OJ the PA

Three months: My life as a new PA-C

2022-09-22T21:46:00.003-05:00

As I'm sure many new PA's can attest to, the end of PA school is a bit of a blur. One minute you're finishing up classes and studying for the PANCE and the next you're ... here? Three months into practice and wondering how it happened.

Graduation was on May 13, 2022, and that was a really wonderful day. My parents came to support me, I enjoyed beers on the terrace with my friends, and I felt wonderful standing on the other side of three years of grad school.

After a quick day of relaxation, I hit the ground running with my studying. I stuck with my plan for the most part, and felt equal parts "I can't possibly study any more!" and "But I'm not ready!" when exam day arrived.

I happened to be at the very same testing center as a fellow student, so when we finished our exams, we headed over to the local mexican restaurant to enjoy tacos and well-deserved margaritas. Hilariously, our brains were so absolutely melted from testing that we could barely hold a conversation!

And then ... we waited. And waited. For what felt like eternity.

On June 3, 2022, I found out I was officially a PA-C.

After that, I jetted off to Canada for a hiking and camping trip with my sister in Banff. After sitting in front of a laptop and study materials for ages, being able to unplug and reconnect with nature was blissful. Even if it was freezing at night and we basically slept with all our clothes on plus hats and three pairs of socks in our good sleeping bags with a small heater taking the edge off. Better than studying!!

With my remaining time off, I moved into my new house and tried to get myself settled (with breaks to go kayaking on the lake, of course).

I started my job in family medicine on June 20, even though I didn't have my license from the state yet. Unlike bigger hospital systems, I was able to work at this clinic in a student capacity until my license was approved. And I have to say, that process was unnecessarily long.

Perhaps it's not this bad in all states, but Wisconsin did not have anywhere near the staff at our department of professional services to handle all the applications. Plus, right around graduation they started to change things over from paper to online applications. Not ideal.

Students, including myself, were calling daily (and never getting calls back), showing up in person, sending emails, contacting our elected officials, and literally begging and pleading to anyone who would listen to help push our applications through. What a mess.

I know multiple people who had to delay starting jobs or fellowships because of how long it took to get their license. I mention this so that future graduates understand this process can be very lengthy. Even though you graduate in May, you may not start a job until September or even October. Prepare yourself.

Starting my job early seemed like a good idea. But in all honesty, I was envious of my friends who were enjoying some prolonged time off. And even more, I felt very alone during the transition into new practice. I was struggling, and I don't think you can really understand that feeling unless you're going through it, too.

I had been told that the first year of practice was the hardest. They weren't kidding.

When you're done with clinicals, you're ready to be done being a student (at least, I was). I knew there was still plenty I didn't know, but I was ready to learn it on the job. Or, so I thought.

I didn't appreciate the weight of, well, everything. The onslaught of tasks and in-basket messages and result follow-ups and paperwork. The full schedule and medication management and decisions being made independently. The anxiety about managing real patient's lives.

And no matter what they tell you about onboarding and how reasonable it sounds, it feels like being dropped in the deep end of a very, very deep pool.

When you're a student, there's the pressure of getting the answer right. But you have time to think about things and look them up. Knowing that someone is checking your answer provides such a soft place to land.

Clinical year students are probably reading that and thinking, soft place to land?! When my preceptor is ripping me a new one in the middle of the OR in front of other people? That ain't soft!

Okay, that's not, but it's a lot different than having to independently decide the care plan for a patient and move forward with that. Your preceptor may embarrass you and that sucks, but no patient's well-being is on the line in that scenario.

My supervising doctor told me after being at the practice for a bit -- if you're 40% confident or less, let me know. But if you're at least 60% confident, just go for it. I know he was pushing me to be more independent, but 60% does not leave a warm, fuzzy feeling in your tummy. More like a gnawing, uncomfortable feeling.

During these first three months, I have felt exhausted. With the variety of patients I've been seeing in family practice, it's like mental gymnastics all day long, jumping from cysts to ear infections to recent strokes to possible appendicitis to controlled substances to dementia to wounds to anxiety and on and on. It's hard to do all this learning and feel so overwhelmed and to be second guessing every little thing you do.

When I compare how I felt the first couple weeks to how I felt this past week, I can say there has been progress. I am starting to feel better about my decisions. I'm nowhere near where I want to be, but I'm growing.

If I have some thoughts after being a PA for a few months, here they are in no particular order:

Choose a workplace where you'll feel comfortable asking questions. Lots of questions.
Be prepared to be kind to yourself. Therapy can help with that.
Have healthy ways to shut your brain off. Puzzles while listening to podcasts is surprisingly effective.
Have a support system ready. Classmates, of course, but also friends and family.
Make a schedule that accounts for plenty of time to sleep. And take naps.
Convenience is key. If there's ever been a time for meal delivery kits and Target deliveries, this is it.
Listen to the thing everyone says but sounds like crap -- it'll get better. At a glacial pace, perhaps, but it'll get better.

One of my Well Child patients drew this photo of me. I hope those are arms and legs, not chin hairs.

Thanks for reading,

Olivia

My PANCE Study Plan

2022-04-23T11:48:00.002-05:00

I'll start by stating the obvious -- the study habits of one person won't work for everyone. I think that by this point in our PA school journeys, we have all realized this! But this feels like an important caveat to mention right upfront when talking about studying for the PANCE. I have spoken to recent grads and read various posts online about studying for the PANCE and if I've learned one thing so far, it's that everyone studies differently ... sometimes a lot differently!

My plan in particular may seem a little too brief for some. But it's important to note that I've had other important studying opportunities throughout clinical year:

PAEA EOR Exams

This is the first year my school has used the PAEA EOR exams (they had previously written their own exams), and many of us were caught off-guard by how challenging these exams were. This isn't a bad thing -- I was forced to amp up my studying and I think I'm better off for having to take these exams. One other important thing to point out is that my school groups together EOR exams. So for example, at the end of one rotation, I would need to take two exams: internal medicine and psychology, family medicine and women's health, and emergency medicine and pediatrics. Surgery was the only stand-alone exam. So this means I had eight weeks to study two large topics at a time, which meant I needed to really stay on task with my studying! But again, I think I'm better off for having studied very consistently throughout clinical year.

CME Resources Certification Exam Review

My school was also kind enough to provide us with a week-long virtual PANCE review course. And while it was absolutely no fun to feel like I was back in didactic year lectures, it was a really excellent review. We had the opportunity to purchase the biggest binder I think I've ever seen with copies of all of the lecture slides and took short practice exams at the end of each day. We completed this mid-way through our elective rotation and honestly, I wish I could have taken the PANCE right after while everything was fresh in my mind! We did take the PACKRAT at the end of the week, and I was really happy to see that my score had improved by 30 points from when I had taken it at the end of didactic.

Now, admittedly, after my last round of EOR exams and Summative exams, I was feeling a bit burned out. So I stopped studying. Seriously. I needed a break to spend time with friends and family, deal with some of my house preparations, and enjoy some much needed time on the couch with my dog! And I tried not to feel guilty about it.

I really think that worked. While it's a little difficult to get back into the swing of things if you're not in the habit of studying daily, I think I'm going into this next month feeling refreshed and ready to go!

PANCE Study Plan

April 24 - May 8: Rosh practice questions and Lange Q&A practice questions (while finishing my final elective rotation)
May 9 - May 13: TBD; this is my final week on campus, but I'm not sure if I need to be there every day yet ... and May 13 is GRADUATION!
May 14: study-free day
May 15 - May 24: Topic-based studying; these are going to be my biggest, heaviest days of studying. I'm planning to use PANCE Prep Pearls and my CME Resources binder to focus on individual topics and then complete focused Rosh practice questions at the end of each day.

May 15: Neurology and Psychology
May 16: Cardiology
May 17: Cardiology, again
May 18: GI and Endocrine
May 19: ENT and Ophthalmology
May 20: Nephrology and Urology
May 21: Dermatology and Orthopedics (then Charlie Berens show!)
May 22: Women's Health and Rheumatology
May 23: Pulmonology and Pediatrics
May 24: ID, Pharmacology and Antimicrobial

May 25: Complete a practice test that I bought from All Things PA-C (it was cheaper than the ones offered through the NCCPA).
May 26: Maybe review a few final things that I need, but otherwise take the day to take care of ME. Get my mind and body ready for the PANCE.

