Category Archives: ED Tech

Half-way, Quarter-way, Some-way

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Most of the members of my PA school cohort are in a group chat. It was in this chat I received one of the better messages lately: “Today marks the halfway point of our didactic year!!” Now, this is a two year program, so it also marks approximately the one-quarter mark of our progress (the schedule for the clinical year is a bit more complex). In either case, it was a nice landmark to reach, especially considering that in 9 days we had 5 tests. And of that 9 days, 2 were the weekend. Of the 5 tests, 3 were, at least for me, particularly difficult. I passed all of them, one just barely. So it’s fair to say it’s been a particularly stressful part of the semester. Now it’s Friday night and I’m relaxing and starting to plan out how to finish up the rest of the semester.

I mentioned in a previous post about life being on hold. And often I still feel that way. I’d be lying if I said there weren’t times I have doubts about continuing on for the next half or three-quarters. It’s not about the grades. While I’d like to be doing a bit better, the truth is, based on what my professors tell me and what I’ve read, I’m well prepared for my clinicals next year and for eventually passing the PANCE. I rarely have doubts about my ability to get where I want to go.

What I wonder at times is a more existential question: Is it worth it? I’ve reflected upon this a bit in the past. I’ll be 59 by the time I become a PA. I know I’m going to enjoy it. But, for how long will I enjoy it? How long do I need to enjoy it to make two years of my life and over a $100,000 worth it? In terms of economic investment, while I haven’t done the math, I think if I had simply continued as an ED Tech for these two years and then three additional years and retired at 62 I’d be better off financially. In terms of time committed to something, I certainly could have worked far fewer hours in IT than the time I’m spending in school or as an ED Tech and come out ahead financially and in terms of leisure time.

So, unlike my classmates, who statistically will spend much of their career as a PA, I’ll spend perhaps 10 years as one. In terms of finances, it’s probably not the greatest career choice this late in life. In terms of work-life balance, at least for two years, it’s definitely not a great choice. I have no real work-life balance for now.

But you know what? Even with those doubts, I’m still confident I’m on the right course. I really enjoy medicine. While sometimes I’m frustrated, especially about pharmacy, I enjoy what I’m learning. I enjoy the problem solving that goes into making a diagnosis. I enjoy the work I know that will be involved. It will be worth it.

I’ll have my doubts at times. I’ll have the exams I’m sure I’m about to fail and I might even fail one or two (several professors have told me, “everyone fails at least one exam in PA school, I did.”). But I’ll get there. I’m half-way through the didactic year and about one quarter of the way through the whole process. Some way, I’ll finish it and be able to add PA-C after my name. I can’t wait.

“Remote DBA Wanted”

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Since I have not really deactivated or updated my LinkedIn profile, I still get emails and the occasional text tempting me with a job offer of some sort. And as I sit here, trying to contemplate my study plans for the night and weekend, I have to say the idea of responding to one of them is appealing. For one thing, the money would be far better. Instead of burning through savings, I’d be building savings back up.

But the truth be told, that thought is only a fleeting one. Firstly, I’ve been away from active DBA work for a couple of years now. I’d have to take time to come up to speed and that would be stressful in and of itself. But also, ultimately I suspect I’d be bored or frustrated again.

And there are definitely nights I miss working as a Tech in the ED. Yeah, there were shifts I hated, but overall I enjoyed it. However, I’ll still pick up some over holidays over the course of the next year. That should sate some of my desire.

My biggest doubts come on nights like tonight where the doubts creep into my head. One of my classmates has tracked how many tests and quizzes we’ve had and the approximate number left in our didactic year. I don’t know the number, but it’s up there. Each one brings a new period of stress. And of course, after our didactic year comes our clinical year, 10 rotations, 4 weeks each. Not only will I be stressed about each area I’ll be assigned to, I may often have to figure out housing for that period of time (and how to pay for it!)

But I remind myself, that it’ll be worth it. That the ED is where I want to be, and while I think I’ve done a lot of good as a Tech, I hope to do even more as a PA.

But those regular hours, and higher pay, they are tempting. Just not like they used to.

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.

It’s the End of the World as We Know It

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And I feel fine…

Ok, that’s not quite true. It’s actually pretty bittersweet. As I’ve written in my last few posts, my last scheduled shift was last night. I said farewell to many people. Actually all week it’s been series of goodbyes.

Sunday was my second to last official shift. But even before it was over, I had already planned on picking up a shift Monday night. The ED was short staffed and I figured I’d take the extra money and also help out. I mention that because I knew that one of my fellow Techs, Mike S. had been planning something for my final shift last night.

So I was a bit confused when my ANM (Assistant Nurse Manager) came to me around 6:00 AM or so and whispered in my ear, “I’m going to need you for a special huddle.” I was a bit confused, but thought perhaps she was going to privately say good-bye or give me some final words of wisdom.

