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.

PAs Under Pressure

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Now that the reality of being accepted to Physician Assistant school is settling in, I’m more and more convinced I made the right decision. This was reinforced the other night when I was working.

The attending mentioned it and one of the more senior PAs turned around gave a hearty “Congrats” and offered me a high five. This definitely helped my ego. But that wasn’t what really drove home my decision. It was later that evening.

A trauma patient came in. During a trauma there are a number of people in the room, one or two techs, one or more nurses and generally at least three providers. One of these will be a doctor, but the others are sometimes PAs. This patient came in somewhat stable but her condition quickly got worse. The decision was made to intubate her.

It was at this point I realized in addition to the attending doctor for the zone the other providers in the room were all PAs. The attending was supervising and monitoring, but otherwise the PAs were calling the shots, including performing the intubation and putting in what are known as a central line and an arterial line.

They rocked it.

My goal is still to be a PA in an emergency department (ideally to come back to where I currently work as a tech.) Above is part of the reason, because the PAs here are very important members of the team and once proven themselves, can do a lot.

But, it’s not just traumas. One might call that the most “sexy” aspect of working in the ED, but the honest trust, they end up spending far more time with the patient with a dislocated shoulder, or counselling a patient on why they should take their meds, or a million other smaller medical interventions. They fill in a lot of gaps and have a lot of close patient contact. I’m looking forward to that.

But hopefully the day will come when I can feel as confident as the PAs I currently work with so that when the trauma comes in, I can rock it like they did.

As always, the above views are mine only and do not necessarily represent those of my employer.

“Regrets, I’ve had a few…”

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With apologies to Frank Sinatra.

Last week I was reminded of one of the few things I missed out on my IT career. A number of friends and colleagues posted about how they had achieved or been renewed for their Microsoft MVP status. It’s one achievement I never obtained.

Let me be clear, I’m not bitter or upset. The honest truth is, I never really worked hard at achieving it. So to me it’s most like seeing friends making the Olympic team and wishing I was there but also recognizing that they worked at it and earned it while I really didn’t. So this is on me. And I’m VERY excited and proud for them. They’re amazing people and they deserved it!

But, with my career change, I’m even less likely now to make it. And… I’m ok with that.

One thing that I’m finding remarkable to me about this career change is how few regrets I’m having. I’m reminded all the time it’s the right move. I was tired of IT and tired of data.

But, the one thing I never tired of was the community, aka #sqlfamily. Honestly, this is what probably what kept me going the past few years: being part of such a community. Let it be said, the #sqlfamily is an amazing group of people: they mentor, they teach, they push the state of the art forward, they make everyone better. I’m a better DBA and IT person because of them.

In fact, in a way, I’d say #sqlfamily probably gave me the inspiration and courage to move forward and change careers.

So regrets, I’ve had a few, one being perhaps not working hard enough to earn an MVP, but meeting, getting to know, and loving my #sqlfamily, I will never regret.

Schrodinger’s PA

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Those familiar with quantum physics know the idea of Schrodinger’s Cat. It’s a thought experiment that posits a cat in a box is in superposition of being both alive and dead until it’s observed (and to be clear, it’s BOTH alive AND dead, not simply alive OR dead until observed.)

Until recently, my PA status has been sort of in a similar state. Until I received notification from a program, I was both “accepted” and “not-accepted”. And this week, the quantum value collapsed and, I’m still both, but in different programs.

Not-Accepted

First, the program I wasn’t accepted into. I won’t give out its name for my own personal reasons, but let’s just say it was my top choice. As many of you know, one of the problems I’ve been trying to overcome in my applications is my poor undergraduate GPA from 34 years. This was a program that on their website said they didn’t have a minimum GPA so I was hopeful. Last year when I was turned down I wasn’t entirely surprised because most PA candidates get turned down their first time around and I barely met the threshold for patient contact hours and honestly, while my letters of recommendation were from folks that I knew would say good stuff, they had limits in how well they knew me.

So I was more hopeful this year, a slightly improved GPA (with more post-bacc classes taken) and far better references and a lot more patient contact hours.

