To apply to PA School, one uses a common application called CASPA. Pretty much every PA school uses this platform for their applications. They also, for the most part follow a similar timeline, of allowing the application process to start on May 1st. My goal had been to have as much completed as I could by May 2nd, or barring that, May 31st. Well here it is June 20th and I’m still working on it.

It’s not for the lack of effort. Even though I finished up the prior semester, I was busy with a lot of other stuff and found myself travelling or working every weekend in May and the first two weekends in June. Between consulting and working in the ED work, I often find myself working 60 or more hours a week. So it’s not like I’ve been lazy.

Now, that said, many of the hours in the ED are actually hours I’m picking up to gain the experience and to expand the numbers on my applications. As noted previously, some schools only require 500 hours but a few require 1000 hours. A number I surpassed a while back. But that’s a minimum, and often below the average. So I definitely want to boost it.

I was actually planning on going in last night for an extra 8 hour shift, but finally convinced myself to slow down and take the night off from work. Or at least from paying work. I did end up, as I had promised myself, working on my application and knocking out some essays. As a result, if I submit the essays as written, I am fully complete with applications to two schools. That said I will be waiting a few more days so I can review the essays and possibly improve them.

And I also now have to consider, in order to apply to a few schools that might be on my list, if I want to take Genetics come fall. And possibly a Medical Terminology course. Most that require that will allow a certificate program, but at least one school wants a 2 credit minimum class. And I’ll be honest, that particular school is not high on my list of schools I’m considering.

But meanwhile, I feel like the Red Queen in Through the Looking Glass, “Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!”

I’m running as fast as I can.

Looking at my notes, apparently I didn’t blog at all during May. I suppose I was busier than I thought. But I figured it was time for another quick update on “Greg’s journey to apply to PA School.”

First, the spring semester of 2023 is in the books. Biochem, Writing, and Stats all complete. Biochem was definitely the most interesting and best of the classes. Stats was delivered at a 100 level and was basic enough I could skip the study seasons and still take the exams without much studying. With the homework bonus (which actually was quite helpful) she gave, technically my grade was 100+. What’s the odds of that? 100% I can tell you since it’s a past event that happened. This was the only class that had an in-person component and it was at 9:00 AM four days a week. It was just useful enough to tie the notes to the concepts that I made a point of attending. As noted, I did tend to skip the review classes, except for the last two exams, where I actually took the exam during the review session as it fit my schedule better.

Writing was hit or miss. It was all online and honestly, little feedback from the instructor, so I’m not entirely sure if I got much out of it. But as most programs want some sort of writing intensive class, it was necessary to take.

The Biochem class was all online and one of the few times in my academic career I actually went to office hours for help. After asking me exactly how long ago I had taken the chemistry pre-req and commenting that they really expected it to be within the past few years, not 35+ years ago, I was even more incentivized to do well.

The professor honestly, had put together one of the best online setups I’d seen, taking good advantage of the tools Blackboard offered. A few of my previous online classes were basically “here’s a lecture, listen and that’s about it.” One was even simply “here’s the Powerpoints, good luck figuring out what’s relevant and what’s not when it comes time to take the test.” In this case however, she had study guides, required participation in an online discussion and made use of online study quizzes to help reinforce the material. In fact you couldn’t move onto the next module until you had taken the quizzes, tests and exams for the previous material. This last detail did munge me up a bit at the very end when I was prepared to take the final but couldn’t see my grade for the previous exam yet (the grades wouldn’t show until after midnight on a specific day so that everyone had a chance of taking the exam without cheating off someone else taking it earlier).

I also had a study partner that I had met during Organic Chemistry last summer that works at AMC with me, so we were able to take advantage of the study rooms in the AMC school library and help each other with homework and studying.

Besides being well designed and run, it was also the most interesting class, as we got to delve fairly deep into some of the biological-chemistry pathways that occur in us. It was pretty interesting to see stuff to that detail rather than simply stuff like “and then Acetyl-CoA enters the Krebs cycle”. Now we got to learn exactly how and why that happens. Trust me, it’s pretty damn cool!

After classes were over, I was prepared to take a little over a week to teach the annual Weeklong Cave Rescue class I teach. Unfortunately my largest client had a major upgrade the weekend before that went sideways, exactly for a reason I had predicted. So rather than leaving town Wednesday night after work with a buddy of mine, I ended up working on the issue for much of the week and finally leaving Friday morning and having to drive all by myself to Alabama. This led to a definite lack of sleep. And even then I had to deal with some work issues. And finally a drive home by myself and then another shift in the ED.

Finally Memorial Day weekend I spent with some friends at an annual retreat of sorts.

