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.

ED Teching vs My Future – A Step Forward?

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Over the coming weeks I’ll probably cut back on my hours as an ED Tech. And I have mixed feelings about that. The main reason being is I’m picking up some IT consulting work that pays a lot better and well, I’ll be honest, the money will help pay for me being in PA school.

Originally I had two goals when I tried to get a job as a tech in the local Emergency Department. The first was to gain the Patient Contact Experience that most PA schools require in order to apply. The second was to confirm whether I really wanted to be in Emergency Medicine. I was able to confirm the second goal fairly quickly.

As for the hours, every school had different requirements, from as few as 200 hours to as many as 1000 hours. Of course the minimum is different from the average and most schools only accepted students who were closer to the average number of patient contact experience hours.

I was able to quickly surpass the 1000 hour minimum within the first 6 months or so of me working in ED (this despite being in theory only a .6 FTE). Obviously that wasn’t enough for my first cycle (and most likely other factors). By the time I applied for the second cycle, I was at over 3,000 hours. I’m now at over 4,000, probably 4,500 hours and odds are I’ll be at close to 5,000 by the time I leave the job. (Edit: I looked through my old pay stubs, and turns out I’m actually over 5,000 hours now, so probably will be over 5,500 by the time I leave.)

In his book, Outliers, Malcom Gladwell cites a “10,000 hour” maxim which basically states to become an expert at something, one needs to spend approximately 10,000 hours of training for it. If it’s accurate, there’s a lot of question about the accuracy of this rule, then I suppose I’m half-way to being an expert. That said, I’m not really sure what being an expert tech means.

However, looking back, I definitely think my extra time in the ED as a tech was well worth it. I’m a far better tech (at least in my mind) than I was 1 year ago, let alone 2 years ago. (Though strictly speaking 2 years ago I was just off orientation). And that extra experience I think will go a long way to helping me in PA school.

Partly it’s a matter of confidence. Partly it’s a matter of skill. I appreciate that my place of employment is a teaching hospital and encourages a team approach. I’ve been in cardiac codes where the attending will run through what we’ve tried and ask, “anyone have any suggestions.” And they truly mean anyone, even a tech can speak up if they feel inclined. In other situations I’ve offered advice and had it accepted. I’ve actually had nurses and providers ask for my input or to help with some more advanced procedures.

I find I really enjoy doing the ED Tech work. And it’s made me both want more and not want more. I’ll be taking a two year gap (other than perhaps some per diem work) from working in an ED while I get my PA degree. Once I have that and pass the certifying exam, I’ll be a PA-C and be able to do a lot more in the ED than I do now. I’m excited about that!

But, I also look at the downside: being a tech, when my shift is over, I do about a 5 minute hand-off and I’m done. There’s no paperwork. There’s also no paperwork during the shift. It’s pretty much all hand’s on. Once I’m a PA-C, it won’t be that easy. When my shift officially ends, I’ll be responsible for paperwork and doing a more extensive hand-over. And, of course during the shift, I’ll be responsible for discharge paperwork and a lot of non-hands on work. I’m…. at best ambivalent about that. But, I suppose it comes with the terrority.

That said, I’m still excited about the next few years!

A Thought on My PA Journey

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When leaving work last night, after a long 16 hour shift, a thought crossed my mind. Even if somehow I don’t succeed at PA school (not something I’m actually too worried about, and not really the point of this post), the last 3 years have been worth it. Almost exactly three years ago I was busy getting the paperwork done to start taking classes at the local community college. The first three classes I signed up for were Biology 1, Intro to Psychology, and Anatomy and Physiology I. I was nervous and excited. It wasn’t easy balancing my work and school schedule, but fortunately my consulting job gave me flexibility. Within the first week I realized how much I enjoyed being back in the classroom. I was in my element. I love learning. And I loved specifically learning these topics, especially Anatomy and Physiology. In fact, besides A&P, I really enjoyed Organic Chemistry (a sentence I never thought I’d write or say) and Biochemistry and Genetics. I’m actually thrilled most schools required these in order to apply, since by the time I had finished them, I had a much fuller understanding of how things happen inside our bodies. It’s been a thrill learning these topics.