Yes, this seems like a lot in a very short amount of time. But I'm a person who is motivated by being under pressure! Plus, I think by building in a few fun plans, I'll be able to keep my focus. Additionally, I may use podcasts to augment my studying ("Physician Assistant Exam Review" has been recommended to me by numerous people), and I plan to do a decent amount of studying away from home in an effort to maintain my focus (coffee shops, public libraries, etc).

Again, no two people are going to study the same. I've learned throughout my three years in PA school what seems to work for me, and I've tried to keep that top-of-mind with building this study schedule. Fingers crossed that it works!

Rest-of-my-life Plan

If the PANCE was the only thing going on in my life, that would be sufficient! But apparently, I like to live in a constant state of chaos, so of course there's plenty of other things to keep me busy:

Close on my house early May
Have the bathroom completely remodeled in the month of May
Move the beginning of June
Run away to Canada with my sister on a camping and hiking trip
Start my family medicine job near the end of June, assuming I don't get eaten by a bear!

Thanks to everyone who has followed along with me on this journey. While I'm planning to post some more updates as I graduate, (hopefully) pass the PANCE, and start my job, I'm not entirely sure what this blog will look like in the future. Thanks to everyone who has been great moral support to me along the way!

Olivia

"Hell Week," Electives and Bear Spray

2022-03-14T19:53:00.004-05:00

I just finished what I'm lovingly calling "Hell Week."

Monday: PAEA Emergency Medicine Exam and Pediatrics Exam (2 hours a piece)
Tuesday: End of Rotation OSCE exam
Wednesday: study day
Thursday: End of Curriculum OSCEs - this included a technical skills test on suturing, two small exams regarding diagnostics, an OSCE and a patient education OSCE
Friday: End of Curriculum PAEA Exam (five. hours. long.)

By the end of the week, I was wiped out. I think I had a glass of wine (or two) while I watched Ozark Friday night. It's a bit of a blur, haha.

I know that I passed my End of Rotation stuff, because I needed to pass before I could take my End of Curriculum exams. But sadly, I won't know the results of those exams until this week Friday. Keep your fingers crossed for me!

And while it feels like I'm done, now that those exams are over, it's not over yet. I am starting my last two rotations -- I'll be doing three weeks in orthopedic urgent care and then four weeks in pediatric urgent care. I think these rotations will help prepare me for my future family medicine position.

I'd be lying if I was counting down the days until graduation (59 days) and taking the PANCE (73 days). And after three long years of hard work, I probably deserve a vacation before I start my job, right? So my sister and I are planning a trip to Banff!

I told her I was not at all interested in camping, but would be fine with a hotel stay and driving to our hiking destinations. But wouldn't you know it, we found this fun little campsite with trapper's tents and picnic tables and rentable camping gear.

And, you know, some warnings about how not to attract bears. I have a bit of a sorted history with bears, but that's a story for another time...

I digress! Looks like I've be roughing it in the Canadian wilderness in a few short months. Wish me luck, because I don't think I've been camping since I went camping in my backyard when I was like 10 years old. And somehow I don't think it counts if you find an really long extension cord and bringing a small TV into the tent.

*me suddenly realizing I probably won't have cell phone reception* 😟

Thanks for reading,

Olivia

Rotation #5: Emergency Medicine (and other life updates)

2022-03-14T19:32:00.002-05:00

During PA school clinical year, you learn a lot of things. And one of those things is the many different ways in which you can be exhausted. Mentally, emotionally, physically, spiritually ... and many other ways that I can't currently articulate because, you know, I'm tired. 😅

I was a little bit worried about making a decision about a job before I had even tried emergency medicine. I had been told before I even started PA school by a mentor that I would probably end up in emergency. And I could see why -- I like wounds, excitement, drama, stress, action. Sounds right up my alley!

I want to start by saying I think I probably learned the most on this rotation. I had great preceptors (yes, even the guy who almost made me cry was a good teacher), felt like I was building on a solid foundation from my previous rotations, and had the chance to see a wide variety of diagnoses. From STIs to broken bones, head lacs to gunshot wounds (including one with a retained bullet in the rectum), DKA to a massive calcified clot on the end of a central line, heart attacks to necrotizing fasciitis ... I got to see a lot.

This rotation was mental gymnastics. Coming up with strong differentials quickly and balancing multiple patients at once, knowing the right imaging and labs to get, and coming up with appropriate discharge plans -- whew! And if that wasn't enough, work shifts that range from 6am-2pm, 9am-9pm, 1pm-11pm, and 10pm-7am. Bounce from overnights to early mornings and somehow be able to function! This is maybe the one downside to living in an apartment building during clinicals -- people are not always so quiet around here during the daytime. Oh well, I lived! And I have a lot of respect for the people who live this life; it's not an easy one.

And it's not just about the work-life balance. It's also about the patients. There's a lot of death and loss, homelessness, drug abuse, patients with inadequate care at home, mental illness. I heard the screams of a mother who just lost a child. I saw a patient try to injure herself right in front of me, and then begging to die.

That's the emotional exhaustion part. The in-your-face reminder of the intimate role we as healthcare providers play in the lives of our patients. I'm grateful to be here, but this isn't an easy job to have.

Let's change the subject, shall we? If surviving my clinicals and trying to stay alert and oriented x3 wasn't enough, I decided to start looking at houses. Initially, this started as a research endeavor. I knew the housing market has taken a big turn in the last couple of years (which worked very much in my favor when I sold right before clinical year), but I wasn't really sure what this was going to mean for me hoping to buy. I was nervous that things were going to be priced really high (uh, that turned out to be very true). But during my research something happened.

I found a house I really liked.

They always tell you not to look before you're ready and to not look above your price range and blah blah blah. And I made that rookie mistake! So then I decided, well, I've been down this road before. Lots of times the photos look better than the house in person. I'll go see it and realize it's not that great and can get on with my life.

Welp, I still liked it.

Long story short, I put in an offer and after some competition and back-and-forth, my offer was accepted! I wish that was the end of it, but if you've bought a house before, you know that's not really the case. We had the inspection, a lot of big things came up, I panicked, we negotiated for THIRTY-FOUR days, and finally came to an amendment we could both agree on. And the appraisal came through above offer. WHEW. So now it's smooth sailing until I close in early May.

Thanks for reading,

Olivia

Rotation #4: Family Medicine (and my future job!)

2022-03-14T18:55:00.000-05:00

Time flies when you're doing your clinical rotations and everything that isn't absolutely mandatory goes to the wayside. I've been MIA for a few months from this blog, but alas, that's life as a PA student. Let's get caught up, shall we?

When I had been thinking about my future job, I wanted to end up in some “sexy” specialty like ICU or surgery (assuming I wasn’t the type to pass out in the OR, which luckily, I wasn’t!).

Family medicine had always been at the bottom of my interest list. I went into this rotation thinking, “let’s just get this over with.” Boy, was I wrong about what I thought family medicine was!

I get to build relationships. I can do procedures like toenail removal and cyst removal. I even helped with a few vasectomies! I get to see adorable little babies. I get to know what actually happens in the long run with my patients (rather than discharge and disappear).

And best of all, I am challenged daily. The breadth of things I need to know to care for my patients is wide. It is so much more than just diagnosing the common cold, which I had previously dismissed family medicine as being.

Every specialty has pros and cons. So, keep an open mind and you may be surprised by what appeals to you the most!

The doctor started making remarks about offering me a job. Because it was so far from what I had originally imagined, I wanted to take some time to think about it.

One day toward the end of my rotation, I was talking with a patient and he asked if I was considering staying. I said yes, but was honest about how it hasn't be what I originally envisioned. And you know what the patient did? He told me to watch a movie.

This movie was probably made before most of you were born. It's called "Doc Hollywood" and it's a 1991 movie with Michael J. Fox. He plays a young doctor, headed to LA for a fancy surgery job. On the way, he crashes his car in a small rural town, and while he's there waiting for his car to be fixed, the townspeople try to recruit him to be their local provider.

