Or more accurately, scoring high on my most recent pharm exam spells relief. I mentioned in a previous post how I walked out of the first pharm exam of the semester worried whether I had passed or not. I was right to worry. I did pass, but barely. And that honestly made me very nervous. With the way PA programs are setup, you can’t afford to fail a class. There’s no “make it up next semester”. Generally if you fail a class, you’re out. Some might allow a make-up exam or some form of remediation if you’re just on the cusp, but most don’t.

And I honestly find pharm the hardest of my classes. This is not because of how it’s taught or anything, but because it’s mostly rote memorization. Often in other classes, you can reason out the answer from first principals. But less so with pharm. It was my lowest grade last semester. So I was nervous if the trend continued I’d be in real trouble.

Now, back in my days at RPI I let my ego get in the way. I mean why not? I was one of the highest ranked students in my high school. Obviously I was smart. So if I had trouble in my classes at RPI, I didn’t need help. I could figure it out on my own. But the truth was, I couldn’t and didn’t. It wasn’t until I started asking for help more that I did better. When I started my journey to PA school, I vowed I’d ask for help when I needed it. And I have been. So, with hat in hand, I emailed the course director on my campus. As I mentioned in a post late last year, any time we fail a grade this is required. But if we pass, even if barely, it’s not required. So I could have let my ego get in the way and simply tried to tough it out. I’m glad I didn’t.

Now I’d like to say there was some breakthrough here and she gave me the key piece of advice. But it’s not quite that simple. We did talk about what I got wrong and why and how to approach the upcoming exam. She gave me a lot of reassurance. And yes, she did give me an idea or two to help with my study habits. We then met again last Friday which helped reinforce some of this. The one real study habit I changed was how I built my flashcards and studied. Instead of focusing so much on drug names and then things like indications, side effects, etc. I focused on certain keywords such as specific contraindications and side effects and then worked back to the drug name. I also for some drugs built up little mnemonics or memory palaces.

For example, one mnemonic I built was to remember that Benznidazole is for Chagas aka “kissing disease” and that Ben would kiss someone and get weak in the knees/bone (bone marrow depression is an adverse effect) and makes him all tingly in the fingers (peripheral neuropathy is another adverse effect) and that if Ben kisses too much he could get someone pregnant (one of the tests you want to give before prescribing it.)

And it worked. While taking the test there were a number of times while reading the stem, I felt confident of the answer even before looking at the possible choices. This is always a good sign. There were a few I definitely had to think about a lot. And honestly, one or two I simply guessed at. But, in the end, I ended up with my second highest exam grade so far this semester. It salvaged my Pharm grade enough to the point where even if I barely pass the final two exams in the class, I’d pass it. Technically I could just barely fail both and still pass. Not that I plan on that.

But the relief I feel, is very hard to describe. I’ve sort of been on a high from it for a few days.

I’ll take that.

It’s a bit cliche to say that the hardest thing about PA school is how much we have to learn. I mean it’s true, but doesn’t say much.

I’ve mentioned in the past how one of the biggest obstacles I had to overcome to simply even be considered to admissions, let alone be admitted, was my undergrad GPA of over 35 years ago. And I get it. If you’re attending a grad program, really any grad program, right after your undergraduate degree, your undergraduate GPA is fairly indicative of how you’ll perform in grad school. And the truth is, 35 years ago, I would have failed out of grad school. But I’m not the person I was 35 years ago.

One of the things I’ve had to do a lot of over the past 8 months or so is adapt my learning style as I go. I have to figure out what has been working and what hasn’t been working. I spoke in my previous post about how tough I find pharm. The first piece of good news is that I passed that exam. Not by much. But I passed. However, I did something I probably would not have done in my undergrad days: I set up a meeting with the course coordinator for pharm to discuss how I should approach things. So I’m already a better student than I was 35 years ago.

For me, the hardest part about pharmacology is that it’s really mostly rote memorization. There are times where the suffix portion of a drug name can help clue you in (e.g. -olol is what we call a betablocker and used for HTN) but not always. Propranolol is a betablocker we use for HTN, but also for Essential Tremors! In any case, rote memorization doesn’t come as easily as it did to me 35 years ago.

My professor gave me some advice, which honestly we had been told before, but this time in a more concrete fashion. See, I tend to make a lot of flashcards on 3″x5″ flashcards. I’ve made a few thousand by now. And they help. But she suggested I keep them briefer and more succinct and make more. She also suggested I keep them simpler. I had been making them far too complex. It sounds like a simple change, but I think it’ll make a difference (we’ll see in a few weeks after my next pharm exam).

That said, I caught myself today making a flashcard on Lyme Disease stages and I realized I was cramming more and more details onto it. I stopped. I realized I was falling back on my old ways. So how does this related to programming?