As I’ve mentioned in the past however, taking classes was the easy part. I simply had to sign up. Getting the required hands on experience took some effort. But I quickly realized I was where I needed and wanted to be. This is evidenced in part by the fact that in 2023 I worked over 2200 hours in the Emergency Department (on top of my consulting work and taking classes) and in 2024, over 2400 hours. I’ve commented before that my IT consulting pays a lot better, and honestly has better hours. But I love what I do in the ED.

The stories I tell (some say bore) others are often the more interesting ones, but even the nights where nothing interesting happens and it’s mostly handing out blankets, performing ECGs and the like are fulfilling. For every shift I do CPR on a patient (and this week for some reason was a busy one, 4 out of 5 shifts I performed CPR compressions on a patient) there’s probably 10 where I’m only going ECGs and finding nothing noteworthy. And I’m OK with that. It’s still patient contact. It’s still making connections with another human being.

Despite biking and hiking less in the last 3 years than I’d have liked, I honestly have been busier and more fulfilled than I have been in years.

I know if I had done nothing but IT for the past 3 years, I would have been richer financially, but been less rich in terms of fulfillment.

The past 3 years have reinvigorated me and made me feel younger. It’s been worth it.

I can’t wait to see what the coming years bring!

So my advice to folks in the new year, especially those later in life like me, branch out. Be brave. Do something different. You don’t have to be drastic like me and change careers, but take a class, start a new hobby or something. It’ll be worth it.

Happy New Year!

2025 A Year in Preview

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In keeping up my tradition of setting some goals (not resolutions) for the new year, here’s my hopes for the coming year.

  • Succeed at PA school – I managed the goal of getting in. Now the next goal is actually succeeding! I know it’s not going to be easy and I think I’m prepared. As I’ve said to others, come May, my full-time job will be being a student. I haven’t had that “job” in 35 years! So this should be interesting!
  • Travel – I want to get in at least one road trip before school starts. I don’t have details yet, but I hope to figure this out soon.
  • See Friends/Make New Ones – One detail about PA school is that I’ll be 4-5 hours from home. So I’ll be relocating for the next two years (the first year is all classroom room, the second is clinical rotations). So I hope to see some of my local friends, and make new friends among my classmates.
  • Biking – Yes, I definitely hope to get some in. I’ll be bringing my bike with me to school. It’ll just be a matter of finding time to do it. Fortunately I won’t be working night shift, which means I’ll be awake during the day.
  • Get our new septic system – Yes, again a goal.
  • Several projects around the house – this will be limited by the amount of time I have between now and May. So we’ll see.
  • That’s about it. Honestly, as long as I succeed at my primary goal, I’ll be happy and content.

In the meantime, check out how I did last year.

2024 A Year in Review

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As I try to do every year, I look back at goals I set at the start of the year and see how well I did. As usual, this it’s a mixed bag.

How did I do?