This is going to sound ridiculous, but this movie helped tip the scales for me. It reminded me about the uniqueness of rural medicine and the importance of building relationships with your patients.

Of course, not working weekends or holidays or overnights was also part of the decision! And having an amazing group of people to work with, who I really connected well with. So when an official offer came through over my holiday break, I gladly accepted it. You're looking at a future family practice PA!

Over my break, I took a solo trip to LA and got to meet the wonderful @theflowery_pa.

P.S. During this rotation, I got to work in a rural women’s health clinic and it was awesome! Vaginal ultrasound to measure cervical length (and see some baby legs kicking mom in the bladder), endometrial biopsy, annual exams, and lots of prenatal exams. I measured fundal height and checked fetal heart times.

Yes, those are speculum reindeer!

Rotation #3: Internal Medicine (and pondering my future)

2021-10-08T10:38:00.004-05:00

When I decided to go back to school to be a physician assistant, internal medicine is what I had in my mind. As a clinical dietitian, I had the chance to collaborate with APPs and loved the idea of being able to provide that kind of care to patients. One of the APPs who I had the chance to work with often while I was a dietitian became my preceptor for this rotation! It was very cool to be standing in the exact spot I had imagined back then.

Back then, though, I did not appreciate just how challenging this job would be! I worked with a small private practice group that has privileges at various area hospitals, and my preceptor and I were based at one large metro-area hospital. The service was crazy busy the entire time I was there, and that was both good and bad. I got to see a ton of different diagnoses, a wide variety of patients, and was challenged to be relatively independent. But dang, it was hard to keep up most of the time. Honestly, I worked more and was more exhausted during this rotation than during my surgery rotation. And everyone told me surgery was going to be the hardest! Ha.

Here are some of the more unique diagnoses I got to see along the way:

Thyroid storm: way too much thyroid hormone in the body that causes symptoms such as fast heartbeat, weakness in upper arms and thighs, insomnia, and delirium
Endocarditis: infection in the heart due to IV drug use; the patient had to stay hospitalized for 6 weeks for IV antibiotics
Hepatic hydrothorax: ascites fluid from liver disease goes into the chest cavity due to a diaphragmatic defect
Cauda equina: spinal nerve roots are being compressed and cause bowel and bladder dysfunction
Abdominal migraine: persistent nausea and vomiting in a patient with history of migraines, successfully revolved with new migraine medications
Penile fracture: I think this one is self explanatory

And the coolest one of all...

Diabetic striatopathy: this is a rare condition where hyperglycemia, usually in post-menopausal women, causes them to have choreiform movements and striatal abnormalities in their brains

Also worth mentioning is that a patient "fired" me because I had "bad vibes," and on my very last day I asked a patient with a tooth abscess and possible jaw osteomyelitis if she wanted nicorette gum, even after she told me she was having trouble eating due to the pain. Doh!

Pondering my future

I've been trying to assess as I go along what I want to do for a job when I graduate. And honestly, I think I have less of an idea now than I ever have! Did I love orthopedic surgery? You bet I did. But did I love it because I did absolutely zero charting and zero rounding on patients and zero differential diagnoses, and just participated in a ton of fun surgeries with surgeons who let me use bone saws and lasers because I was a bright-eyed student? Yeah, I have the feeling that had a lot to do with it!

I recently participated in a virtual Q&A for an orthopedic surgery fellowship, which I am certainly interested in. However, I would be lying if I said I didn't have reservations about being a glorified student for another year. At the same time, the chance to dive so deep into a specialty and build my skills is also really appealing!

This internal medicine rotation is the first rotation I've had where I feel like I've seen exactly what life is actually like as an APP in this role. General surgery was also very close to reality, but I did very little charting there as well. Either way, it's a lot to think about. I certainly miss the hands-on aspect of surgery. Surprising even to me, I really like the blood, guts, and gore. Taking out a big pilar cyst and doing a debridement of infected bilateral BKA wounds are a couple of my favorite memories so far. And let's be real. Wearing scrubs all day is the best. Ha.

I'm trying to keep an open mind for a lot of reasons -- I am not even halfway done with clinical year. I have a lot yet to see. Who knows, I could fall in love with emergency medicine or one of my electives. And, perhaps this is due to the pandemic, but a lot of my former classmates who graduated this past May have had a heck of a time finding jobs. Many of them ended up taking jobs in areas they hadn't originally planned to go in to. The city I live in is very saturated with PA new grads, too. So I'll also have to consider if I'm willing to move for a job, or if I'd prefer to take when I can get here.

Lots to think about!! And I'm going to try and just enjoy the ride and not get ahead of myself.

Thanks for reading,

Olivia

Rotation #2: General Surgery

2021-08-08T11:59:00.006-05:00

Another one bites the dust! It's crazy to me that another rotation (and therefore all of my surgery experience) has come to an end.

If I want to be one thing, it's totally honest. This rotation was challenging. I had a ton of fun during orthopedics -- I felt like a lot of providers and residents wanted to show off how great their subspecialties were. And they succeeded! But I didn't get pimped very much and I wasn't seeing patients independently.

That all changed in a big way when I went to general surgery. Did I learn a lot because of this? Absolutely. Did I feel like an absolute pile of garbage most days because I felt like I couldn't do or answer a damn thing right? Yes. Did I talk to my classmates and get some reassurance that many rotations feel like this? Also yes. Thanks for making me feel less alone, guys. The days were long and the list of things to study was even longer. But here we are, one rotation down. We've survived, so far at least!

One big tip? Don't be afraid to ask for feedback. Because here's the thing. If you're missing the mark with something, then at least you will know what to focus on. Or, you'll be pleasantly surprised to hear positive feedback (even if you're convinced they think you're a dumb*ss).

I distinctly remember one day being near tears at least twice (once because I was exhausted and I felt I was doing especially bad with the pimping, and once because the OR nurse had decided it would be fun to bully me when I was already emotionally at the end of my rope), and I asked for feedback at the end of the day. Yes, I needed to review anatomy, but also I was doing a really good job catching on in the OR (assisting with the patient before and after the procedure, using the laparoscope, that kind of stuff). Honestly, that positive feedback is what kept me from falling into a pit of despair for the whole weekend. It was exactly what I needed to hear, but I wouldn't have heard it had I not asked.

It certainly wasn't all bad. Again, it was a great learning experience. I had the chance to see a lot of different diagnoses:

cholecystitis and biliary colic
all kinds of hernias
anal condyloma and hemorrhoids
diverticulitis, crohn's and ulcerative colitis
bowel resections and ostomies
total and partial mastectomies
lipomas, pilar cysts and sebaceous cysts
hydradenitis supprativa (lots of this, surprisingly!)
amputations (both in the OR and post-op care)
roux-en-y gastric bypasses and sleeve gastrectomies
and so much more!

I really started to work on getting my suturing down, and had more chances to use the stapler! I was seeing patients independently in the ED, assisting in their cases in the OR, and then doing their post-op follow-up. It was really nice to be a part of the care from start to finish (well, without seeing them follow-up in the clinic, I suppose, but close!).

I'm also really happy that surgery was first for me. You're nervous as heck for the first rotation, and you're going to be nervous for surgery, so why not get it all done in one shot?! Ha. Plus, learning to suture on sedated people is really nice!

What's next? Internal medicine. I'll be working for a small private practice in their clinic as well as seeing their patients at a large metro area hospital (where I used to work as a dietitian!). I'm both excited and nervous, but that seems to be the name of the game when it comes to clinical year. Excited and nervous and stressed 100% of the time.

Thanks for reading,

Olivia

Rotation #1: Orthopedic Surgery

2021-07-10T12:00:00.003-05:00

And just like that, four weeks of orthopedic surgery have already come to an end! Time for a little (okay, long) recap, shall we?

Overall, I sincerely enjoyed my orthopedic surgery rotation. My primary preceptor works in Total Joint, which is where I spent my first week. To make sure I got a nice, broad view of ortho surgery, she asked me to rank my preferences for eight different areas, and then got me set up with my top choices, spending one week in each.