I have to say, I was a bit surprised when I was denied again. Not so much that I was denied as much as how quickly it happened, less than 24 hours between my application being complete and being rejected. Last year it took a week.

This time I decided to reach out to the program director. Unfortunately that didn’t really make a difference. It turns out that despite their website claiming they don’t have a minimum GPA, in practice, they basically admit to having one.

But that happens.

Accepted

However, just over a day after exchanging emails with the director of the above program I received an acceptance letter from another program. I have to say I was quite excited.

So now I was non-accepted officially at one school and accepted officially at another.

That said, there’s on small issue which is a concern. Any PA program in the US, like any respectable college needs to be accredited. A program can have:

  • Developing – Not accredited – just like it sounds. They can’t matriculate students. This means one can’t take the program and then take the PANCE (Physician Assistant National Certifying Examination). So this is an absolute no go for me.
  • Provisional – Generally new programs that don’t have much of a history. This could be a program that has developed everything, but is still being observed. One can attend and graduate and take the PANCE. However, it’s not clear how good of a program would be because of its lack of histroy.
  • Continued – This is the gold standard. This is what you want to see in a program. This means it is meeting the standards required. Odds are very good that you’ll matriculate and pass the PANCE on your first try.
  • Probation – This can be problematic. The accreditation body has found problems. Programs have two years to fix this. If they succeed, great. If they’re making progress, they can get a two year extension. If they fail to make progress, accreditation can be withdrawn. If this happens in the middle of you attending, this can be “bad”.

There’s other categories, but those are the important ones.

So why do I mention them? Because the program I was accepted into is in probationary status. I have to admit, this makes me nervous. On one hand, I’m in a program. On the other, there’s a chance it could disappear before I can qualify to sit for the PANCE. That’s a HUGE concern.

That said, right now, I’m most likely going to make the down payment and secure a spot in the program.

“But Greg, you’re crazy! That’s risky!”

Yeah, potentially it is, but I’m not overly worried. For one thing, the program is nearly 3 decades old. So it’s not like it’s some new program struggling. It’s hit a rough spot that they appear to be taking steps to overcome. The faculty and staff seem very confident, which is a good sign. The program itself has some very strong points (and admittedly a few weaker points). And from reading comments of students currently in the program, they are feeling very well prepared to take the PANCE. Their most recent PANCE pass rate was 98% for a first time taker. This compares to the national rate of 92%. I can live with that.

And while I have to put in a non-refundable deposit soon, it doesn’t mean I can’t later change my mind. For example if another program accepts me, and I like the program better (there are many factors that can go into such a decision, accreditation status is just one, cost of attendance, cost of living, facilities, etc. are others) I can forfeit the deposit. I’d hate to do that, but it’s an option in the back of my mind.

So, I’m now semi-officially a PA Student… at one place, waiting to hear from others!

A Certain Kind of Bravery

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One part of my job as a tech is to help with psychiatric patients. They may be checking in for a variety of reasons, but one that stands out are those who are checking in because of what is termed “suicidal ideations”. These are the folks who for whatever reason are having suicidal thoughts and afraid they may act upon them.

For such patients, we get them changed into hospital scrubs and then put them in a room where they can be observed. We’ll keep an eye on them until they are cleared by a psychiatry doctor. Basically we take away anything that they might use to harm themselves (hence no belts, sharp objects in the room, etc) and make sure if they do suddenly try, we can stop them.

The honest truth is, pretty much every patient I’ve had to do a “one to one” sit for has been fairly sedate. Generally by this point they’re calm and simply trying to purge the thoughts and waiting for psychiatry to take a look at them.

So why brave? Because society has a stigma against people committing suicide (a good thing in general I think) and it has a stigma against folks who express suicidal thoughts. This stigma can often reinforce the already negative thoughts in their head.

People with suicidal ideations have them for many different reasons, but often they feel a sense of worthlessness, “the world would be a better place without me” or “No one cares about me”.

And yet, they’re taking a leap of faith. They’ve come to us because they believe that “some cares enough to make sure I’m safe” and “the world is better with me still in it.” That’s brave.

Some sadly can’t find that bravery for a variety of reasons, or they’ve been brave multiple times, but the last time they couldn’t be.

