My Journey So Far

While showering this morning (right after listening to a lecture on women’s health for pharm) I got thinking about my journey to becoming a PA and reflected on how far I had come. I thought I’d share some of those thoughts.

The official “start” date was I believe December 28th, 2021. I think that’s the day when I sprung upon my wife the idea of a dramatic career change. I’m grateful that she was supportive from the moment I suggested it, even if neither of us fully understood what was involved.

I didn’t really announce it until January 1st, 2022. Looking upon that post, I’ll have to admit I was a bit optimistic. I thought I might be able to finish it by 2025, 2026 at the latest. Well it’s going to be 2027. But, short of something traumatic happening, that date is pretty much set in stone. I know the date of graduation, but I will still have to pass the PANCE after that. So the exact date is still up in the air a bit.

Unofficially, I can’t say when I started. Was it in 2015 when my dad was sick and folks kept asking me if I was in healthcare, or when I met with a friend and now colleague to talk about medical school, which at the time we agreed wasn’t practical?

Was it earlier when I got involved in the NCRC or a bit later when I became an instructor, often helping teach the medical curriculum?

Perhaps it was when I first took SOLO at RPI. Or perhaps earlier? For example, I think my first aid class and CPR class was in elementary school at Lee H. Kellogg.

I think I’ll stick with the December 8th, 2021 goal. I do know that after graduating RPI, the thought of grad school wasn’t in my mind. My GPA was so low that I had ruled it out. But by 2021 I was ready for change.

So what have I done since then?

In January 2022, after jumping through some hoops, including getting vaccine titers, I started taking my prereqs. It quickly became clear that I wouldn’t be able to get all the prereqs in and get in the necessary patient contact hours in time to apply in 2022. So the goal of getting accepted in 2022, starting in 2023 and finishing by 2025 was quickly dropped.

It wasn’t even until October of 2022 that I could start acquiring my patient contact hours.

In the meantime I kept taking more classes. By December of 2023 I had ended up taking 41 credits for prereqs. In May of of 2023 I started submitting my first applications for PA school. And shortly after I started to receive my rejections. I had known my GPA would hurt me, but I was hoping the rest of my application and story would be get me a spot. The closest I came was being put on the waiting list for the school I currently attend, Arcadia. But there was no movement there.

So I went into 2024 already planning a second round of applications. By now, I had taken pretty much all the requirements I could, let alone needed. This did let me focus on working more in the ED, so that was nice. I slowly wound down my consulting. I was at this point very much committed to getting into PA school. Honestly, if I hadn’t, after dealing with a second round of defeat, I might have gone back and retaken some of the more basic classes from undergrad that I hadn’t done well in, but I was hoping to not have to do that.

I had a number of submissions in in May of 2024, basically as early as possible. And then I waited. And waited.

I finally heard back from one of my top choices. It was a no. I exchanged a few emails with the program director, but there was no change. The day after the last email from him, which honestly, I found a bit dismissive, I received an email about another decision. This is the one that changed my life. July 9th, 2024: It is our pleasure to offer you acceptance for admission to the Physician Assistant Program (the “Program”) at the Delaware campus for the class matriculating in May of 2025. It was from Arcadia. I don’t think my feet touched the floor for a week. The only hard part about this decision was whether to put down the required deposit and secure the spot, or wait and to hear from other schools which might tempt me. I didn’t want to risk the spot, so I put my money down. And it’s a good thing too, since it was my only acceptance. From then on, I could relax. At least until May of 2025.

As May 2025 approached, I started to make plans. One of them was forming my Council of Moore. Another big one was a road-trip. I’m so glad I did that. It really helped me clear my head. And then in May of 2025 I showed up and met my classmates.

May 2025 is less than a year ago. But honestly, it seems like it was both a decade ago and yesterday. I’ve often described PA school as like drinking from a firehose. And it has been. I’ve had my ups and downs. Since January though, things have generally be on the upswing.

We’re just over 10 weeks from starting our clinical rotations. I have a number of exams and quizzes between now and then (roughly 2 dozen quizzes, tests, other grades between now and my com). But I think I’ve got a handle on them. With the growing light of spring and the end of the didactic year so quickly approaching, things feel good. Yes, I’m realistic I still have a lot of exams and I could do poorly on any of them, but I’m at the point where clinical year is all in sight. And I can’t wait.

And now, back to studying for Pharm and my other 3 exams/quizzes this week.

Tough Times

There’s many reasons I maintain this blog. It started talking about my thoughts on design (both database and real word) and on metacognition and other topics. Often I spoke about caving and the NCRC. But sometimes I write, because I have to. This is one of those.