  • Well, my primary goal was to get into PA School. Last year I had gotten waitlisted at one and declined at all the others. Close, but not close enough. This year started off rough. I was able to submit what I think was a much better application. I had a few more courses to add to my transcript. This helped bring up my GPA (though not above the magical 3.0 that most schools require for a cumulative GPA). But my last 41 credits were all 4.0 and if I include my last 60 (some schools have look back windows of 30-60 credits), it’s nearly a 3.7. Not too bad if I may say so myself. I submitted fairly early in the application cycle.
    In addition, I think I had a stronger essay for my application as well as better letters of recommendation.
    And then the first rejections rolled in. One was particularly disappointing since it was one of my top choices and they claimed to not have a minimum GPA. After exchanging some emails, I learned that while they claim not to, in fact in the last 5 years, they haven’t accepted anyone with a cumulative GPA under 3.2. That definitely felt like a bait and switch to me.
    However, the very next day I received the email that would change my life. In fact, I had to read it more than once since I was in shock. Even when I got the emails explaining how to put in my down-payment I have to admit I didn’t believe it! That said, for now I’m keeping the name somewhat under wraps as I’m still waiting to hear from two other great schools. But the key point is, regardless of what happens with them, I’m going to PA School in 2025!
  • Another goal I had was to keep working in the Emergency Department and keep my Red Badge status so I could be the lead tech in Traumas.
    • Not only did I succeed with this (as of last night over 2450 hours, including PTO) but I added to my resume the role of being the Tech who taught the Red Badge class to new techs. I’ll be handing that role over in a few months (and am already taking steps to make that happen) but it’s been a great job.
    • I also moved to night shifts for most of my shifts in the ED. Honestly, I love the crew and atmosphere, but it’s done shit for my circadian rhythm and for planning day events.
    • One benefit of another year in the ED is I got to become familiar with a lot more procedures and help out with a lot more than I did in the previous year. These are skills and experiences that will aid me well when I start taking classes.
    • More than once I got to listen in as an attending gave an in-depth “lecture” to a resident or med student. Also very valuable!
  • I definitely cut back on my IT consulting. My largest client and I mutually agreed to part ways as of April 1st. This was refreshing in many ways, even if the drop in income was noticeable. Ironically enough, they approached me just before Thanksgiving asking if I was available part-time starting in January. I’ve agreed to pick up some more time with them. This will most likely result in me cutting back some hours in the ED, but as I don’t need to built my resume there, I think it’s financially it’s a wise choice.
  • Work on me and be a better person – I was intentionally a big vague here, but I think I managed this a bit. I definitely tried to relax more and snap less. I’ll continue to work on that.
  • Hiking – I absolutely failed at this. I think I did one hike this year.
  • Biking – I also absolutely failed at this. Honestly, I’m not sure if it’s a result of age, perhaps some long Covid impact lung capacity (though I’ve never tested positive for Covid) or what, but I just found it harder to do the longer rides I preferred doing, especially at the speed I wanted. I also think the fact I was working nights and sleeping days didn’t help.
  • Caving – Ironically, despite having the NCRC weeklong in NY this year, I didn’t get into caves much this year. The best part was taking a local reporter into a local cave during our mock rescue.
  • See friends – Again, with my schedule, I didn’t do as much of this as I wished. And tonight, when normally we’d have a lot of folks over, I’m self-isolating because of a cold (not Covid thankfully).
  • Travel – this is one that Randi and I did manage to do! We flew out to Seattle and stayed with close friends for a night before boarding the Empire Builder for Whitefish Montana. There we disembarked and spent 3 solid days exploring Glacier National Park. Let’s just say 3 days is not nearly enough. When done we took the Empire Builder from Whitefish back to Chicago where we stayed a night at a hotel and then flew home. I’m already trying to figure out how to get back!
  • Septic system – Let’s not talk about this.
  • Several Projects around the House – well, just one, but it took finally biting the bullet and getting a table saw. But I think I’ll work on a few more before moving away for PA school.
  • Classes – I did take one more. If I had more time I might have taken more, or had I not gotten into a PA school I might have taken more to help with my transcript, but decided to focus the time on relaxing and working nights more.
  • Blogging – well I did blog, and as promised, not as much. So I guess I succeeded on that one.

So overall, us usual some hits, some misses, but the biggest hit is one I really was working for, so I’m content.

57 and 1

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I’m a day late on this blog, my usual day is Tuesdays. And my birthday fell on Tuesday this year. So you’d think I’d have written this yesterday, but, well I guess I just didn’t feel like it.

The honest truth, for some reason, my 57th birthday was a bit of a mixed bag, and I’m not really sure why.

It started off fairly well. My daughter continued her tradition, since attending college, of calling me just before midnight so she can be sure to say Happy Birthday at midnight. (Technically my wife wished me happy birthday before she went to bed, but that was before midnight, so my daughter wins on the “first on my actual birthday”). My son then came up to my office wish me a happy birthday. And finally the next morning my wife was the third to wish me one.

And of course all the Facebook posts that came in. I really appreciated those. Though, despite trying this year in advance to setup a charity (which in the past has worked well to raise money on my birthday) again, it just didn’t show up. I’m not sure if Facebook changed how they did birthday charities or what. I suppose that’s one reason my birthday was a mixed bag to me. I wanted to spread a bit more joy and didn’t.

But really, I think part of it is, my birthday is a bit of a reminder of something I realized several years ago: statistically I have fewer days ahead of me than I have behind me. That bothers me. I don’t fear death per se. It’s part of life. It’ll happen eventually. And I’ve certainly seen enough of it at work lately. But damn it, I’ve got so many things I want to do! I need multiple lifetimes to do even 1/2 the things I want to do.