But for those to do end up checking themselves in, I am awed that they are brave enough to make that leap of faith.

I’ll close by saying: if you or a loved one are having suicidal thoughts, please take a leap of faith and trust someone cares.

Call 988 – the national suicide hotline.

Or go to your local hospital and tell them you need help. They’ll help.

The world is a better place because you’re in it. Let’s keep it that way.

Back in the Saddle Again

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With apologies to Gene Autry, I’m back in the saddle again. CASPA, which is the Centralized Application Service for PA programs, opened up for applications for the 2024-25 round of PA school applications. I actually logged in last night, but there were no changes, at least as of 1:45 AM ET. So sometime between then and 10:00 AM today they finally opened things up.

So I’ve officially started the process for the second round of PA school applications. As loyal readers know, last year, my total was all “thanks for applying, but no” except for one school that waitlisted me. For various reasons I didn’t pursue that one very hard. While I had had hopes for being accepted last year (which would have meant I’d be taking classes now, or starting within a few months), the chances honestly where low. It’s actually pretty common for folks to take 2-3 attempts before getting in. There are a variety of reasons. So to play a bit on Arlo Guthrie’s words from Alice’s Restaurant Massacree, “Kid, have you rehabilitated yourself?” In other words, what’s different this time?

Well, my overall GPA is still an issue, there’s little I can do to completely fix that short of taking probably another 30-40 credits worth of classes. But my science GPA has improved and I’ve added a few more useful classes to my transcript that will help with a few of the schools I’m applying to.

Of course, as I mentioned some schools tend to want to see repeat applications, so I’ll be checking that box.

My patient contact hours are much higher. For the schools I am most interested in, the minimum number of patient contact hours was 1000 hours, I had barely met that last time I applied. Now I’m at over three times that number, with over 3000 hours under my belt. This also exceeds the mean average for most of the schools I’m applying to. I’m hoping this shows my dedication and interest. And as I’ve said before, the fact that it’s in the ED helps a lot because it shows I have a wide variety of medical experiences (things I’ve assisted in or observed first hand include several spinal taps, a thoracotomy, bone reductions, and more.)

And finally, better references. This isn’t to disparage my previous references; the people I had selected I have a great deal of respect for and I believe they share the same in regards to me (and at least one shared the letter of reference he sent on behalf and I was overwhelmed by his positive words). But this time around, with at least two schools, I will have far more targeted references, for example from graduates of their schools, so that tends to help. In addition, at least one professional reference is one that knows me even better than the reference I used last time. So, I’m hoping these references make an even bigger impact than last time.

I haven’t fully decided which schools I’m applying to this time, nor exactly how many, but the process is moving forward. There’s a few schools that are obvious choices for me, and a few that are on my no list this time around that were on my list last time.

But that said, this weekend (only because I’m starting a 12 hour shift in 2 hours and need to sleep tomorrow) I’ll be moving ahead quickly with the application process.

I’m excited and nervous!

Close Encounters of the Eclipse Kind

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One of the clips of a movie I like is from Close Encounters of the Third Kind, just before the alien mothership arrives at Bear’s Lodge (aka Devil’s Tower). “Is everything ready here at the Dark Side of the Moon?“

Well, yesterday everything was ready. In 2017 I had taken a bit of a leap of faith and driven all the way to my uncle’s place in South Carolina in order to observe totality. Despite thirteen hours driving southbound and I think close to twenty driving northbound (due to traffic and a nap) I decided it was totally worth it. Totality was unlike anything I had ever experienced before in my life. If you didn’t get to see it then or in 2024 (or any other time) let me tell you that there is a 100% difference between 99.9% coverage and totality.

So, with some last minute planning, Randi, Ian, and I were aboard Amtrak’s Adirondack yesterday, bound for Port Henry, NY. It appears we were far from the only ones who had decided to forgo driving and to risk potential tardiness (though we had a buffer of over an hour) and cloud cover (mitigated by fully refundable tickets). According to the conductor, 130 people were scheduled to get off Port Henry that day. In contrast, it appears on average, Port Henry has 3-4 people get off or on the train day. Amtrak apparently called the town supervisor a few days previous to let them know 150 people were bound there. Suddenly they were planning to do some stuff right near the train station, something they hadn’t planned on before.