I was suddenly reminded of when I was hired for a programming job to work on a project using Visual Basic and Visual C#. Both are what programmers call “object-oriented” languages. I had grown up on more procedural languages. I really had very little experience programming in an object-oriented language. In fact I told them that during my interview. Their response was “we want you anyway. So I quickly came up to speed and started to think like an object-oriented programmer. And for this project, this was actually a great paradigm. The program helped engineers design and specify the parts for a particular type of physical object.

But every once in awhile I’d find myself facing particular programming challenge and finding the code hard to write and very complex when trying to solve the problem. And then it would suddenly dawn on me, I had stopped thinking in terms of objects and was trying to think like a procedural programmer. Once I went back and approached the problem from an object-oriented paradigm, often the solution would pop out very quickly and the code would be shorter and clearer.

It took a paradigm shift. So I simplified the first card greatly.

And then made three separate cards

This helps in two ways. For example, rather than have to remember every detail on the overly complex card and perhaps confuse them, I can focus on the individual stages of Lyme. If I forget one, I’m only impacted in that area at test time.

But also, I can use the cards “forwards and backwards”. i.e. I can look at the front (which states the stage) and work on recalling the signs and symptoms for that stage. Or, I can look at the back and try to recall what stage it is. It reinforces the memorization process AND means that if they ask a question in either direction, I’m more likely to get the right answer.

Does this work for everything? No. But I’m already liking it for some things.

Will it work? We’ll see.

But the point is, for me to get better at pharm (though ironically this is for a medicine lecture) I need to make a paradigm shift in how I study. Wish me luck.

For several years now I’ve set some goals for the upcoming year. These are not resolutions per se.

Last year I didn’t set too many goals because I knew I’d be starting PA school. This year my list is perhaps even shorter. But here goes.

• Finish my didactic year of PA school. I’m two semesters down, one semester to go. It won’t be easy, but I think I’ve got it.
• Start my clinical year. I have a total of 10 four-week clinicals I have to do. They’ll extend until April next year. This will be difficult and involve a lot of travel, but I think I’ve got it. But ideally at least one or two will be local to Albany.
  • Related to this one: Going to South Africa. I applied for both an international rotation in South Africa (with a focus on procedures) and a small scholarship. I received both. The scholarship doesn’t come close to covering the additional cost of the rotation, but it helps take some of the sting away.
• Last year I mentioned seeing friends. While always a goal, I don’t think I’l have too much time for that.
• Biking – I’ll definitely continue doing this because I need the physical activity and it helps my mental health.
• Beyond that, not many goals this year. Only a few goals, but they’re big ones.

As I’ve done in the past, I like to take a look at the goals I set out at the start of the year and see how I did.

• My primary goal of course was to succeed at PA school. My last two weeks were rough. But I’m doing well and my professors reassure me that I’m doing fine. There are parts I very much enjoy and did well in. And my professors reassure me that I’m doing well. So even though my GPA isn’t quite what I’d prefer, overall I’d call this a success.
• I had a goal of a road trip. I accomplished that in spades. This was perhaps one of the best decisions I’ve made in a long time. I needed this trip in ways I didn’t realize and it refreshed my soul in many ways. Being able to visit a friend one last time was also a poignant part of the trip.
• My goal of seeing/making friends has been mixed. I haven’t had a chance to catch up on old ones as much as I would like. As for making new ones, while I definitely like my classmates quite a bit, I can’t say I’ve made as deep personal connections as I might like. This is an area where the difference in ages is definitely a factor. Ironically, in some ways I’m perhaps have a closer connection to a couple of the professors, but because of our roles, there’s definitely a certain professional distance we maintain.
• Biking has been a salvation for me. It also was a reason I decided to get out of my first lease and into one closer to campus. My initial apartment was in downtown Wilmington and while it was nice enough, I realized for many reasons it was far from ideal from me. One of those reasons was how impractical it would have been to bicycle at all. The last few weeks of the fall semester I didn’t get much biking in because of the weather. However, I now have a rowing machine and I’ve been using that. Once the weather gets warmer again, I expect to bike more.
• New Septic – well, once again, we didn’t do this. But this time for a very good reason. We solved, at least for now. Even if the solution is only good for five years, that’s costs we aren’t spending money on now.
• As for projects around the house, it’s hard to say. I got a few done. I put up a new section of fence around the pool. This one us more privacy and is in better shape. I also finished off putting a ceiling over our upper deck. I still have others I want to work on when I get the time.
• That’s about it. I’d say for my goals, I did pretty well this year. Check in tomorrow to see the goals I’ll be setting for 2026.