Around 6:45 I took aside the orient I had that night and told her she was going to give the report to the incoming tech and asked her what she was going to present. I’ve done this dozens times as part of a new techs orientation, especially when they’re about done. Well, it’s a good thing I did since at about 6:58 the ANM came and practically dragged me by the elbow, “we’ve got to get to huddle.” Now I was completely confused. I couldn’t figure out why it was so important I get to huddle. That’s generally only for the incoming shift and the only folks who brief is an ANM or the person taking over as Charge Nurse. In any event, my orient ended up giving the hand-off report without me and did great.

Well imagine my surprise when I walked in and saw a table full of donuts and bagels and folks congratulating me. All I could keep saying was “but I have two more shifts!” I was at first a bit embarrassed, partly between the attention being given me and the fact that I felt it was a bit premature. But by the end I’ll admit I was on the verge of tears. It was a very touching moment.

Last night, despite it not being a surprise, was also very touching. While I greatly appreciated the day shift send off, the truth is, most I hadn’t worked with much or if I had, it had been well over a year ago. The night shift send-off though; I knew most of them very well. We’ve done battle together. We’ve broken bread together. We’ve staved off death together. And sometimes, we’ve mourned together. They’re my ride or die crew. So having a chance to celebrate with them was extra special to me.

Some of my night shift ride or die crewmates

Besides the food and music though, I was looking forward to one more tradition afforded folks leaving. The picture in one of our trauma bays.

Nurses, doctors and techs sitting in a trauma bay.
Part of the Night Crew giving me a silly send off

After the photo in the trauma bay, we received a Level 1 trauma that took me the rest of my shift to help with, including getting them to the OR. It was a sad, but somehow appropriate way, to end my shift.

The part that meant the most to me tonight were the well wishes and votes of confidence from my colleagues. In a few short weeks I’m going to embark on what’s probably going to be one of the hardest, prolonged challenges of my life, and it really meant a lot to hear so many people saying positive things.

Yes, I’ll pick up a few shifts over school breaks, but it won’t be the same. This was the end of an era. Over 5,500 hours (by my best estimate) of working as a tech. I’ve learned so much and made such friends and gained such mentors. So I walk away a bit sad that I’ll miss working with such great people on a regular basis. But also extremely excited about my new challenge and honored that such folks have such faith in me.

And as always, my views and thoughts do not reflect those of my employer Albany Med Health System.

Reflections on Being an ED Tech – Some of What I’ve Learned

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As PA school quickly approaches I’ve been reflecting a lot on my job as an ED Tech over the last 2.5 years. I’ll probably end up blogging a few times on this topic.

My first official day working in the ED (as opposed to the orientation I underwent the week previous) was on October 18th, 2022. Most of the PA schools I applied to required a minimum of 1000 hours of patient care experience. Obviously more was better. I hit that in under 6 months.

I’m now at over 5,500 hours I believe. I honestly stopped counting awhile ago. In the past 2.5 years I’ve worked a LOT of extra shifts. And for the most part, I’ve loved it. Yeah, there are the shifts where I’ve been given an assignment I wasn’t keen on, or the shifts that I went home from emotionally drained. But overall it’s all been worth it.

At some point I might talk about the specific skills I’ve learned. But the most valuable thing I gained was “my voice.” Anyone who knows me, knows that in general I don’t have a problem sharing my thoughts (as this sometimes self-indulgent blog is proof of). But the difference in my confidence between that first shift and now is stark.

On my first shift, heck my first hundred or more shifts, I often followed the lead of others. There were multiple reasons for this, but basically it came down to two: they had the credentials and they had the experience. Related to this, they didn’t know me so they couldn’t necessarily trust me.

I’m proud to say, that has changed. I still don’t have the credentials, but I now have the experience, and they know me and trust me. One example is the language I’ll use at times. One night a nurse went into one of the trauma bays to grab a bag of saline. Now there are signs that tell folks not to do this, but I’ll be honest, it happens. Two years ago I might not have said anything or if I did, it would have been phrased, “Oh, you took something out of the trauma bay? I’ll make sure to restock it.” This time I said, “Oh you took something out of my trauma bay? I’ll have to make sure to restock it.” Yes, it went from “the trauma bay” to “my trauma bay.” I realized the more I worked on the trauma side of the department that I was taking ownership of things like the trauma bays. I take pride in making sure they’re ready for a trauma. This pride means that a few weeks ago, when in the middle of the trauma a nurse reached for an item and it wasn’t available, my stomach dropped. I felt like I had failed them, even though honestly this was I think the third trauma in a row in that bay and I had had no time to stock. No one blamed me or even looked askance at me. But I still felt like I had failed. So yes, when I’m working in that zone, the bays became “mine” in the sense I took pride in making sure they were setup.