Image of Amfleet Cafe car at concrete platform for Port Henry, NY train station.
The Adirondack, preparing to depart Port Henry, NY after dropping us off.

Like last time, the build-up was interesting, but also a bit boring. It’s not until you’re at over 50% coverage or so do you start to notice a dullness start to cover the land. It’s sort of like a cloudy day, but different in a way I can’t necessarily describe other than muted. This grows as coverage increase. We spent our time walking around, buying and consuming a pizza made in portable trailer based pizza oven (not bad, but I normally wouldn’t have paid as much for it as I did, but hey, I was hungry and it was supporting local business).

As 99% approached, we could definitely feel the temperature drop and now everything was really simply in dull colors. At that point, my eclipse glasses were basically glued to my eyes (with an occasional peak at the landscape around me).

White plate with a colander held above it, showing the Moon's shadow.

Then 100%: Totality. Glasses came off. People cheered and shouted. There was a hole in the sky where the Sun should have been. If you’ve never seen it, it’s bizarre. Literally where the Sun should be, is a dark black dot. It’s the darkest thing in the sky. It’s a bit unsettling.

I can’t recall if I saw it last time, but this time I definitely saw the Sun’s corona. When one considers who big the Sun really is, the eclipse drove home how far from it the corona can extend. I also saw, and confirmed with others, that I saw what apparently was a solar prominence. It had a very distinctive red color and for me appeared at about the 7 o’clock position on the Sun.

Then, just minutes after beginning I saw a flash of the “diamond ring” and put my glasses back on. It was over. We waited for our train, boarded, and once my ticket was scanned, I fell asleep. It wasn’t so much because it was anti-climatic as much as because I had just worked my standard 12 hour shift, plus 3 more the night before. (I literally went from work, straight to the train station).

I still can’t really put to words the experience, but I do know Randi and Ian also came away with the belief that the trip was well worth it.

I will just say this, if you ever get the chance to be in totality, do it. This is especially true for the folks I’ve heard about and say things like “well I was at 99.9%, that’s good enough”. No, it’s not. So, if you make plans to see an eclipse, get into totality. Yes, I get it, you might live or work at say 90% and decide “that’s good enough” and logistically it may be, but honestly, the closer you are to totality, the more worth the effort it is to get all the way. It’s not worth travelling from 40% to 60% but it is for 99% to 100%.

And here’s looking forward to the next North American eclipse in 2044, and perhaps ones elsewhere sooner!

Randi overlooking Lake Champlain
Randi overlooking Lake Champlain

My Inbox Today

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I posted Tuesday about the end of my contract with my largest client. One of the last set of steps I took was to take my email address off many jobs and alerts. The difference has been stunning and well worth it.

My inbox for my main business account is now down to fewer than a dozen emails a day. I apparently missed 4-5 alerts from my client that I’m getting cleared up, but other than that, now it’s emails related to other items.

Not only has this made my email box reading a lot easier and faster, it honestly has given me a lot of relief. For example, for the last few months of 2023 and the first two of 2024, there was an important job that started to randomly fail around 4:00 AM. If I was at work in the ED, I’d be stressed about getting home in time to rerun it (and to try to debug it). Fortunately I finally resolved that about a month ago, but still kept my eye on it.

In addition, there was another major server issue that would randomly occur with one of the VPNs. We hadn’t seen the issue in months, but I had been paranoid about it failing. Sure enough, I found out from a former coworker that it failed Sunday night for the first time since December. And my first thought was “well thank god it’s no longer my problem.” I mean I felt for them that they had to deal with it again, but it wasn’t anything I had to worry about. That was refreshing.

This morning, after a 12 hour shift in the ER, a bunch of us went out to breakfast. It’s the first time I could do that and not worry about having to get home in time for a meeting or needing to check email. Again, it was refreshing and relaxing.

I think I’m enjoying this so far.

A Door Closing

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So I’ve hinted a bit on some social media about a change. The change has come. I would have posted more details yesterday, but given that particular date, I didn’t want anyone thinking I was trying to do an April Fool’s Joke.