The title photo for this post should show a shot of my 4-month whiteboard calendar that I used to use to plan out my months in advance. As you can see it still has May on it. I haven’t had an opportunity or even really a need to update it since May. In May I had a variety of events scheduled, but pretty much since then, as the calendar shows, it was all school, all the time. Though I was home over August break for a week, I didn’t bother updating the calendar.

To me it’s a symbol of how hyper-focused my life has been these last few months. Now it’s time to update it for the next few months. There still won’t be much on it, a couple of breaks and the scheduled “core competency exam” which is nothing more than simply a comprehensive test on everything we’ve learned over the previous 3 semesters.

The real interesting stuff starts in May, the second quarter of the year, so it doesn’t show up here. That’s when we get ready for our first clinical rotation and then head out for it.

In any event it’s sort of an interesting perspective on how I spent my last eight months and will spend my next four.

A couple of hours ago I finished taking my Medical Comprehensive Exam for the second semester. It was a doozy. But I passed. Technically I have a paper, that was submitted to two different classes, that I’m waiting for grades on, but mathematically it won’t change my GPA. So, that means this semester is in the books.

I go back and forth on talking about my GPA and individual grades in this blog. There’s several reasons. I don’t think there’s much purpose served by bragging about a particular grade, especially because the next exam could go in the other direction. On the other hand, I do hope folks thinking about applying to PA school end up reading my blog and I think it’s important to have some transparency.

So in interests of transparency, my GPA this semester is a 3.0. Last semester was a 3.3. To progress forward, one needs a minimum of a 2.7. So I’ve got that covered. (And even then, if that happens, they have a remediation step.) However, going into the last few weeks, I was in the solid 3.3 territory. So what happened?

Here’s where I want to be very transparent. The last few weeks have been difficult for me. Thanksgiving break couldn’t have come at a better time. I was burnt out and needed a change. Picking up a few shifts in the ER had a big benefit on my mental health. But the last two weeks still got to me. I had a pharmacology exam which I did about as well as I had hoped on, but it definitely pulled down my grade. Pharmacology is simply a hard subject for me. I have one more semester of it. I’m going to struggle, but I’ll make it happen somehow. This is probably what dragged down my GPA the most.

But what nearly broke me is what happened on my birthday. I had an exam in a class called Diagnostics and Clinical Procedures. Going into the exam I had a 90.97 average. This one I knew would be tougher. I thought I was prepared. Then that afternoon I got my grade back. 66%. A failure. This requires a remediation meeting with a course director. This brought my course grade down to an 83.11. That was a huge drop. This is what really dropped my GPA from a solid 3.3 territory into the 3.0 territory. A couple of my professors and mentors had warned me in the past that “everyone fails at least one exam.” I was confident going into this one that this wouldn’t happen. Well, it did. It was devasting. I really lost my mojo.

That didn’t help considering I had the Med Comp exam coming up this morning. Now, the truth is, even with that failed exam, I knew I was safe from failing out. I had enough of a GPA to guarantee at least a 2.7 no matter how I did on the Med exam. But obviously I wanted more. But I will admit that I was on the edge a nervous breakdown. I was in a tough place mentally, questioning my self-worth, my abilities, and even if PA school was meant for me.

Wednesday night was very rough for me. I’ll admit that I thought about just tossing it in. PA school has beaten many. We’ve already had at least two students in our cohort who have left the program this year. At least in my case, I could fall back on being an ED Tech or going back into IT. As I’ve mentioned in the past, I make far better money in IT. And have far better hours. So quitting wouldn’t be the end of the world.

I write the above, not for sympathy, but for any potential (or current) PA students who are reading this. I want you to know, if you feel this way, it’s ok. You’re ok. Sometimes PA school can just break you that much. Sometimes you hit a limit. It’s ok. We’re all human. This is something I have to remind myself of time to time. I had people to reach out. If things didn’t improve, I even considered talking to my university’s counseling center (even though my campus is remote and I wouldn’t do much in person.)

I also reminded myself of one of my best friends. Back in our undergrad days he had a GPA of 4.0 for the first few semesters. He was acing everything. And then… the first none 4.0. He admitted it hurt. But also told me something that I found interesting. It was freeing. Since perfection was no longer a possibility, he could relax a bit. He’s still one of the smartest people I know; a polymath even. And he’s gentle, kind, and a wonderful person. He’s more than his GPA would ever show.

My remediation session with the course coordinator went well and ironically, afterwards I realized I was glad I had failed the text rather than just barely passing. A failed test requires remediation. Just barely passing makes it optional. Had it been optional, I honestly doubt I’d have gone to it. But by going to it, three things happened. The first was, I learned where I had a fundamental misunderstanding of a couple of concepts. Yes, a few answers I had just remembered the wrong thing, or put down the wrong answer. But on a couple of concepts, I had a fundamental misunderstanding that we were able to correct. So the failure actually helped me learn and improve.