And now, I’ve started my last planned prereq, MicroBiology. Ironically this was the last class (and last final) I took for my original undergrad degree, but at the time I didn’t pay for lab, despite ending up taking it at the professor’s insistence anyway. So ironically it appears it’ll be the last exam before PA school, unless I decide on my own to take more this fall.

So that’s the update from here. Now back to work (after the second night in a row of working until 3:30 AM).

Work and school have conspired to use up my time, so I’ve been blogging less often. But I wanted to make a point of blogging this week because I’ve reached an unofficial milestone.

Over the weekend I reached my unofficial 1000 hour mark as an ED Tech.

I say unofficially because I’m using a fairly conservative method of counting it and officially, I reached it close to two weeks ago. So why am I counting my number, that came later, rather than the earlier number? Because this one is more meaningful to me and gives me more of a margin for counting.

Officially, by the timeclock, I reached 1000 hours over two weeks ago. However, this time included by 24 hours of initial classroom orientation and the time to get my CPR recertified and some other training where I wasn’t even in the Emergency Department.

The other factor, was that officially, many of my shifts have been 8.5 hours, with .5 reserved for lunch. However, due to staffing shortages, often many of us techs will work through our meals (and swipe the timeclock for that, guaranteeing we get paid for that time). But it was simply easier for me to ignore those “worked through meals” and only count an 8 or 12 hour shift as 8 or 12 hours, not 8.5 or 12.5 hours.

So, I simply tracked time I was actually in the Emergency Department.

Now I’d like to say that when I hit my unofficial 1000 hour mark I was doing something exciting like working a trauma or even something routine like taking an EKG. However, the truth is, I was sitting at a desk going over some study materials. I was working what’s known as the “BB-Short Stay”. Generally when working here, there’s very little to do (I think I did 18 sets of vitals in 8 hours, and one bed change. But, that’s the nature of the job sometimes.) Fortunately, my next 4 hours of that shift was back in the main area of the Emergency Department and I was able to be more active.

That’s not to say I didn’t celebrate a bit:

So, a final note, the reason for the 1000 hour celebration, is that a number of the schools I’m applying to require a minimum of 1000 “patient contact hours” (one only requires 500 hours and another 750 hours) and now I’ve met that! That’s why I don’t count the classroom orientation or the like because that’s technically didn’t involve any patient contact.

At this point, I can start applying, despite a few classes this semester pending final grades and for most schools, needing to take Microbiology, which I’m doing over the summer.

But this was the single biggest hurdle that I had the least control over. For classes, I could simply sign up. However for the patient contact hours, I had to first get a job, ideally in a place that gave me more contact than simply “taking a set of vitals now and then” and then gain enough hours. Officially my job is only 24 hours a week and I started in late October. Fortunately I’ve been able to pick up a lot of extra hours, hence hitting my 1000 hour mark in only 6 months. My hope of course is that my 1000+ hours of patient contact in an Emergency Department stands out compared to say someone who has only had 1000+ hours in say a medical office where they’re simply taking vitals.

So this bridge crossed!

Slowly but surely getting there.

Standard Disclaimer: nothing here represents any official policy or action of my employee Albany Medical Health Systems and I do not speak for them in any capacity or in any way.

But I would walk 500 miles
And I would walk 500 more
Just to be the man who walks a thousand miles
To fall down at your door
The Proclaimers

Ok, I haven’t quite walked 500 miles, though a few days it’s felt like it. But I have reached sort of a milestone. I’ve worked over 500 hours as a tech in the Emergency Department. The PA programs I’m looking at require some sort of minimum number of “patient contact hours”. One only requires 750. The primary programs I’m looking at require 1000 hours. This has been the biggest single worry I’ve had in meeting my prerequisites. While there are a number of classes I need to take (and I’m almost done with those), this is the one that would take the most amount of time and was the hardest to line up.

But here I am, at the end of January and I’ve hit the half-way mark. This means that I’ll be well on my way to hitting the 1000 hours long before applications are due. So that’s good.

But, there’s more than that. Honestly, I’m loving it. Yeah, there’s a lot not to love. There’s cleaning up after patients. There’s being stuck in a zone with very little happening. One can get tired of doing their 20th EKG of the day and 17 nasal swab. But overall, I’m really liking it. And I think I’m getting better at it. I even “gave an order to a doctor” the other week.

Ok, let me be clear. Techs really don’t “give orders” to anyone. Sure we can ask another tech for help or even ask a nurse for help. But typically we’re the one being asked to do things. And we have no medical authority to “put orders into the system.” That said, we’re often closer to the patients and what’s going on with them than the doctors. This makes sense. We see the details, they see the big picture.