Total Joint

I don't think a ton of people can say that on their very first day of PA clinical rotations they got handed a bone saw! I got to cut through the patient's tibia to make the flat surface for the knee joint. I was literally vibrating with excitement as I handed back the bone saw. So cool.

Pro tip #1: Don't forget your shoes at home for your first day! Yup, this girl totally forgot her tennis shoes at home and had to do an entire day in my Toms slip-ons. Luckily I had blue shoe covers on, so no one except my preceptor knew this. Ha!

Pro tip #2: Breathe through your mouth when the cement is being mixed. Did the flying bone chips and blood splatter on my face shield do me in? Nope. But the cement... yup! I got super lightheaded from the overpowering smell and unfortunately had to step away from the table. My preceptor did a great job normalizing this for me, reassuring me that almost passing out meant nothing about my ability to do well in surgery. Needless to say, the next time cement was used, I breathed through my mouth only and did just fine.

If you're worried about feeling faint in the OR, you are not alone. I was seriously scared that I wouldn't be able to handle the OR. I've had vasovagal experiences in the past with PEG-tube placements and seeing brand new ostomies, so I had real concerns about all the gore in surgery. However, I think having gone through Gross Anatomy at the beginning of PA school really helped with exposure therapy.

During my cement episode, I turned to my preceptor and calmly stated that I felt light headed. I stepped back from the table and the circulating nurse removed all my gear for me. She then walked me back further to the wall and instructed me to sit on the floor with my back against the wall and gave me an ice pack for the back of my neck. Please note, that this does take a minute or two to get done. Speak up sooner rather than later so your gear can safely be removed before you go down! After a couple minutes of sitting, I got up and went to the staff break room to get something to drink. When I felt better, I was able to come back into the OR and watch the last parts of the surgery. No one cared. No one made me feel bad. The surgeon commended me on knowing when I needed to step back before anything bad happened.

This is important -- if you think you may pass out, don't try to tough it out. I've been told this by many people and I couldn't agree more. It is much, much, much better to play it safe and responsibly manage yourself than it is to try and push through and wipe out. One of the residents I worked with later that week told me about how he tried to push through and passed out in the middle of a surgery. This is bad for so many reasons: you can hurt yourself, someone else, contaminate things... just don't. One of the surgery techs told me about a student who waited too long to speak up and passed out while trying to leave the OR, instead smacking his face on the edge of the door. Don't be that guy.

Okay, enough about passing out in the OR. I also need to talk about how I almost broke the sterile field! The surgeon asked for the bovie (a cautery device). I saw the blue cord and lifted up on it to try and find where the bovie was hiding (a number of things actually sit on the patient and can get lost in the folds/creases of the sterile drapes). Unfortunately, the bovie had fallen off the patient and below the level of the table, therefore making it unsterile.

"STOP!" the surgeon shouted when he realized what I was doing. Luckily I hadn't brought the bovie up onto the patient, but it likely brushed up against my gown on the way up, so I stepped away from the table, got a new gown and gloves, the bovie cord was snipped and a new bovie was connected, and I got to jump back into the surgery. Important lesson learned!

As a student, you are thinking about so much all at once. Retracting properly, using the suction well, learning about the surgery, listening to the surgeon and other staff, and trying to function safely in this very foreign sterile OR environment. It's a lot! Chances are pretty good you'll make a mistake. Don't be offended when you're corrected. Be honest if you think you did something wrong. Learn, and move forward.

During my week in Total Joint, I had three surgery days and two clinic days. On my clinic days, I got to do my first ever joint injections! Those are actually a lot of fun. I watched about three injections before my preceptor asked if I wanted to give it a go. Yes!

Preceptor: "Is it okay if Olivia does your injections?"
Patient: "Sure." *I get myself all situated in front of him* "Wait, is this your first injection ever?"
Me: "Umm, yes." *pauses, trying to figure out some way to reassure him* "...but I've practiced on mannequins!"
Patient: "Yeah that's not really the same thing." *laughs*
Me: "Yeah, I suppose you're right, it's not."

Luckily, he still let me do his injections and they went really well! I also got to watch a joint aspiration and remove surgical dressings for a patient who was two weeks out from her surgery. Overall, a really great first week.

Orthopedic Trauma Surgery

This rotation was so much fun! Granted, I think I needed to see a chiropractor after I was done, but I had an absolute blast working with some really smart residents and surgeons. I was a little worried about being at a teaching hospital and that I wouldn't get good hands-on experience with residents and medical students around, but I got really lucky in that there were no medical students around the week that I worked with this group. This meant I got tons of great experience without having to fight for my shot.

One of the interesting parts about this group is the overlap with emergency medicine. I got to follow along and assist with evaluating patients, placing splints, and getting surgical consent from patients in the ED.

As cool as that was, nothing compared to this OR experience. I even got to be first assist a few times! Literally on my eighth day of being a clinical student, I was first assisting for a fourth year resident in a surgery. Just us! That was absolutely mind blowing to me, but it was such a good experience.

This week, I was also able to start doing simple interrupted and horizontal mattress sutures, I assisted with wound vac placements, and helped with some post-op splinting as well. I got lots of exposure to many different kinds of fractures, lots of practice with scrubbing and prepping patients before surgery, and lots of experience assisting with the surgeries.

I figured orthopedic surgery was a bit of a wild card for me; I was either going to love it or hate it. After seriously enjoying my trauma surgery week, I felt like this could be a big contender for a job or fellowship after graduation. But it's still early, so we'll see!

Also, shout out to the amazing circulating nurses and scrub techs who provided tons of guidance and tips about handling instruments, staying sterile, proper gowning and gloving, and so much more. Be open to the advice of these very experienced folks!

During my trauma week, I spent four days in the OR and none in the clinic (I could have, but my preceptor and I agreed that the OR time was very valuable, and since the clinic had no patients scheduled that Friday because of resident graduation, it made the most sense for me to skip it and savor all the OR time I could get -- I wasn't going to argue with that!).

Ortho Oncology Surgery

This week was admittedly a little overwhelming. I was paired with a PA who loves to teach, which is amazing, but oncology is a very vast area of medicine and there was so much to be learned. But, this meant the opportunity to go through a lot of different patient cases, review scans, and most importantly, discuss can't-miss diagnoses even if I don't end up in orthopedic oncology. Don't go messing around in a lipoma until you're 110% sure it's really just a lipoma!!

I was able to sit in on a tumor board meeting, during which cases were presented and the pathologist provided insight into the different diagnoses. Earlier in the week, I had assisted with an open biopsy for a patient with a lesion in her humerus; during the tumor board meeting, I was able to find out the results -- Rosai-Dorfman syndrome. And while this isn't cancer, there's a chance the patient will need both steroids and chemotherapy to treat it. So cool!

I also had the chance to take a sample during another open biopsy down to pathology and see this team work to help differentiate if a patient had melanoma or multiple myeloma in his bone, so we could proceed with the rest of the surgery accordingly. Turns out it was melanoma, and I was given a laser to burn that area of the patient's bone and hopefully help kill any remaining cancer cells. A laser.

During this rotation, I was also able to assist with probably the wildest surgery of my entire career. We did a radical resection of most of a child's femur and a large portion of his tibia to remove osteosarcoma and replaced this with a custom implant. It was amazing to watch the surgeon carefully dissect away basically all of the soft tissue on the child's leg to complete the bone resection. He also did a rotational muscle flap which was cool to see as well. Honestly, I'm still reeling from this experience!

Hand and Upper Extremity

Thanks to the 4th of July holiday, this part of my rotation was cut short and I could only spend four days in this subspecialty, but it was a good experience nonetheless. I spent three days in clinic and only one in the OR, though (which was a bummer because this girl loves her OR time!). When I was in the OR, I assisted on a distal radius fracture repair with a plate and screws and carpal tunnel release, and then observed a small finger amputation (due to destruction from a giant cell tumor) and a distal biceps tendon repair.

I found this clinic time to be valuable especially because I felt like I was starting to get in my groove with patient evaluations, determining what special tests to complete during the physical exam, the right questions to ask the patients, and then how to give my preceptors an efficient oral presentation. My preceptor started pushing me to make treatment recommendations, and while I wasn't always right, it was good to start exercising that part of my brain as well.