And it’s not only lack of time, but the fact that I’m seeing my body age. Yes “age is only a number” but in this case that number is 57 and I notice it. For example, wounds, even as simple as a scratch take longer to heal. My stamina has slowed down. And well, as any guy can say, their refractory period at this age, even with drugs, isn’t like what it was 40 years prior!

There were definitely some nice upsides though.

One was an unexpected gift: an email from the PA school I’ve been accepted to with an academic calendar, so I can start to plan my life in 2025 and 2026 (hint, not much time off).

And then my wife and I joined coworkers at trivia night (and folks, while I was 100% wrong about the USS New York, I think their answer was “wrong” too (in the sense that they made an assumption based on its later historical significance)) and had a lot of fun at that.

So overall, my birthday was fun, but I don’t know. Perhaps the weather didn’t help. The thoughts of aging, who knows.

And 57 is sort of an odd number. I mean it’s not a big milestone like 60 or something.

I don’t know.

But here I sit, at 57 years and 1 day thinking about life.

But not for too long because I ended up deciding to go into work last night and picked up an 8 hour shift. And then sat in on a lecture on poisonous mushrooms given by one of our attendings. So… on my 57 and 1… I’ll spend most of the daylight hours sleeping!

Tools

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One thing that makes humans rare among species is our ability to shape and craft and use tools. This was on my mind last night as I went to bad.

A couple of years after my dad died, I wrote a post about using his Milwaukee right angle drill. I still have that drill and while I rarely use it, it still brings back memories.

Yesterday I added a new tool to my toolbox. Well, to my set of tools: a portable table-saw. When I first moved into the house, decades ago, my dad gave me his old table-saw as he had upgraded to a much heavier duty one so he could build cabinets and the like. When he passed, I decided to keep the larger one, but had no place for it, so I gave it on “permanent” loan to a friend who went above and beyond the call of duty to help me during my dad’s illness. He had the room I didn’t.

In the meantime, I had gotten rid of the original one, for a variety of reasons, including that it had some bad memories. You see, back in my senior year of high school I was using it to cut some cedar shingles and it kicked back on me. I’ll be honest, I’m lucky to still have all 10 fingers. And that’s in part because of receiving some sutures at the local hospital.

As for the new table-saw, it had been on my bucket list to obtain for awhile and I finally bit the bullet and bought it on Sunday, assembled it yesterday and used it to start finishing some projects that really needed what a table-saw can offer. And so far, I love it. It has a number of safety features my old saw didn’t and it’s much easier to adjust. I think it’ll be a very useful addition to my toolbox.

But I wasn’t done with saws with with memories of my dad’s tools. Turns out I needed to cut out a notch in the piece of trim I had just cut on the table-saw. There’s no real safe way of doing all the necessary cuts on a table-saw. But that’s ok, I realized I needed a coping saw, something my dad had. Sure enough going to his toolbox in the basement I found it and got my cut started. (I’ll admit I cheated for the rest, once I had enough started to fit a jigsaw blade, I used my jigsaw to finish it.)

But I want to circle back to sutures. One of the skills I’ve watched a lot of in the ER is doctors and PAs putting in sutures. The overall mechanics didn’t seem complex, but I wanted to get in practice before I had to PA school in May. Fortunately one of my members of the Council of Moore was able to set me up with some of the items needed. A quick shopping trip on Amazon got me a practice suturing pad. I’ve had the items for a couple of weeks, but finally last night decided to pull them out and pull up Youtube.

And I was right. The hand motions are just as I thought. Pierce the “skin”, rotate the wrist to drive the needle through, pull the suture mostly through, wrap the suture twice around the needle driver, grab the end pull through and voila, the first knot.

Or so I thought. My suture kept unravelling. I watched more videos, they all showed the same thing. I was baffled. I kept trying, suddenly I had something that looked right and didn’t slip. But I had no idea what I had done, so I didn’t count that one.

After getting fairly frustrated I decided to hand-tie one to see confirm what it should look like. That was easy. Back to using the needle driver. No luck.

