Category Archives: Physician Assistant

My thoughts about my journey getting into (and soon attending) PA School.

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.

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.”

Countdown T – 1 Month

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I’ll be posting a few more follow-ups to my recent road trip but for now a break from that and something else: counting down.

One month from today, on May 27th, I’ll be going through orientation for my PA program. I’ve already met a few classmates at the open house a few months ago, but this is the first time all of us will be in the same place at once.

Then the very next day classes start. Or as I like to think of it, I’ll be starting a marathon of sprints. The next two years will be very busy for me.

I think I’ve mentioned before, the first year is all didactic teaching. I’ll be spending a lot of time in the classroom, lab, study areas, and in my apartment, focusing on learning and memorization.

While I took over 40 credits of classes as prereqs in prep for this, that was spread out over the course of about two years and I never took more than 12 credits at a time. And these were undergrad level classes. My first semester I’ll be taking 18 credits. All graduate level. (Ok, I’m not sure I’m too worried about the one credit class, “Professional Practice I” but still that leaves a lot). On the other hand, I won’t be doing any IT consulting or ED teching during this time, so my primary focus will be just that, learning. But I’m still nervous. I want to do as well as possible. I can’t afford to have a repeat of my undergrad experience in terms of grades and study habits.

The second year is my clinical year. This is where I have 10 clinical rotations of 4 weeks each, with testing between them. This I’m not too worried about. For one thing, my hands on experience and observations in the ER should help me a lot here.

In fact I recently spoke to a friend of mine who is currently in a PA program. She’s had years of hands on experience as a paramedic. She mentioned it was striking how uncomfortable some of her fellow students whose medical background was basically that of “scribe” were with the hands on stuff. I mean I get it. For example, sticking a needle to draw blood in a living breathing human being is a bit daunting. For her, that was just another Monday.

In the meantime though, before I can even start classes, I have a number of things to do:

  • Put the BMW on the market – it needs work and I don’t have the time for it or need.
  • Find an apartment – I’ve got a place picked out, just need to sign the lease. Ideally I’d have a roommate to cut costs, but looks like that’s not happening.
  • Come up with a list of items I’m bringing with me for the apartment (clothing, cooking utensils, etc)
  • Acquire bigger items (like a bed, possibly a dresser).
  • Finish projects around the house
  • 4 more scheduled (and I’ll probably pick up 1 or 2 other) ED Tech shifts
  • Work to change from a .6 FTE ED Tech to what they call the “school” track where I can work during breaks.
  • Get a lot of paperwork done. I’ve already authorized the background checks and other paperwork. I have to start getting my vaccination information together. One they want details on is chickenpox. Well I was born well before the varicella vaccine was even out there. So I don’t have any vaccination records for that. Fortunately they’ll accept a titer for that.
  • Mow the lawn!
  • Finish up some other projects around the house.
  • Attend Rebecca’s Senior Film showing (that I also happened to act in!)
  • Attend Rebecca’s graduation!
  • Run an Orientation to Cave Rescue class in two weeks
  • Give a talk to the local ER docs (and others) about Medicine in Cave Rescue
  • Write above talk!
  • And much more.

There’s a lot to do, and on one hand a month seems like forever, on the other hand, it seems like it’s not enough time.

I made the decision in December of 2021 to apply for PA School. At the time I had the outrageous idea that I’d be able to apply in 2022 and start in 2023. I realized very quickly that was unrealistic and impractical so I set a new goal of applying in 2023 and starting in 2024. I knew that was an outside shot, something like 70% of first time applicants don’t get in, and I had my very low undergrad GPA hampering me. So, here it is, I did a second round of applications in 2024 and am, starting in 2025. So not too far off my first realistic schedule.

I’m excited. And nervous. But mostly excited.

The Next Decade

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This past week I visited an open house at the PA school I’ll be attending starting in late May. It definitely made things feel very real. It almost reminded me that I’ll be the oldest there by far. This gives me a feeling of cognitive dissonance.