Let me start with two recent things shaping my current thought processes. My Pharm exam this morning. I won’t get a grade until Friday probably. And despite how hard I studied for it, I don’t expect it to be good. Pharmacology is my nemesis. It stresses me out. So, I’m completely stressed right now and to be honest, wondering if all the stress is worth it. But that’s a topic for another day. (Though you can read my thoughts from the end of last semester here.)

The second part was learning one of our cats has cancer that has metastasized. Many folks don’t believe us when we say we have two cats because they never see this one. Pisantar definitely is a bit skittish and tends to hide when company is around. But, of the two, he’s ultimately the more curious and probably more intelligent one. I have bonds with both cats, but sometimes I think I identify with Pi (as we call him) a bit more. So, that double whammy has me down.

But, what I really wanted to write about is something that finally gelled in my mind the other night. By now we’re all familiar with the shocking killing of Alex Pretti. When I saw the first video released I was shocked, upset, and sick to my stomach. Things haven’t gotten much better. If anything in some ways worse. And then the other night it hit me. He was an ICU nurse. He was one of us.

In over thirty-five years of IT, I’ve worked with teams large and small. And along the way, a few have passed, all from natural causes, including Covid. Honestly, one, given his health, didn’t surprise me at all. But, I’ll be honest, even though I’ve made friends, the closeness has never been as much as it has been with my coworkers in the ER. Even ones I might not consider close friends, I share a close, intimate bond with. I think it’s because in my IT jobs, the worst that could happen was a database might crash, some money might be lost, even jobs might be lost, but no life was saved or lost. Obviously in the ER it’s different. We have a common goal and a common enemy. We struggle to keep people alive for one more day. It doesn’t matter who they are or why they are there. They need help. We help.

In the ER I’ve encountered the best of the people and the worst. I’ve been punched. I’ve seen my coworkers be called the worst names (I once threatened to have a person ejected because of their behavior). I’ve seen threats be made. But I’ve also seen the family member cry on the shoulder of a nurse because we saved their mother. I’ve seen the wife smile, knowing her husband’s chest pains are just indigestion from her dinner, not a heart attack that could have made her a widow. I’ve seen the satisfaction on the team’s face when our compressions and meds were successful and we know the person was discharged, neurologically intact. We’re there. We’re making a difference, no matter who the patient is.

And, no matter who our coworkers are. There are coworkers whose political believes I disagree with. There are the coworkers who have rubbed me the wrong way. But, when push comes to shove, those are the very same coworkers I know will do everything in their power to try to save someone. We work as a team. We are a team.

No one I know goes into Emergency Medicine for the money. We do it because it’s who we are. Because we want to make a difference. We want to be part of something bigger and better than our individual contributions. We want to be part of a team.

Now in some ways, the ICU is a different place. It’s quieter. Far less chaotic. But at the end of the day, it’s the same thing. People doing their best to help their patients. People are there to make a difference. They’re a team.

And this extends beyond the ER. Many of my coworkers are also EMTs and paramedics. Or rescue animals. Or do other acts of service. It’s why I’ve done the NCRC for so long, it makes a difference. We’re one.

So, I realized, when Alex Pretti died, it was like a coworker died. It was someone I could have been close to. Someone I could have worked with to save a life.

I couldn’t imagine going into work knowing one of my coworkers had had their last shift. That one of my coworkers had run their last code. That one of my coworkers had pulled drugs from the Pyxis for the last time. We had lost one of our own. When I saw his flag draped coffin rolling out for the last time with his coworkers standing there, I realized, I was there too, in spirit.

It could have been any of the team I work with. And I realized, too, that knowing me and my spirit and desire to be out there, helping, it could have been me.

mRNA Vaccines

I was planning on writing a more detailed post, complete with images and citations, but I’ll be honest, I don’t have the energy or time right now, so this will be simpler than I’d like.

One of the claims some people have made about the mRNA based Covid vaccines is that they alter your DNA. This basically isn’t possible. But I want to delve a bit into why.

We’ll start with something often called the Central Law or Dogma of Molecular Biology. I’m going to paraphrase it at first: Information passes from DNA to RNA to Proteins and never in the opposite direction. I’ll explain why this is mostly true and why it is vitally important to understand when it comes to the mRNA based proteins. But first, some definitions.

We’re all probably familiar with DNA, the double-helix first observed and described by Rosalind Franklin and later better described by Francis Crick and James Watson. This is where genetic information is stored. In computers, we think of data as stored as bits, 1s and 0s. DNA is similar, each “lattice” in the ladder is made up of a pair of AT (Adenine/Thymine) or GC (Guanine/Cytosine) molecules know as base pairs. Whereas in computers we’re often dealing with bytes which is a group of 8 bits, DNA is grouped as three base pairs at time.