I also had the chance to following a patient to hand therapy to watch a special splint be made for him. The occupational therapist who did this even gave me some of the material to try and make a splint for myself (it was ugly, you guys!!). I appreciated the chance to see this particular patient encounter from start to finish, and enjoyed having insight into what other members of this team are able to do for the patients.

Overall Thoughts

I'm absolutely amazed that my first rotation is already done. It was seriously bittersweet to turn in my badges knowing that this wild ride of ortho surgery is already behind me. Again, I requested a rotation on orthopedic surgery kind of as a wild card; I didn't really know what to expect and wasn't sure if I was going to like it. I think it was amazingly valuable that I got the chance to work in so many different areas in just a few short weeks, and I could certainly see myself working in a couple different orthopedic subspecialties in the future.

If I could have done anything differently during this rotation, it would have been a better commitment to studying for my EOR. I spent a lot of my evenings focused on ortho content, as to prepare for the actual work I was doing on this rotation. But since this isn't really going to be the content on my EOR exam, I'm a little nervous that I'm behind on my studying. Time to kick it into high gear I guess!

Thanks for reading,

Olivia

The Big Transition: Didactic to Clinical Year

2021-06-11T11:24:00.001-05:00

I'm back! No better time than the transition between didactic and clinical year to resurrect the blog, am I right? Let's do a quick look back on didactic year and talk about what's ahead.

Review of Didactic Year

As a reminder, I was a distance education student, so unlike most PA students who complete didactic over one year, I did it over two years and completed most of it from my home community. Because I was "part-time" I was able to work and even started a new job during my didactic period (probably wouldn't recommend that...). I worked 24 hours per week during my first year (because the job was new and quite challenging, and I was doing the "Big 3") and then increased to 32 hours during my second year (because, hi, money is nice and I felt more comfortable stretching myself a little thinner, haha).

I've written in the past about how I studied in PA school, so I won't repeat that here. Instead, I will say this: doing PA school part time and being able to continue working was a great experience. I do have some concerns about the "Big 3" content being a year ago already (do I remember it?!), but being able to keep my foot in the door at the hospital I work at, keeping my patient care skills alive, and honestly, having the opportunity to step away from life as a PA student was really great. Plus, during a pandemic, it gave me the chance to be around other humans. I seriously can't imagine being a full-time PA student stuck at home doing online school during a pandemic. For those who went through that, I give you all major credit for surviving!!

And you know what the end of didactic means -- white coat ceremony! We were able to do a socially distanced version in person this year with family and friends watching a live video stream. It was great to be able to mark this major turning point in our education together.

Thoughts Heading into Clinical Year

I am terrified. I'm just going to be honest about that. Like I said before, because my didactic education was stretched out, I'm worried I've forgotten a lot of information. But there are two things I remind myself about to keep me off the hypothetical ledge: All the students who have gone before me have survived. We did the PACKRAT last week, I did fine, so I must know more than I think I do.

I'm trying to give myself a little grace. I may not feel 100% going into my clinicals, but I can't go back and change anything. Instead, I can commit to being a good learner and having a really good study schedule for my upcoming EORs (end of rotation exams).

We had clinical orientation week this week, and I am wildly overwhelmed. Quizzes, assignments, online learning, radiology modules, evaluations, CEXs (???), daily patient logging ... my to-do list just got REALLY long. And then add reviewing for what you're seeing on rotations as well as studying for the upcoming EORs and it is a lot.

Again, everyone who has gone before me has survived. I will, too. I foresee more crying in the shower like I did at the beginning of didactic, but I will survive! Haha.

And if you're curious here's the list of my rotations so far:

Orthopedic surgery (4 weeks)
General surgery (4 weeks)
Internal medicine (8 weeks)
Family medicine (8 weeks, rural)
Emergency medicine (8 weeks)
Electives (TBD!)

I'm a little bit sad because my internal medicine was originally planned to be split (4 weeks internal medicine and 4 weeks of surgical ICU). Unfortunately, the SICU wasn't able to be confirmed in time, and so I'll be doing all 8 weeks in internal medicine, with some of that being outpatient. Not exactly my ideal situation, but I'm sure it'll still be rich with good learning opportunities.

Life Updates

I wouldn't be me if I wasn't making my life as wild and hectic as possible! I made a last minute decision to sell my home and move into an apartment during my clinical year. While there was a plethora of reasons which I won't bore you with here, I knew this wasn't my forever home and with the market being so hot right now, it was a great time to make some good money (important for someone with grad school debt who is now unemployed!), and I liked the idea of having less responsibility while going through my clinical rotations. In other words, the short term CHAOS I am currently dealing with will be worth it in the long run.

The timing isn't exactly ideal; I'm moving two days before I start my orthopedic surgery rotation! But, I'm choosing to look at this like a glass-half-full situation and at least it is happening BEFORE I start my rotations. It's all about perspective right?? And, it also means I've been so busy worrying about moving that I haven't been able to worry too much about rotations. Ha!

Blog Moving Forward

Posting will likely continue to be inconsistent, but I'm hoping to share my life as a clinical year PA student! Not only will this be a great place for me to debrief, but I hope you learn something, or at least can be entertained.

Thanks for reading,
Olivia

PA School Applications: Don't Sweat the Small Stuff

2020-11-21T12:44:00.000-06:00

When I knew I wanted to go back to PA school, I started to focus on networking with PAs in the area, especially since I had hoped to stay local. I met with a couple of recent graduates who told me about their journey over some Starbucks, spoke with PAs and MDs at the hospital I worked at, and even went as far as using LinkedIn to find people who might be able to hook me up with other connections.

One of my old tech/marketing friends was connected to a faculty member from a school I knew I wanted to apply to. So I asked her to virtually introduce us, which she so kindly did, and this faculty member agreed to meet for coffee to give me advice.

We met at a small coffee shop in his neighborhood, I bought us some coffees and we sat down to chat. Honestly, it was terribly awkward. I got the sense that he wasn't that interested in being there to meet with me, so I tried to keep things brief as to not waste his time, but I still wanted to show my sincere interest in the profession and the university he worked for.

I asked about how students are selected for interviews, and we started talking about the various factors that go into this process. He asked where I did my undergrad, and I told him it was a local public university. He shook his head and said something along the lines of, "Yeah, that would put you in one of our lower tier lists."

I was both offended and disheartened. Yes, I realize you need to sort through your bazillion applicants somehow. And that's why things like GPA and patient care hours and such are important. You'll get sorted accordingly. But these things are not the end-all-be-all. You can still get accepted to amazing PA programs if you can shine in other ways.

This is why it kind of drives me nuts when people share their stats on social media. Yes, it matters, but I think all that does for pre-PAs is discourage them if their stats don't line up. Plus, you can be a great applicant on paper and interview poorly and none of that will matter.

Here's the moral of the story: Don't be discouraged if your stats aren't perfect. Emphasize your strengths, explain any weaknesses, and show them who you really are.

The school that faculty member worked for? I applied to it the next cycle, got an interview, rocked the interview, and was offered a spot in their program. I got myself all worked up about being from a "lower tier school" for nothing. It ended up not mattering at all.

Spoiler alert: I also got an offer from my first-choice shortly thereafter, and declined their offer. Sure, I lost a fat deposit in the process, but I feel like everything worked out the way it was supposed to. Again, don't get yourself too worked up about GPA or clinical hours or shadowing time or undergrad degrees or previous work experience. Show them who you are from a broader perspective, and if you're a good fit for the program, those details won't matter as much as you think.

Do everything you can to have a strong application, but don't sweat the small stuff. You got this.

Thanks for reading,
Olivia

Campus Visits: Highs and Lows

2020-10-29T21:21:00.002-05:00

I just spent two lovely days on campus for my second and final campus visit of the semester. Here's what we accomplished each visit:

Visit 1

Lumbar punctures
Sterile technique
Clinical cases
Practice H&Ps
Focused H&P 1 with a standardized patient

Visit 2

GU exams with a specialized teaching associate
Joint injections
Chest tube placement
Clinical year Q&A
Focused H&P 2 with a standardized patient
Suturing

The GU exam was quite the experience. Our university brings in specialized teaching associates who are experts in either the male GU exam or female gynecologic exams. We discussed taking a proper sexual health history, teaching patients about condoms and proper usage, the correct language to use for these intimate discussions, and more. They also taught us proper technique for performing these exams... on their own bodies.