On one hand, often when I’m at work, or when I was taking classes, I feel very young, often decades younger than my chronological age. One of the best compliments I received from a fellow tech was, “Greg, you run the techs in their 20s into the ground.” The tech saying it was herself in her 20s.

And the idea of going back to college makes me feel pretty young.

That said, the reality is, I’m entering a career that while will probably last me the rest of my working life. But I at most probably only have a decade in it or so.

I’ll be 57 when I enter school. I’ll be in the didactic phase for 12 months.

That makes me 58 when I finish the first half and start my 12 month clinical phase.

This means I’ll be 59 when I graduate and take my PANCE (the certifying exam that officially makes me a PA and allows me to practice as one.)

Many people plan on retiring at 65. I have never really had that as a goal. I figured I’d want to keep busy beyond that, even if I ended up working at a more relaxed pace.

But the real limit may come when I’m 69. PAs have to basically take an exam every 10 years. The honest truth, as I approach that date, I’ll have to give it some thought if it’ll all be worth it. Perhaps it’ll be the sign to retire. But also, working in the ED (as is my current plan) requires a certain physicality that at 70, I’m not sure I want to deal with. And while PAs can make lateral moves, I’m not sure what other specialties I’d enjoy.

So, we’ll see. Do I make it the full 10 before retiring? Do I re-up? I can guarantee I won’t be re-upping when I’m 79! (Unless someone discovers the fountain of youth!).

So if I have one regret about my approach PA career, is perhaps I should have done it decades ago.

But in the meantime, I’m going to enjoy the living hell out of the time I’ll have for it

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!

2025 A Year in Preview

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In keeping up my tradition of setting some goals (not resolutions) for the new year, here’s my hopes for the coming year.

  • Succeed at PA school – I managed the goal of getting in. Now the next goal is actually succeeding! I know it’s not going to be easy and I think I’m prepared. As I’ve said to others, come May, my full-time job will be being a student. I haven’t had that “job” in 35 years! So this should be interesting!
  • Travel – I want to get in at least one road trip before school starts. I don’t have details yet, but I hope to figure this out soon.
  • See Friends/Make New Ones – One detail about PA school is that I’ll be 4-5 hours from home. So I’ll be relocating for the next two years (the first year is all classroom room, the second is clinical rotations). So I hope to see some of my local friends, and make new friends among my classmates.
  • Biking – Yes, I definitely hope to get some in. I’ll be bringing my bike with me to school. It’ll just be a matter of finding time to do it. Fortunately I won’t be working night shift, which means I’ll be awake during the day.
  • Get our new septic system – Yes, again a goal.
  • Several projects around the house – this will be limited by the amount of time I have between now and May. So we’ll see.
  • That’s about it. Honestly, as long as I succeed at my primary goal, I’ll be happy and content.

In the meantime, check out how I did last year.

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.

Tools

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One thing that makes humans rare among species is our ability to shape and craft and use tools. This was on my mind last night as I went to bad.

A couple of years after my dad died, I wrote a post about using his Milwaukee right angle drill. I still have that drill and while I rarely use it, it still brings back memories.

Yesterday I added a new tool to my toolbox. Well, to my set of tools: a portable table-saw. When I first moved into the house, decades ago, my dad gave me his old table-saw as he had upgraded to a much heavier duty one so he could build cabinets and the like. When he passed, I decided to keep the larger one, but had no place for it, so I gave it on “permanent” loan to a friend who went above and beyond the call of duty to help me during my dad’s illness. He had the room I didn’t.

In the meantime, I had gotten rid of the original one, for a variety of reasons, including that it had some bad memories. You see, back in my senior year of high school I was using it to cut some cedar shingles and it kicked back on me. I’ll be honest, I’m lucky to still have all 10 fingers. And that’s in part because of receiving some sutures at the local hospital.

As for the new table-saw, it had been on my bucket list to obtain for awhile and I finally bit the bullet and bought it on Sunday, assembled it yesterday and used it to start finishing some projects that really needed what a table-saw can offer. And so far, I love it. It has a number of safety features my old saw didn’t and it’s much easier to adjust. I think it’ll be a very useful addition to my toolbox.