Another example is my interaction with the providers and nurses. When I first started, I would always wait for their cue on what to do outside of the most basic expected skills. Now, I’m far more likely to make a suggestion or be expected to contribute. A few months ago with a patient with several severe bleeding wounds, I was the one that suggested to one of the providers to use a clotting agent we keep in the trauma bay. He wasn’t aware we had it, let alone how well it would work in this case. Fortunately between taking a Stop the Bleed class and being responsible for stocking the trauma bays, I knew it was there. Recently, one of the nurses asked me to show her and a couple of others how to set up a particular piece of equipment based on the manufacturer’s instructions. I’ve earned the trust and confidence of my coworkers. This is an amazing feeling.

I want to add one key note to this. I’ve said before and I’ll say again, one thing I really appreciate about where I work is that it’s a teaching hospital. I basically sat in on a graduate level lecture on pain meds given by one of the attendings to a med student one night (it was a slow night so I had time to stand around and listen.) The attendings, especially a few in particular I work with, encourage questions. This has been invaluable. “Hey why did you do X? Would Y have worked?” I’ve learned a lot this way.

So it turns out, not only was being an ED Tech the right thing for me, I’ve learned a lot and absolutely loved it. Who knows, maybe I’ll write a book someday about it. In the meantime, just one more shift before I head off to PA school.

And as always, my views and thoughts do not reflect those of my employer Albany Med Health System.

T-12 hours and Counting

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I’ve been counting down my final shifts for about a month ago. You’d think it would be easy, but it’s a bit harder than you think. Officially I’m what’s known as a .6 FTE (Full Time Equivalent). This means I’m scheduled for 24 hours a week (i.e. 60% of a 40 hour work week). In reality, I pick up a LOT of extra shifts. I’ve done this for three main reasons:

  • To get into PA School I needed a high number of Patient Contact Experience hours.
  • I get overtime pay
  • Often times the apartment is very short-staffed and well, I can help out and get the above benefits.

So, even two months ago I could easily say, “Ok, with my vacation. I have X number of shifts left.” But like how NASA countdowns don’t proceed uninterrupted or without changes, my countdown had its own changes and interruptions, including picking up more shifts.

So, I had a rough idea that when I had say 8 official, scheduled shifts left, I likely had 12-16 total shifts left.

So barring any changes, Thursday is my last shift as .6 FTE ED Tech.

Note I tossed in the .6 FTE. That’s because for a few reasons I applied for and was accepted as a “student” track tech. This means during my few breaks from PA school I’ll be able to pick up a few shifts. But I won’t be picking any up right away. Between Thursday and the start of school I’ll be finishing figuring out where I’m living, packing, finishing some projects about the house. So Thursday is it for awhile.

But honestly, I’m ready to move on. I’m excited and nervous. I’m also a bit sad. I will miss working with so many great people and having such an impact on the lives of people.

So, “We are at T-12 Hours and counting.”

Day 15 – Reentry!

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Spaceflight has shown that reentry is the most dangerous part of a flight. More people have died on re-entry than during launch. And even in uncrewed flights, there have been a lot of mishaps on reentry.

My reentry to normal life didn’t really have the risk of a fiery burn-up, though, had I not gotten enough sleep, a fire and crash was distinct personality.

After leaving my friend’s house I drove for another hour or two before getting some food and then eventually some sleep. I ended up pulling over at two separate rest stops to nap. The final time I woke up around 9:00 AM. I had hoped for an earlier start since I was still about 9 hours from home. But obviously my body needed the sleep.

There’s not much to report on the rest of the drive home other than I was struck by how green things were in the Northeast. Partly this was due to it being Spring and in the weeks I was gone a lot had bloomed. But also, I had been in the desert for so long which is a lot of reds and oranges and whites and grays, but very little green. The contrast was striking.

But the danger was a bit more subtle. It’s one thing to basically spend two weeks with no schedule and no responsibilities. It’s another to return those things. Here it is Saturday, and I’m still catching up. Laundry is done and half the car is unpacked. I’ve still got more to go. That said, it’s not like I haven’t been doing things. I spent most of yesterday dealing with paperwork related to starting school in a month.

And as strange as it sounds, Wednesday night/Thursday morning, I picked up a 4 hour “princess shift” in the Emergency Department from 3:00 AM to 7:00 AM. Based on the texts requesting help and looking at schedule, there were only 3 other techs scheduled so I knew they could use the help. I figured my sleep schedule was already messed up, so another late night/early morning wouldn’t be a problem. And honestly, it sort of helped me reenter my normal life.

At this point I have four regularly scheduled shifts left before I stop working as a .6 FTE tech. I will probably pick up one or two more during that time. But the time is quickly coming when I’ll be in that transition from working to schooling. I’ll have a couple of weeks to finish up projects around the house, sign a lease on a place in Delaware, and to move enough down there to setup housekeeping. So, my reentry is just a pause before the next journey. But I think I’m ready now.

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!

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.

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.