So the door closing is that as of March 31st, my contract with my largest client is over. This was actually a mutually agreed upon date. In fact, when my manager scheduled a meeting with me in December, I knew it was coming and expected he would want to end things in January or even perhaps December, so honestly, I was quite pleased to have the extra time.

That said, it was obvious to both parties that this was coming. I was spending less and less time on projects for them. This was due to actually a variety of factors. Strangely, a huge part of it was something that I hadn’t planned on: Grand Jury Duty. During the weeks I was on the Grand Jury, between that, the class I was taking and my ED Tech work, I had very little time left over to spend with this client, so they didn’t assign me any real projects at that time. But even besides that they had been using my skills less and less and I had been allocating less time to them. So, the end was inevitable.

And to be honest, I’m actually very excited about this. When I made the decision over two years ago to apply to PA School, it was driven in a huge part because I was tired of IT. I was also tired in part of having to learn new things in IT. Specifically, I didn’t want to learn who to do what I was doing in new ways. For example, the SQL Server world is moving more and more to Azure and other cloud providers. I’m actually in favor of this. But it’s really simply doing much of what I do in a new way. That’s not a challenge that excited me.

If I am to learn new things, I want to learn them in a new domain of knowledge. Becoming an ED Tech and eventually a PA is just that, learning new things in a completely new field. Some of my skills remain the same. One of them is my ability to solve problems. I’m just applying that skill in a new arena. This is exciting.

What’s also exciting is for the first time in over a decade, and ignoring two breaks, really since before the turn of the millennium, that I don’t need to be checking my email almost constantly. For a variety of reasons, most of my IT jobs over the past 3 decades have, if not required me to be available 24/7, at least highly encouraged me to be available 24/7. With my ED work, when I’m done with a shift, I’m truly done. No one is going to call me at home and ask me to log in and do an EKG on a patient. Right now my ED work is officially only part time, but I can pick up shifts, something I’ve been doing a lot. But on the flip side, I’m under zero obligation to pick up shifts if I don’t want to. The fact that I’m not on call and that I can pick up or not pick up when I want to is very liberating. I’ve been looking forward to this for awhile.

Another short-term change is that I don’t have to worry about trying to fit in client meetings with my currently highly variable sleep patterns. Last week for example, because of the shifts I picked up and one regular shift and my client needing meetings, I basically only got about 8 hours of sleep in a 56 hour period. I couldn’t get a solid “night’s” (since I generally sleep during the day because of the ED night shifts I work) sleep. I had to wake up and attend meetings. That’s over with.

And in some ways, there’s no going back. That’s not strictly true. My IT skills are still fresh and relevant and I have enough industry contacts that if I wanted to change course back, I could. But I don’t see happening.

Really the only downside is the change in income. Trust me, IT work pays a lot better than ED Tech work. However, fortunately we’re the point where total income isn’t as big as factor as it once was. Basically I can afford to “follow my dream” and we can still maintain our lifestyle. We’re fortunate that way.

So what’s next? Well later this month the application process for my second round of PA School applications begins. I’m much more hopeful this time around, though we’ll still have to wait and see. Assuming that’s successful, sometime in 2025, I’ll start a two plus year journey of again diving deep into learning with very little free time and I’m looking forward to that.

But in the meantime, I expect to travel a bit more, relax a bit more, work on some more projects around the house. Overall, I expect to simply enjoy life more.

And perhaps even blog a bit more than I have been.

Pride in my Work

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I was driving home from my work in the ER the other night and a thought passed through my head, “You know, I’m damn good at my job.”

Now this may sound a bit conceited and perhaps it is, but I went with it. The truth is, it applies to by my IT work and my ER Tech work.

Now, let me be clear, I’m not saying I’m the best there is. I’m not even sure I would say I’m great, nor would I claim I’m the best ED Tech there is in our department. I’m not even sure there is a single “best” since our job responsibilities are so broad. But I am damn good.