Don't get me wrong. I was very nervous about this and it was a bit awkward. But what better opportunity to learn about this than when the "patient" is also the expert and can give you excellent feedback on things like positioning, pressure, pace and more. I felt 100x more confident by the time we completed this four-hour long training session.

But then tack on a joint injection lab and chest tube lab, and by the time I got back to my hotel room to start reviewing for my H&P the next day, I was absolutely wiped out. I seriously could have fallen asleep no problem at 7:30pm.

My focused H&P the next day went... okay. It wasn't my most stellar performance, but I felt like I've made some improvements over the first one regarding my interviewing abilities and physical exam technique. But I felt flustered especially at the end when it came time to determine the treatment, and definitely chose the wrong medication. Yikes, yikes, yikes.

I was able to forget about this blunder pretty quickly, though, when I walked into our last lab of the visit -- suturing! A slew of pigs feet and suture kits lay before us, and I was instantly jazzed up and ready to tackle the next thing.

During this time, we had a chance to ask our clinical year coordinator any questions we had, and believe me, we all had plenty! We have about 18 days to fill out a preferences form (if we want to split any rotations, what specialties we like, where we have housing, etc), so that means it's getting closer!

I got in the zone and really, really enjoyed giving suturing a try for the very first time. Granted, my vertical and horizontal mattress sutures could really use some work, but you gotta start somewhere! I left feeling excited about this hands-on skill and looking forward to more opportunities to practice.

But that high didn't last long and was left feeling... heavy.

At first I thought it was the emotional exhaustion lingering from our GU activity. But then I realized it was a combination of things. Yes, the GU exam was a big deal. But that, combined with planning for our clinical year, plus feeling less than stellar about my focused H&P, I was left wondering... how in the world am I going to go from where I am now to ready for clinicals in just seven short months?!

We have learned so much. When they say it's like drinking from a firehose, they are not lying. But now I find myself getting questions from my dietitian colleagues inquiring about random medical topics, and I'm saying, "well, I should know that!" Recalling what I've learned is such a difficult task. If you don't use it, you lose it, right?

I should be doing more. Studying more. Reading more. Reviewing more. Practicing more.

I'm feeling inadequate, tired, unintelligent, pressured, overwhelmed... did I mention tired? I genuinely want to be ready when clinicals come around. I don't want to make a fool of myself and more importantly, I want to show that I can care for my patients well. This educational process isn't just about passing classes and getting the degree. It's about coming out the other side competent enough to have peoples' lives in your hands.

I try to remind myself of how I felt as a dietetics student. I learned a lot in didactic but the rubber really hit the road when I finally got into my internship and could put that knowledge to use. Really solidify it with experiences. And practice. Lots and lots of practice. Maybe if I keep reminding myself of this, it'll help take some of this pressure off.

This stuff takes time and patience and practice and diligence and commitment. I can do that if I remember to be patient with myself, too.

Thanks for reading,

Olivia

How I Study During PA School

2020-09-02T17:06:00.001-05:00

Many students find that they need to adjust their study habits when it comes time to tackle the information overload of PA school. I was certainly in that camp. My study skills up until that point were effective, but I knew both the time commitment and complexity of material was going to be a challenge.

If you're starting PA school and freaking out about your study habits, don't panic! Take a deep breath and consider what has worked well for you in the past. For me, I'm old school and I like writing things out by hand. Plus, I've found that digital flashcards are a great way to practice topics that require a lot of repetition.

My study habits may not work for you. But, I still wanted to share so you have some ideas as you build your own studying framework.

1. Use OneNote to take notes on PowerPoints during class.

My laptop is an HP Envy x360, so it flips into a tablet. I import any provided materials, like PowerPoints, into OneNote and use my tablet pen to jot down notes and highlight important things during the lecture. Also, writing things down during lecture helps to keep me focused and engaged during online lectures, when it seems to be especially easy to zone out or get distracted!

2. Review these notes and use PANCE Prep Pearls to create hand-written study sheets.

I am someone who learns by writing things down. Not typing. Not highlighting in a book. Writing with a pen and paper. So, I embraced that. Now, this can be a time consuming process if you're not careful. I regularly reminded myself to focus on the most important or most challenging concepts, and tried not to waste my time on stuff that was easier to understand. I didn't always do a good job of this, but keeping that top of mind helped me to stay focused and efficient.

I used PANCE Prep Pearls if I was unclear about something from the lecture and wanted another resource to concisely answer my question. I found that even though I wanted to read the whole chapter and highlight important stuff as I read it, I often didn't have time for that.

3. Use Quizlet to make pharmacology flashcards.

Pharmacology was challenging for me, so repetition was key. Initially, I tried to make hand-written flashcards but there just isn't enough time in the day. So, I typed these out and rather than noting everything about each drug, I tried to focus on the most important and unique features. I created these flashcards to be used with the "matching" game on Quizlet, and sometimes my classmates would play along with me and we'd get some good competition going to see who could be the fastest!

4. Do practice questions!

My university would provide a practice test for each exam, and this was an excellent way to review as the exam got closer. Plus, sometimes the questions would be repeated on the actual test! I almost always supplemented this with questions from Lange Q&A. Sometimes this didn't work out perfectly (for example, my university would split Endocrine into two separate exams), but it was still pretty easy to use the Lange book as practice (ie., yes I should know the answer to this question!).

In my opinion, it's one thing to know the content, and it can be entirely another to apply what you know to a test question or scenario. This forced my to exercise my knowledge in a new way to really make sure I understood the content.

5. Review additional materials, time permitting.

I'm probably in the minority here, but I'm not a big objectives person. But, my classmates were amazing at sharing resources with each other (I shared my pharmacology Quizlets, they shared completed objectives!). If I had time before an exam, I found that reading through the objectives was a great way to just look everything over one last time and make sure there wasn't anything I had missed via my own methods of studying.

Again, think about what methods have worked for you in the past, and start there. You may need to make some minor adjustments along the way to optimize your strategies, but it doesn't make a whole lot of sense to change your ways and have it backfire. You know your learning style best.

Thanks for reading and happy studying,
Olivia

Resiliency: PA School During a Pandemic

2020-08-26T14:53:00.001-05:00

I saw this article on Facebook and it really hit home for me: "Your 'Surge Capacity' is Depleted -- It's Why You Feel Awful." I strongly encourage you to read the whole article yourself, but a few things stuck out to me that I feel compelled to share.

First, what's surge capacity? It's your adaptive abilities for dealing with acute stress. The problem with a pandemic is that it isn't really acute in the same way that a massive tornado or other disaster might be. We're in this for the long haul, and if you're like me, those adaptive abilities have worn thin.

For me, this has looked like feelings of helplessness and exhaustion. I've spent a lot more time on my couch watching bad reality TV than I'd like to admit. But with school starting in up in less than a week, that really isn't going to fly. So how does a student (in an intensive graduate program) keep moving forward?

"Both-And" Thinking
One of my favorite lessons from this article was the idea of using "both-and" thinking. Used in ambiguous situations, it allows you to say "this is terrible, but it also might not be terrible. As a student, this might mean saying, "Online learning isn't the experience I wanted, and this my opportunity to chase my dream of becoming a PA." Or, "I'm a goal-getter and badass student, and I'm being patient with myself and understanding not every day is going to feel great."

Self Care, but Different
I've said in the past how important self-care is during PA school. That's especially true now, but it may look a little different than the pedicure or dinner with friends you may have had before. For me, I've been trying to prioritize being outside (whether I'm biking, hiking with friends, or better yet, socially distanced at the beer garden!). Your time is limited in PA school, and you'll be tired, so thinking of safe and enjoyable ways to spend that bit of free time may not be easy. But it's so, so important.

Healthy Habits
Speaking of being tired, self care also extends to your day-to-day habits. Going for a run or a walk. Eating healthfully. Getting enough sleep. These things all help to reduce stress and help you feel more resilient. If you don't take care of yourself, you'll be more likely to burn out.