Then it hit me. While the videos talked about wrapping in two different directions, clockwise and counter-clockwise, there’s really two other directions! The first, which is what I had been doing was wrapping the suture with the tip of the needle driver pointing towards the wound (and hence the free end). The second, was angling it the other way so effectively the tip of the needle driver is towards the needle end of the suture. It’s subtle but once I did that, I was able to create the knot I wanted.

The clockwise/counter-clockwise comes in when tying the knot twice to ensure it’s correctly tied (strictly speaking it’s what’s called a surgeon’s know which is much like a square knot, but with an extra wrap on the bottom half.

I’ll admit I’m still working on getting this part right, lest I end up creating the surgeons knot equivalent of a granny knot. But that’s honestly a minor issue and one that I’ll soon solve with muscle memory.

There’s obviously a lot more to learn about suturing, but getting this part down is a huge win for me.

So in one day I’ve come full circle, from a table-saw, to a coping saw, to a suture. But this time the suture was simply practice by me, not necessary on me.

One last comment: my statements above are not endorsed by my employer, Albany Medical Health System nor do they reflect the views of my employer.

Another Regret and Another Milestone

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I blogged a few weeks ago about a few regrets I’ve had since leaving behind being a DBA but I was reminded of another just over a week ago. It’s an event that combined two of my favorite things: SQL (or more accurately #SQLFamily) and trains! And that’s… SQL Train!

No, it’s not a new Microsoft product or something. It’s an event when a bunch of SQL DBAs and others take the train from Portland Oregon’s SQL Saturday event up to Seattle in prep for the PASS event. So you already know it’s a great group of people. And of course I love riding Amtrak and that’s one segment I haven’t ridden yet, so I would have enjoyed it. It’s something I have been meaning to do for years but never got around to it. That said, I’m sure if I showed up in a future year, I’d be welcomed by my SQL Family, it’s how they role.

That said, this weekend I did something new: I acted in a movie. Technically it’s not my first, but it’s by far the most involved I’ve been. A bit of acting, my daughter is in her senior year of film school and needed a “dad like person in their mid 50s” for a role. After not being able to find someone local to fill the role, she asked me. This involved me leaving work at 3:30 AM Friday after my shift ended, driving a bit, napping for several hours, getting gas, a bit more of a drive, napping again, driving, getting some food, I finally showed up on set. Total, I spent about 6 hours on set on Friday, and 10+ hours on Saturday and 8+ on Sunday.

I’ll admit between short notice (less than a week) and little time (5 12 hour shifts in that week) I wasn’t as prepared as I’d like, but I managed to get most of my lines right.

I’ll say this, as much fun as it was, I do hope I’m a better PA than I am actor! I’m not about to give up my night job.

And that’s it from here this week.

Two Years in the ED

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It’s been two years since I first walked into the ED as a tech. It’s been quite the ride.

For those who haven’t heard or read the story of how I got into the ED, Next Steps tells the tale. Even after getting the job, I was trepidatious. It wasn’t long before I decided I was definitely in the right place. And now I’m even more convinced that I am.

My original hope was that I’d be in PA school by now, but honestly, the extra year has been worth it. There are several reasons. For one thing, I’ve gotten a lot better at being a tech.

It also has given me the opportunity take over and teach the “Tech in Trauma” class required by all techs before they can become red-badged (meaning they can be the lead tech on traumas). I’ve also spent a lot more time assisting in procedures, including providing traction while the orthopedic doctor set a femur, suturing, even being part of a thoracotomy. While I wasn’t the ones doing the main work, simply observing such stuff has helped me to learn and will be invaluable once I start my clinical portion of my education.

I also, once I was accepted, decided to take an additional step at ensuring my success. Like the days of old when a monarch might assemble a Council of War to advice them for upcoming battles, I’ve assembled a Council of Moore. I asked three people in the ED that I have a lot of respect for, one of the attending, a PA, and one of the assistant nurse managers to be part of my Council of Moore. We’ve had one meeting already where I was able to get some good advice and as I go through the next two years I’ll be relying on them for advice, feedback, criticism when necessary and even a wee bit of cheerleading. Had I started PA school a year ago, I doubt I would have taken this step, much to my detriment.