Image courtesy of Wikipedia.

But what’s the purpose of these three base pairs? I’m going to overly simplify, but an entire strand of them makes up a chromosome. (Humans have 46, 22 “identical” strands and then a set of XX or XY strands. Identical is in quotes because sometimes when replicated, errors can creep in creating a mutation. And of course some people have more than 2 of each, such as Trisomy 21, aka Down Syndrome, or even XXY, or can be missing one of the pair, such as X0. But that’s beyond this post.)

But three base pairs together can encode later for amino acids. Amino acids make up proteins.

Within each chromosome are multiple genes. Genes are what make you look like you and be human. You have genes for example that control your blood type, hair color, and more.

That said, two things can happen to DNA: Replication and transcription.

Replication is necessary when a cell divides and basically the entire chromosome is duplicated so each cell has a copy. This is extremely interesting in and of itself, but again, beyond the scope of this article.

What we care about here is transcription. This is when part of the chromosome, specifically a specific gene is accessed in order to make a protein. This can get fairly complex and honestly, we’re learning new details about how genes can be activated and used all the time. (For example, so called “Junk DNA”, i.e. areas that don’t encode for genes, turns out that can be very important too and it’s not junk.)

So, before I can get into why mRNA vaccines can’t alter your DNA, let’s dive into a bit more how a protein is made and how this related to vaccines.

An important detail to keep in mind here is that in what are called eukaryotic cells (which is what makes up almost all multicellular creatures, including you) chromosomes are within the nucleus of the cell. It’s difficult for anything to get in or out. Basically there’s a wall around them with closely guarded gates.

That said, the nucleus receives a signal that a particular protein is needed. So, the particular chromosome, which is normally very tightly wound unwinds at the location of the gene needed for that protein. Then a special enzyme (and they are different between eukaryotic and prokaryotic cells i.e. single cell bacteria and the like) called RNA Polymerase that starts to “walk” the gene and create what’s known as Messenger RNA or mRNA (see we’d get to this eventually).

When it’s done reading, this new strand of mRNA leaves the nucleus and goes into the cytoplasm of the body of the cell. There, “molecular machines” known as ribosomes will latch onto it. These actually come in two sizes, large and small. You have millions of these in each of your cells. When a piece of mRNA is floating around a large and small ribosome will clamp to the “start” end and start to read it. As they read it three base pairs at a time, they will attach the amino acid that matches that 3 base pair encoding. This amino acid is brought to the ribosome unit via something known as Transfer RNA or tRNA. Once the end of the mRNA is read, the ribosomes come apart and the mRNA may be read again or destroyed. (I won’t get into the signaling factors that control this, but the key part is eventually all mRNA gets destroyed and its base pairs typically used for other purposes.)

The created protein may undergo other transformations and be moved to other locations within the cell, to the surface of the cell, or even ejected from the cell.

And that his how a protein is made. Notice the direction matches what I said above DNA->RNA->Protein. It’s one way.

But what keeps it from going the other way? That’s really the question here.

Let’s start by stating up front that your DNA DOES in fact contain genes that apparently came from viruses. So that central law obviously has an exception. But what makes that exception?

Specifically it’s an enzyme known as Reverse Transcriptase. Humans sort of have a form of this, but it’s used for a very specific (controlling telomere length during replication). There are a few other weird things that could do something like this, but basically for the mRNA Covid vaccines they don’t. The simplistic reason is that the mRNA vaccines don’t include the encoding that is required for Reverse Transcriptase to start its work. It’s sort of like a guard asking for the password to get into a military base. If you don’t have it, you’re not getting in.

Moreover, an mRNA vaccine encodes for a specific protein or proteins. That’s it. It doesn’t contain enzymes like Reverse Transcriptase, nor do the mRNA segments contain the encoding to allow for any form of reverse transcriptase. Even if somehow DNA was formed from them, it would then have to make its way into the nucleus (which is very difficult to do) AND the be incorporated into an existing chromosome. This just beyond the point of believability.

But, let’s say somehow it DOES happen. You know what the most likely result is? Nothing. Your body has no reason to activate such a gene. It would sit there like other inactive genes doing nothing.

So, for those who read this far, or who skipped the end, your cells and the mRNA vaccine for Covid simply does NOT possess the mechanisms to incorporate the the vaccine into your cells and even if it did, the net result if anything would be nothing.