In this case though, several of us, including one of the residents, were cleaning up a patient that soiled herself. As I wiped, I noted she was raw and said she couldn’t feel when she was urinating, which meant she’d wet herself again without warning. This would only make things worse for her. When we were done, I turned to the resident and said, “I think you need to put in an order for a Foley (catheter).”

“Oh, you think so?”

“Yes, she can’t tell when she needs to urinate and ends up urinating without warning which ends up getting her skin irritated.”

“Ok.”

Sure enough about 30 minutes later a nurse was putting in a Foley.

I’ve said we often do the scut work. Which is true, and a few people have thought that I was saying that as a complaint. It’s not. It’s an observation. We’re doing the little stuff that needs to be done that the nurses and doctors don’t have time to do or often won’t notice. That said, actually they often do notice. A nurse will go in to do something and see the well stocked IV cart and thank one of us. Or they’ll ask for something and we’ll already have it in our hand, knowing they’ll need it. Again we’re thanked.

Last night for example, I spent probably close to two hours restocking IV cabinets. I’m not sure the last time that day they had been restocked, but some were pretty barren. When I was done, it felt good knowing that the next time a nurse went into the room to start an IV or do some other procedure, they’d have the tools they needed right there.

Then of course, there’s the big stuff. Helping out with a stroke page or a “leveled” trauma. This is where the experience comes in and I’m definitely 500 hours more experienced than I was just over three months ago. I still don’t have my “red badge” so I can work trauma’s on my own, but I’m getting the experience. And it feels good.

All this is a means to an end, getting the required hours to apply to PA school. But it’s also been great. I’m very grateful I’m getting the experience in an ED where my day can vary from restocking carts to handling not one, but two trauma patients in the same evening. And that was just one shift. In other shifts I’ve helped with multiple traumas.

Hopefully not just the quantity of hours, but the quality of the work will help my application. But no matter what, I’m still enjoy it.

Disclaimer: my works do not in any way reflect my Standard Disclaimer: my writings do not reflect the views of my employer, the Albany Medical Health System. In addition, any errors in the above descriptions are my own and nothing here should be taken as medical expertise or advice.

This isn’t a story about Sisyphus, but rather something very different.

There’s a saying in the EMS field that “Air goes in and out, blood goes round and round, any variation on this is bad.” It really reduces medicine to a very critical base level. If those things aren’t happening, your patient is in very bad shape. They may have broken bones, be in acid ketosis or have a variety of other major medical issues, but if they’re not breathing or don’t have a pulse, none of that matters. I’ve mentioned CPR previously and plan on writing a longer post on it in the near future (especially in light of Damar Hamlin’s collapse on the field). But today I want to talk about something that can only be done by experts and that’s intubation.

Before starting as a tech, I was aware of the general concept of intubating a patient, but had never seen it done, let alone assisted in any way. At a VERY general level, a patient is sedated and essentially paralyzed while a tube is inserted through their mouth and into their trachea. Once this is done, the patient is either ventilated by a machine or by the use of a bag-valve mask (BVM).

A patient may be ventilated for a variety of reasons, for example, they may be unable to maintain a patent (open) airway and the ability to breath on their own, or in a very recent case, the doctors made a decision to sedate a patient who was moving too much to be placed in the CT scanner. Given his risk factors, this meant that he’d probably lose his ability to maintain his own airway, so he was intubated as a precautionary measure.

I mention all this because there’s something important to to understand. Once a patient is intubated, basically the medical folks are breathing for them. The first few times I watched or assisted, this fact didn’t really register with me. Since then I’ve come to realize how important of a factor this is. In the recent case, the decision wasn’t made lightly. The patient actually was breathing fine, but the doctors couldn’t evaluate for other, possibly life threatening, injuries until he had been scanned. So they made the decision to basically take away his own ability to breath for a short period of time. That’s a pretty heady decision.

Roc is short for rocuronium, one of the common drugs used to help temporarily paralyze the patient. Its name sticks out in my head. There’s generally at least one or two other drugs all administered in a very short sequence (basically to relax the patient and then inhibit things like the gag reflex) period of time, generally under a minute and then the doctor has less than a minute to get the tube in. Once the tube is in, then either a BVM is temporarily attached to the tube, or a ventilator is attached immediately. In either case, we’re now breathing for the patient.

As a tech, obviously I’m not the one pushing the drugs or inserting the tube (I’ll get to that in PA School) but I’m often involved with squeezing and releasing the BVM to provide airflow. I also get to watch all this.