But I wasn’t done with saws with with memories of my dad’s tools. Turns out I needed to cut out a notch in the piece of trim I had just cut on the table-saw. There’s no real safe way of doing all the necessary cuts on a table-saw. But that’s ok, I realized I needed a coping saw, something my dad had. Sure enough going to his toolbox in the basement I found it and got my cut started. (I’ll admit I cheated for the rest, once I had enough started to fit a jigsaw blade, I used my jigsaw to finish it.)

But I want to circle back to sutures. One of the skills I’ve watched a lot of in the ER is doctors and PAs putting in sutures. The overall mechanics didn’t seem complex, but I wanted to get in practice before I had to PA school in May. Fortunately one of my members of the Council of Moore was able to set me up with some of the items needed. A quick shopping trip on Amazon got me a practice suturing pad. I’ve had the items for a couple of weeks, but finally last night decided to pull them out and pull up Youtube.

And I was right. The hand motions are just as I thought. Pierce the “skin”, rotate the wrist to drive the needle through, pull the suture mostly through, wrap the suture twice around the needle driver, grab the end pull through and voila, the first knot.

Or so I thought. My suture kept unravelling. I watched more videos, they all showed the same thing. I was baffled. I kept trying, suddenly I had something that looked right and didn’t slip. But I had no idea what I had done, so I didn’t count that one.

After getting fairly frustrated I decided to hand-tie one to see confirm what it should look like. That was easy. Back to using the needle driver. No luck.

Then it hit me. While the videos talked about wrapping in two different directions, clockwise and counter-clockwise, there’s really two other directions! The first, which is what I had been doing was wrapping the suture with the tip of the needle driver pointing towards the wound (and hence the free end). The second, was angling it the other way so effectively the tip of the needle driver is towards the needle end of the suture. It’s subtle but once I did that, I was able to create the knot I wanted.

The clockwise/counter-clockwise comes in when tying the knot twice to ensure it’s correctly tied (strictly speaking it’s what’s called a surgeon’s know which is much like a square knot, but with an extra wrap on the bottom half.

I’ll admit I’m still working on getting this part right, lest I end up creating the surgeons knot equivalent of a granny knot. But that’s honestly a minor issue and one that I’ll soon solve with muscle memory.

There’s obviously a lot more to learn about suturing, but getting this part down is a huge win for me.

So in one day I’ve come full circle, from a table-saw, to a coping saw, to a suture. But this time the suture was simply practice by me, not necessary on me.

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.

Another Regret and Another Milestone

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I blogged a few weeks ago about a few regrets I’ve had since leaving behind being a DBA but I was reminded of another just over a week ago. It’s an event that combined two of my favorite things: SQL (or more accurately #SQLFamily) and trains! And that’s… SQL Train!

No, it’s not a new Microsoft product or something. It’s an event when a bunch of SQL DBAs and others take the train from Portland Oregon’s SQL Saturday event up to Seattle in prep for the PASS event. So you already know it’s a great group of people. And of course I love riding Amtrak and that’s one segment I haven’t ridden yet, so I would have enjoyed it. It’s something I have been meaning to do for years but never got around to it. That said, I’m sure if I showed up in a future year, I’d be welcomed by my SQL Family, it’s how they role.

That said, this weekend I did something new: I acted in a movie. Technically it’s not my first, but it’s by far the most involved I’ve been. A bit of acting, my daughter is in her senior year of film school and needed a “dad like person in their mid 50s” for a role. After not being able to find someone local to fill the role, she asked me. This involved me leaving work at 3:30 AM Friday after my shift ended, driving a bit, napping for several hours, getting gas, a bit more of a drive, napping again, driving, getting some food, I finally showed up on set. Total, I spent about 6 hours on set on Friday, and 10+ hours on Saturday and 8+ on Sunday.

I’ll admit between short notice (less than a week) and little time (5 12 hour shifts in that week) I wasn’t as prepared as I’d like, but I managed to get most of my lines right.

I’ll say this, as much fun as it was, I do hope I’m a better PA than I am actor! I’m not about to give up my night job.

And that’s it from here this week.