The second thing was I decided to walk over to campus and back. I almost regretted the decision, given how chilly it was with the windchill, but I’ve found being outside like that helps my mood. Simply getting out of the apartment did help, but combining that with over a mile walk in each direction is what really made a difference.

Finally, there’s a new noodle and dumpling place on the way that I decided to try. I got some pork and vege (sic) dumplings in spicy peanut sauce. They were AMAZING. Some good food goes a long ways to improving ones mood.

So all that helped me to improve my mood. I can safely say I’m not in that place now. I’m content. I’m relaxed. I have three weeks to spend with friends and family. Three weeks to recharge my batteries.

Three other things have also helped.

• Friends and family. You know who you are, the ones who take my panicked texts and reassure me. The ones who give me kind words of support or care packages. They mean a lot to me. More than you can possibly imagine. Knowing I had people in my corner made a huge difference.
• The confidence my professors have expressed in me. I trust them. They’ve helped a lot of students become PAs. If they think I can do it, then they must be on to something.
• Finally a bit of a humble-brag. Without going into details, but an incident at work where the attending later told the Charge Nurse, “thank God Greg was in the room.”

So the semester is over. I survived. I’m two-thirds of the way through my didactic year. This semester was 25 credits. Next semester is another 25 credits. I won’t be easy. But after that, are clinicals. I look forward to that. The testing doesn’t stop for awhile, but I’m getting there.

So the takeaway, especially for fellow PA students or potential ones: yes, it can get tough. But you can survive. Make time for yourself. And don’t let any single setback put you off. We all have our good days and bad days. Wednesday was a bad day for me. Today is a much better day.

I realized years ago, that at times, I’m driven by what I might call a scarcity mindset. This isn’t just being frugal, but that’s definitely part of it. I don’t like wasting things. I can often be frugal. I’ve been known to drive the extra mile to save a penny a gallon on a tank of gas. I’ll buy in bulk often when I can.

No, the scarcity mindset to me is more of a “don’t let something to go to waste because you don’t know when you’ll be able to replace it.” Coupled with this, is “don’t buy something you won’t fully use.” That’s partly where the frugality mindset comes into play.

The above is a photo of green foam blocks that a florist might use. It’s an example of an early manifestation of my scarcity mindset. When I was a kid, I’m guessing around 6 or 7, I got my hands on one. I’m guessing it was left over from one my of aunt’s weddings. In any case, all I knew was I had one. And I didn’t know where to get more. I didn’t necessarily have a use for it. But because I only had the one, I didn’t dare use it or handle it too much, lest I wanted it later on for some more important reason. To this idea I have no idea what that reason that might have been, but still I didn’t use it. It was scarce to me. Why I never asked my mom where more could be found I’ll never know. Instead I simply held on to it. I never did end up using it and at some point it was lost. Now, of course years later, I know where I could get as many as I need or can afford.

But that mindset has stuck with me. I realized that earlier this semester when I decided I wanted to go old-school and start taking notes on some 3″x5″ index cards I had. I must have grabbed some from my office in New York before I moved into my apartment and set up my study area here. I started taking notes on them, but I was parsimonious at first since I only had 50 of them. Of course I knew where I could get more, but I didn’t have the time and I wasn’t sure how many I really wanted to buy. I finally went on to Amazon one night and realized I could buy a package of 500 for under $8.00. I of course being frugal, hunted for the least expensive pack of 500 I could find. But even then I resisted. “What if I don’t use them all? That’s a waste.” But I realized that $8.00 was a small drop in the bucket of my educational expenses and if they helped me pass some tests, it was a wise investment. And counter to that, if I didn’t spend $8.00 and failed a test, that wouldn’t be a wise savings. I’ll add that I’m now on my second pack of 500 and I’ve bought a dozen different index card boxes to hold them grouped by test and or subject.

There have been a few other items I resisted ponying up money for for school. One example is a subscription to ChatGPT. I at first tried to be frugal and use the free model, but I’d hit limits on usage. I’d question myself if it was worth paying the $23/month it would cost for a subscription. Now months later, I’m so glad I ponied up.

At times I still resist using something because “I don’t know how I’ll replace it” or “is it worth the cost of replacing it” but I’m overcoming that. Within limits, I’m trying to get into the mindset that yes, spending a bit of money here and there to drive the mission forward is worth it. Don’t be pennywise and pound foolish. The mission here of course is graduating PA school and having enough retained knowledge to pass the PANCE exam.

I’m still working on overcoming some of these built-in mindsets and that’s one of them.