This has been one heck of a summer. Kudos to the students who have managed to balance everything so far! PA school has always been a tough road, and now we just have a few more roadblocks to navigate now. But we're all highly capable people! As always, lean on your support system -- your classmates, faculty, family and friends. Be patient with yourself. You've got this.

Thanks for reading,
Olivia

PA School Interviews: 35 Practice Questions and Tips for Zoom

2020-08-22T10:10:00.002-05:00

Getting ready for PA school interviews? Congratulations! And while interview season may look a little different this year (Zoom calls, anyone?), the importance of being properly prepared is still the same!

I used to work in advertising and public relations, and sometimes I would prepare experts to talk to the media. What was the most important thing for the experts to do? Know your key messages. There's going to be topics you know will likely be addressed in an interview, so be prepared to speak to those specific things.

Same goes for PA school interviews. Yes, I've heard of programs asking some off-the-wall questions that you probably wouldn't see coming, but generally speaking there's a variety of likely topics that will come up. My advice? Think through how you want to answer those questions ahead of time. For me, this looked like an 11-page Google doc with sample questions I prepared answers for. It forced me to think through scenarios I'd want to share and my key messages about who I was as an applicant that I wanted to be sure my interviewers knew.

I didn't memorize my answers. I didn't sound rehearsed. But I did sound prepared! And that's the goal, right?

Check out these sample PA school interview questions that you can prepare to answer prior to your interviews:

Tell us about yourself. (Tip: practice keeping this concise)
What makes you unique? What are you famous for?
Tell us about a time you worked with someone you didn't like. (Make sure this story has a happy ending!)
Tell us about your biggest strength and biggest weakness as an applicant.
Tell us about a time that you didn't meet expectations. (Again, have a happy ending here. What did you learn? How did you change moving forward?)
What kinds of challenges do you see involved with being a PA student?
How many hours a week do you plan on studying? How have you prepared for the rigorous nature of PA school?
What have you done to get yourself prepared for the PA profession?
What have you done to increase your changes of being accepted into PA school?
What have you done, other than shadowing, to prep for the PA profession?
Why do you want to be a PA versus an NP or MD? What's the difference between a PA and an NP? What's your understanding of what a PA does?
How do you see healthcare changing in the next 5 or 10 years? How will that affect the PA profession?
What's an important aspect of the PA and physician supervisor relationship?
If your physician supervisor tells you to do something that you know is incorrect, what do you do?
If you had to choose a role in healthcare other than PA, what would you choose and why?
Who is the most important person on the healthcare team?
If we didn't accept you, what do you think the reason would be?
What's your plan if you don't get accepted this cycle?
Why do you want to be accepted by our program versus others you applied to?
How did you evaluate and choose the programs you applied to?
Why should we accept you into our program?
What contributions would you make to our program?
What significant issues are facing PAs today?
Describe a time a patient interaction made an impact on you.
Describe the most stressful work or school-related situation you've been in and explain how you dealt with it.
How do you deal with stress?
How do you manage your time wisely?
Do you work best alone or in a group?
What do you enjoy doing in your free time?
Looking at your application, it looks like you may have struggled with X. Can you tell us more about this? (Again, don't focus on the bad, focus on the good that came from this experience!)
You've had several jobs in the past (or, changed majors, etc). How do we know you'll finish this program if you're accepted?
What's your ideal job as a PA?
What experiences influenced you to choose this career path?
And of course, a new one... How had COVID-19 influenced or changed your path to becoming a PA?
Do you have any question for us? (Tip: Yes, yes you do! Never say "no" to this question.)

An interview I did as a dietitian at a hospital for a local news station.
Note: this would be much too casual of an outfit for a PA school interview!

Want more tips?

Dress to impress. This is still important if you're doing a Zoom interview! Lots of people wore black suits with a white blouse or dress shirt underneath. I wanted to look professional but stand out a little bit, so I wore a pencil skirt, dark purple blouse, and black blazer. And one of my most important tips if you're doing any in-person interviews? Don't wear heels if they are uncomfortable or you can't walk in them! A nice pair of black flats look just as professional if you're more comfortable in them. Plus, campus tours can be quite long and the last thing you want is some sore, blistered feet by the end.

Set up your space well. Having the right lighting and background for your Zoom call is key! Natural light from a window can be great (just make sure you aren't distracted by what's going on outside), but properly positioned lamps can work well, too. And choose a background that is clean and clear of any clutter. Your messy bed or office clutter in the background doesn't exactly send the right message! It's okay to have some limited decor in the background, as long as it's not too distracting for your interviewer. A blank wall is fine too, but leave a little space between you and the wall for better visual effect.

Choose the right tech. If you're doing a Zoom call, you want your interviewer to be able to see you as crisp and clear as possible. So if you're choosing between a laptop, iPad, phone or other device, pick the one that makes you look the most clear, even if it's not the biggest or best screen for you to look at. Also, test your audio ahead of time. If needed, use some headphones with a mic in it (like the Apple earbuds) instead of your device or computer's built-in mic.

Good luck with your interviews!

Thanks for reading,
Olivia

Stay Focused: Tips for Dealing with Distractions

2020-08-12T10:48:00.002-05:00

I've been an online student for the past two semesters, and it can be a real struggle to stay focused and not get distracted by ... *waves arms widely* ... well, everything. Seriously. I mean, my house is cleaner and my meals more elaborate when I'm actively avoiding doing my work, but that procrastination can have serious consequences. So here are my five tips for staying on task:

1. Keep a strict schedule.

My rule was "alarm goes off at 5am, butt in desk by 5:15am." Thank goodness for that programmable coffee maker! I did my grocery shopping on certain days, limited my TV time each week, and left a finite amount of time open for hanging out with friends. This sort of regimented lifestyle made sure that I used my time well and didn't waste time that I should have been studying. Additionally, I broke up my studying into smaller time periods most days (like, a little before work and then some after work) which helped me to stay focused. I think this is because I didn't get "brain drain" from a marathon study session (but believe me, I did those, too!). Read all about my daily routine in this post.

2. Use a timer for both study time and break time.

Whether it's your phone, Google Home, or a cube timer, I think it's helpful to allot time for studying and breaks, especially on days when you can't seem to get in the groove. I like studying for 50 minutes and then taking a 10 minute break. Setting a timer for the break time is important because otherwise you may find yourself scrolling through social media and not realizing a half hour has gone by.

3. Consider hiding your phone or using an app blocker.

When I'm sitting in a classroom, I'm not likely to pull out my phone because I don't want my classmates or worse, the lecturer, to see that I'm not paying attention. But when you're sitting alone in front of a computer watching a recorded lecture or a Zoom with your video turned off, there's no one to see that you're liking Instagram posts instead of focusing on the lecture. So, I highly recommend leaving your phone in another room or considering an app blocker so the temptation to get distracted isn't there.

4. Have separate spaces for studying, relaxing, and sleeping.

I understand that this isn't always possible, depending on your living situation. When I lived in a studio apartment last summer, my bedroom was my living room which was my office. I tried not to study in bed, but that wasn't always possible. Anyway, the point I'm trying to make is you want to associate certain areas with certain tasks -- an office for learning, a living room for relaxation, a bed for sleeping. Seriously. Keeping technology out of your bedroom can mean better sleep (and as hard-working PA students, we need good sleep!). Creating these boundaries also allows you to separate studying from the rest of your life. So when you do step away from your desk to enjoy some chill time, you can more effectively turn off that student part of your brain.

5. Listening to recorded lectures? Treat it like the real deal.

If you were sitting in a classroom, you wouldn't be able to say, "Hey, professor. Can you pause for a minute while I go get a snack?" So don't do that now! If you're frequently stopping (or worse, rewinding) a lecture, before you know it, a one hour lecture has taken you two hours to get through. And while lectures are important to watch and take notes on, it's not the most important part of my study habits -- so why would I dedicate more time to it? Instead, I want to get through the online lectures just like I would in person, and then get down to business writing my own notes, reading PANCE Prep Pearls, drawing things out on my whiteboard, making Quizlet flashcards and doing practice questions.