When I started working in the ED my goal was at least 1000 hours of patient care experience, because that’s the minimum of what most schools I was applying to required. At this point I calculate I have approximately 4,500 and will have well over 5,000 by the time I start school. It’s been long and tiring, and some weeks I’ve worked 60 or more hours in the ED, but it’s been oh so worth it.

So here it is two years later and I’m still going strong and raring to start PA school come next May!

One last comment: my statements above are not endorsed by my employer, Albany Medical Health System nor do they reflect the views of my employer.

All’s Quiet on the PA Front

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I can’t believe it’s been since July that I’ve made a blog post. That’s two whole months of not posting. There have been multiple reasons, including laziness on one hand and being too busy on the other. Looking over my work calendar I’ve worked a number of Monday night overnight shifts, which means I’ve simply been asleep during the time I’d normally be posting on Tuesdays.

At the start of the year I picked up a lot of extra shifts, in part to ensure I had more patient contact hours when applying to PA schools. That obviously paid off. Since then I’ve picked up shifts for the extra money and experience and honestly because some nights we’ve been short-staffed and I’ve felt like helping out. One of the benefits of picking up shifts on short-staffed nights is that I’m often in the A-Zone which is not only where the traumas come to, but also where the tech desk is next to the provider desk. This, for me, is the real benefit. I learn a lot this way.

For example last week, both the attending and the lead PA that night had students following them. And in good Socratic fashion, they took time out to further their students education. Since these were slow nights, this meant I was able to listen in and even participate. As a result, I got basically graduate level lectures on hyperkalemia and pain management. That’s pretty cool.

I also in the last month was able to take advantage of some time schedule and visit the campus of the PA school I’m currently planning on attending. It was both exciting and a bit of a letdown. The letdown is because (and this is typical of a number of programs) it’s not on the main campus of the associated university and is basically in an office building. So much for that ivy covered wall experience. That said, I’ve had that, so that’s ok. But it was definitely exciting because I was able to stand in the classrooms and lecture halls I’ll be in in about 8 months!

I still wake up and have to pinch myself and say, “did I really get in?” I’m in a number of Facebook groups for prospective PA students and it’s heartbreaking to see some of the posts as they list their rejections and the like. I give advice where wanted and condolences where appropriate. There are also the successes which are nice to see and to give congratulations on.

But at this point, PA school itself is 8 months away. I’m thrilled and nervous!

Second Down Payment

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I mentioned a few weeks that I had been accepted at a PA school. I won’t lie when I say that sometimes I lay in bed and think, “did I imagine that? Perhaps I read the email wrong!” I even went back and reread the email at least once, if not twice.

But since then three events have reinforced that I’m in. Last week the first down payment had to be submitted by midnight Tuesday night. I got out the credit card, went to the webpage and submitted my information. First deposit accepted. I figured they wouldn’t take my money unless they had accepted.

Later in the week there was a scheduled Zoom meeting for accepted students. At that point it was really sinking in. I mean they wouldn’t invite me to such a meeting unless I really was accepted, right?

The Zoom meeting was interesting, and being a good student, I did take notes. I don’t think there’s a quiz later, but I figured it’s better to be safe than sorry.

And just this morning I whipped out the credit card again and made the second down payment, also accepted.

I mentioned in my earlier post a concern about the school’s accreditation status. But two things have allayed my fears. The first is a practical manner. The way the review process works, if the worst case scenario happens, it would be only a month into the program and I’d work to get my money back and still have plenty of time to resubmit to other programs if I really wanted to try for a third round. Though I’d probably want to retake some undergrad courses to help my GPA.

The second is a more nebulous reason. I managed to find some forums for students in my cohort and some had contacted current students and their thoughts on the current probationary status was that the school in fact was making good progress in fixing the cited deficiencies and they all had great things to say about the program.

So, that makes me feel far more comfortable and prepared to stay the course and attend this school. For now, so that I don’t influence any potential recruiters at other schools (yeah, right, like they’ll read this!) I’m keeping the name out of my posts.

But, I’m getting more and more used to saying, “Yes, I’ve been accepted and will be a PA student next year.”

So yes, I’m no longer Schrödinger’s PA. I’m accepted and will be a PA student next year.

Coming up… more self doubts…