As for the actual placement of the tube, it’s definitely an acquired skill. Since Albany Medical Center is a teaching hospital, often it’ll be a resident or similar attempting it the first time around. Only once have I seen a failure (which was very quickly followed up by a success by a more experienced provider). Even this part is fascinating since they will use a tool known as a Glidescope. This is essentially a curved plastic piece with an LED light and camera at one end. This goes in first to help restrain the tongue and epiglottis. The image is displayed on an LCD monitor. Once it’s in place the actual tube is inserted. All this can be watched if you’re standing in the right place (which often I am.) I have to say it’s rather amazing to see all this. And to watch an experienced provider do a tube is amazing. They do it so quickly.

In any event, I have to say, it’s pretty amazing to watch as the providers take over the “air goes in and out” part.

In a future post I’ll cover the “blood goes around and round” part, which is something any of my readers can (and should) learn how to do anywhere they see someone in cardiac arrest.

Standard Disclaimer: my writings do not reflect the views of my employer, the Albany Medical Health System. In addition, any errors in the above descriptions are my own and nothing here should be taken as medical expertise or advice.

My life lately has been dominated by numbers. There are good numbers. There are bad numbers. There are less than ideal numbers and there are holy-shit numbers.

It may seem crass at times to reduce a patient to their numbers, but there’s a certain effectiveness to it.

First, there’s their medical record number. I honestly don’t care about this other than the fact that for parts of my job (such as recording an EKG) they need to have a bracelet on them with their name and medical record number on it. I’d call this a neutral number.

Then there’s a number like 130/80 for a blood pressure. Generally this is a good number. But context can matter. Was it 180/120 a few minutes ago and is continuing to drop? If the next reading is similar, great. If the next number is 100/60, the nurses and doctors are going to start to get a bit concerned. If it was 100/60 before and now has risen to this and stays here, they’ll relax.

Even a number like 170/120 might not elicit much concern if the patient is otherwise stable. Yes, your cardiologist might be concerned long-term, but for short-term if it’s stable, the nurse will consult with the doctor, but won’t be rushing around too much.

60 is another number. Are we talking pulse or blood sugar or respirations? In the first case, that’s a pretty good number. In the second, it’s a bad number and again will get folks moving a bit. In the final case, that’s a very bad number!

346 is another number. If it’s a blood sugar, then we’re starting to talk holy-shit (to the point where the hand-held monitor I use to measure it will require an extra notation in the recording.)

When I was learning my wilderness medicine and later started teaching it, I developed the idea of what I call “Sesame Street Medicine”. This was not a knock at all at what we were doing but more on an approach to take. There’s a lot to be learned from “One thing is not like the others”, just like in Sesame Street.

In the cases here, other than blood sugar, which I suspect most of my readers have never looked at theirs, one can often rely on their own experience to get somewhat of an idea of whether a number is good or bad. This can be a useful guideline when looking at numbers. Consider your own numbers. Consider numbers you’ve heard from friends. Now compare.

Now, obviously a trained medical person can definitely glean a lot more information from the numbers than a layperson can, but that doesn’t mean as a lay person you can’t look at some of the numbers and start to think, “that seems less than ideal.”

But yes, in the end, we look at numbers. A lot. In context they can have a lot of meaning. So no one wants to reduce a patient to only their numbers, but numbers can be a good start.

Content warning: death and depression follows. But also hope and happiness.

Disclaimer: Events are also a bit fictionalized in time and details

Yesterday I felt a man’s life leave his body.

Today, I felt the life course through a man’s veins, a man who had been dead moments before.

One dead. One alive.

I know my time in the field has been short, but I don’t think I’ll ever fully appreciate the difference.

One dead. One alive.

In another room a woman dies while her family still is on their way. Too late to say their goodbyes.

In another room a man comes in on the worst day of this life, but leaves alive.

One dead. One alive.

Later a man, who had wished for death, comes in and now fights the nurses trying to keep him alive because he fears they’re there to kill him. He survives to fight another day.

One alive.

In one of my favorite episodes of M*A*S*H, Hunnicutt, Hawkeye, and Houlihan fight to keep an injured soldier alive at least long enough so they can record his death on the day after Christmas, rather than Christmas Day itself so the soldier’s children don’t have to think of Christmas Day their father died. In the end, they can’t do it and end up falsifying the records in order to cheat death.

Despite the title of the episode being “Death Takes a Holiday”, the truth is, death never takes a holiday.

In my very short time working in the Emergency Department I’ve seen people die and I’ve seen people live.

But this shift, the eve of Christmas Eve has been especially poignant and has hit me a bit harder than other shifts. The death of a loved one, especially an unexpected death can be hard. I think so doubly so during the holidays.

But also, as I said above, I saw a man who was dead come back to life again because of the efforts of all those around him, complete strangers doing their best to give death a holiday. This time the succeeded.

Today and tomorrow, I’ll be giving my family an extra hug. I hope you can too.

Disclaimer: my views do not represent my employer: Albany Medical Health Systems or Albany Medical Center.