading.

That was Then, this is Now

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I had a few photos that didn’t really fit into my previous post so decided to create a separate one.

Heading into my final shift

This was my first shift actually in the ED. I think the bottom set of scrubs were some I bought locally. Marginally better than what I was given at the end of my first week of preliminary orientation.

Celebrating the 1000 hour Mark

By now I was 1000 hours into teching. You can’t tell from this photo, but my scrubs are better fitting and I’m feeling far more comfortable in the job.

Heading into work for my final shift was a fulltime tech

Definitely comfortable now!

Poised for a quick getaway!

While we don’t have assigned spots, I usually considered one of the spots around here as “mine”. I could usually get such a spot about 90% of the time. Why so important to me? My car was headed straight down the ramp. So by not having to back out, or come down from other areas, I could get out of the garage that much faster.

I make this look good

5,500 hours ago I know I would not have looked so relaxed and comfortable at work. But now, I’m definitely comfortable and relaxed. Even in the middle of a trauma. I think I’ve come pretty far. And now I set off on the next part of my journey.