I’ve talked about my IT work and how some of my code is still running years later without any real issues. It’s not world shattering code, I didn’t write the next LLM AI code (and I’m not even sure where I’d begin on that) but it does its job and is solid. So I’d say I was damn good at my IT work. I’m a published author (though last year apparently my book sold zero copies according to my most recent royalties statement) and have several online articles to my name. I’ve also spoken at numerous conferences. I’m proud of my work. Yeah, there’s better folks out there in many specific SQL areas, but I’m still proud of what I’ve done.

Similarly, with my ER work, I’m at the point where I think I’m pretty solid. There’s one skill I definitely am NOT solid on (blood draws for those curious) but other than that, I look back at where I started over 3000 hours ago and I’m proud of where I am.

There are several reasons I like to think I’m good at my job. One for example is that I’m often the “go to” person. More than once a nurse or even doctor has told a colleague, “oh, go ask Greg, he’ll probably know.” Often this is in relation to where particular equipment or materials is stocked, but sometimes it’s on a policy or procedure.

I also appreciate the fact that in terms of general skills I have received positive comments.

Lately I’ve also been doing a lot of precepting new techs, something I very much enjoy and I like to think I’m good at (and based on the comments from more than one, they seem to appreciate my teaching). I also received a HUGE compliment from one of my managers who praised me for how I teach and what I was teaching. One of my real joys in life is to be an effective teacher and to have that recognized really meant a lot to me.

And, as I am about to begin the second round of PA School applications, I’ve had more than one of the provider offer to write a letter of recommendation for me. This also means a lot to me.

Now that all said, as I stated at the top, I’m not great at my job. I think anyone who starts to claim that is probably wrong and should have a close eye kept on them. But I think I’m damn good and every day I strive to be a bit better than the previous day and to keep getting better.

So I’m good, but every day, a bit better. I hope.

Ending an Era, Starting Another

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First, a quick update on my PA school applications. Another school reached out to me yesterday to say “Thank you for applying, but no.” There’s a longer story there, but suffice to say, I’m now down to waiting to hear from one last school, which is a super longshot, so at this point, I’m basically considering my first round of PA school applications over. (Astute readers may recall I’m still waitlisted on one, but it’s doubtful, even if I move to “accepted” I’d attend there at this point.)

And I’m fine with that. It’s very hard to get into PA school on your first round from what I understand. But more so, now, it gives me some closure for the rest of the year. Several events I had been trying to plan, but were in limbo lest this most recent school accepted me, can now be finalized. So, the no, while a bit disappointing gives me some certainity.

Meanwhile, another step in the process been moving forward, and that’s ending my consulting status with my largest (by far) client. This has been a mutually agreed upon process and if anything, my work with them extended longer than I had originally hoped or expected.

It’s a bit bittersweet though. For one thing, the money is pretty good, and that makes a difference when making my plans for school and other projects. But honestly, I haven’t been able to dedicate as much time to the client as I’d like because of my ER schedule and how much time I’ve been dedicating there. Most of the time I’m now working overnights in the ER. This client has required my time for meetings and other events during the day. This has meant a few weeks where I’m definitely sleep deprived for multiple days in a row. So while I’ll be making less money, I’ll definitely be getting more sleep. I think that’s a good trade-off.

It’s been clear to me for awhile, that the move to medical is the right one. This is evident in my paychecks as much as anything else. I honestly make about 6-12x as much doing IT work (depending on scheduled work or overtime work) as I do for my ER Tech work. This means I can easily work 2 hours of IT and then go into the ER and work a 12 hour shift and make about the same at each. Obviously, in general most of us would rather work the 2 hours than the 12 hours for the same pay, but I 100% enjoy the ER work more.

So, at the end of this month, I’ll be removing a number of scheduled ongoing meetings from my calendar. I won’t be checking my work email account nearly as much. I’ll sleep in a bit more. I’ll evolve my non-work schedule around my night shifts. And I’m good with that.

When I started working in the ER over 15 months, and 3100 hours ago, I saw it as sort of a “necessary evil” to get my patient contact hours for PA school. I wouldn’t say I wasn’t looking forward to it, but I definitely did not expect to enjoy it quite as much as I did. Fortunately I have. It’s reinforced to me that medicine, in some capacity, is where I want to be.

So, one era, IT is closing, and the other, medical continues to open.