Thanks for reading and happy studying,

Olivia

Online PA School: 20 Tips for Success

2020-08-01T11:43:00.002-05:00

I'm a distance education student, which means I'm quite familiar with this whole online learning thing. I'm not going to sugar coat it -- it can be isolating, which is further impacted by the pandemic. But I will say this -- with the right mindset, a lot of patience and dedication, and support from classmates, friends and family, you can totally do this.

Have a dedicated study space or two. This will help you stay focused.
Never study in bed -- keep that area strictly for sleep.
Get enough sleep! PA school is dang hard and you need a non-groggy brain.
Keep a schedule. Mine involved getting up at 5am every day. Gross, I know.
Set timers if that helps you stay focused. Study for 50 minutes, chill for 10 minutes.
Put your phone in the other room. Instagram can wait.
Have a study crew. Me and two other students in my area would get together to study all day at a coffee shop before each exam, and we transitioned this to Facebook video messenger after the pandemic. This was a lifesaver.
Consider not wearing yoga pants every day. Yes, they are the epitome of comfort. But I think subconsciously they can make me lazy. Look good, feel good, do well.
Make time for friends, exercise, socializing, whatever gets you feeling recharged. Since the pandemic, I've made time to hike with two friends almost every weekend.
Accept the fact that you will ugly cry during this adventure. And that's normal.
Have the right tools. I have an HP laptop that turns into a tablet, and a monitor. Perfect set up for watching lectures and simultaneously taking notes in OneNote.
Have the right resources. Like most PA students, I relied heavily on PANCE Prep Pearls. I also really like Lange Q&A for practice questions. Osmosis Med is wonderful for videos.
Take care of yourself. Be active and get some sunshine, fuel your mind and body with healthy foods, and take care of your mental health.
Taking anatomy? Get some colored pencils and a drawing book. Drawing things out helped me understand it better, and it's nice to change up the studying method!
Get a programmable coffee maker. It's easier to get up early when the magic bean juice is ready and waiting.
Consider having a giant whiteboard in your study space. Use this for making to-do lists that are always visible, or for drawing/writing things out.
Don't. Get. Behind. I know it can be easy to say that you'll catch up later but believe me, that's a recipe for disaster.
If you're watching pre-recorded lectures, try to avoid pausing and rewinding too much. Before you know it, a one hour lecture has taken up two hours of your time. Treat it just like an in-person lecture. But put those slow talkers on 1.5x speed!
Don't hesitate to ask your classmates or professors questions. I remember not wanting to "look dumb" during anatomy but you're doing yourself a real disservice if you don't ask. Learn and move on. Chances are you're not the only one with that same question, anyway.
Practice gratitude. Online learning probably isn't the way you planned to start PA school. But you got accepted into PA school and now get to work toward your dream of becoming a PA-C! This is all going to be worth it.

You can do this! Good luck.

Thanks for reading,

Olivia

No Buy 2020: Is it time to give up?

2020-07-28T10:11:00.001-05:00

Did you know that the average anticipated debt load from PA school is $112,500?! So if you're wondering why a lot of my posts this year have been related to budget, this is why!

I recently posted about the No Buy turning into a Low Buy, after a friend and I admitted to both feeling a bit burned out by the limits on our spending. But I'm not sure anymore that this plan is going to work for me.

The No Buy started after I evaluated my 2019 spending habits and was left wondering, "where the heck is all my money going?!" I know a couple of things about myself -- I am not a fan of spreadsheets, and I can make excuses to buy just about anything. So I needed a simple strategy to limit my spending, and thanks to some YouTube inspiration, my own version of a No Buy was born.

And so far, it's been pretty successful. I am spending 71% of my monthly average from 2019. I was able to save enough to pay off my car loan early, while still having a decent amount of savings to fall back on. I even snuck a little bit of travel in there, too (including the cost of flights that were cancelled due to COVID, and are now in the form of credits waiting to be used in the future, sigh).

While making the decision about my car loan, I was taking some long, hard looks at my finances and the road ahead. In short, it's not the prettiest road you've ever seen. I have ten months left of making money, to be followed by probably 14 months of, well, nothing, since I will no longer be able to work during my clinical year. I've known this was the reality, but it still ties my stomach in knots. I think part of the burn out, too, is just feeling tired of being a poor college student at this stage in my life.

But, alas, here we are. So now what?

After reviewing my spending habits this year, and projecting what the next 24 scary months will look like, I have determined that I still need to do better. I need to spend even less. Like, cut down what I'm currently spending by a third. Hot dang. That feels really discouraging because I already feel like I've cut out a lot. But maybe I really haven't?

This means that for the month of August, I'm going to trial run a new budgeting method.

I have set a fixed amount I can spend in four categories: groceries, eating out, gas, and other spending. These are loosely based on my spending habits so far this year. And if my trial run for August seems to be working, I'll make this my budgeting strategy from here on out.

Here are the rules I've laid out so far: I can "steal" funds from another category as needed, but I can't exceed the total amount allotted for all the categories combined. If I have excess, I can roll it over into the upcoming month (which would be ideal, to save for things like hair appointments, grooming for Milo, etc). If I overspend (which I hope not to do but this is real life), I have to make up for it in the upcoming month. I can use the allotted money however I want, which will hopefully curb this feeling of being deprived by the No Buy. But again, there's a limit. That means I still need to proceed with caution (a skill I have hopefully developed after seven months of a No Buy!).

One of my biggest concerns is that this bucket-style budgeting method hasn't been the most successful strategy for me in the past. I forget to track my spending and then I don't really know where I'm at and suddenly we're at the end of the month and I've busted my budget.

But, I think this day-by-day monitoring is what I need right now. So, we're going to give it a go.

I'm hopeful about this strategy because, again, it eliminates the deprivation of a No Buy. Plus, I've only made four categories to make it relatively simple. I have a little notebook I can take with me everywhere for documenting. Fingers crossed this is what I need to be even more successful with my budgeting!

If you have any tips or recommendations, please don't hesitate to share!

Thanks for reading,

Olivia

Life as a Dietitian: More than just Ensure!

2020-07-15T11:49:00.005-05:00

Guess what? I just reached 500 followers on my Instagram! I think it's so cool that people are interested in my dietitian-to-PA journey. I've also started sharing short videos in my Instagram stories about nutrition topics that I think would be of interest to my followers, and so far they've been well received.

With that in mind, I thought it would be fun to walk through a day in the life of a dietitian, because I think a lot of people don't really understand what we really do all day. Now, dietitians can work in a variety of areas -- food service, outpatient care, bariatric surgery, oncology, school nutrition, dialysis centers, private practice, etc -- and each one of our days would probably look quite different. So, this is my perspective, as a clinical dietitian in a large metro hospital.

Side note #1: this is what life looks like this summer, while I'm not taking any classes. Things are WAY more hectic when I'm also taking classes!

Side note #2: this day is just an example, and therefore kind of made up to demonstrate the variety of work I do.

7:45 - Arrive at work, put my lunch in the fridge and say "hi" to my lovely coworkers! Fire up my computer and sign into my floors in Epic so if other people are trying to find out who the dietitian is for their patient that day, they'll see my name in the treatment team.

8:00 - Start making my list of patients for the day. We do a full follow up on patients every 7 days, so I highlight the people who are due for a full follow up. Then I review the consult list. Consults are often for things like enteral and parenteral nutrition and diet education. Next, I'll see which patients have been screened by nursing staff during their admission questionnaire and have nutrition concerns. These questions are along the lines of "have you lost weight recently without trying?" and "do you have a poor appetite that has been affecting your intake?"

Finally, I'll look through reminders I've left for myself about things I want to check in on about a patient, such as how they've been eating recently or lab results. Some of these check ins are quick and easy, so I'll cross them off my list right away. Let's say I have a patient who has end stage liver disease and I checked their vitamin A and E results. Looks like vitamin A came back low, so I'll write a short note, get the supplementation ordered, and send a quick FYI page to the doctor to keep them in the loop. One great thing about my current hospital is that dietitians have order writing privileges for oral supplementation.

9:00 - Time for Care Coordination Rounds (CCRs)! During these meetings, doctors and/or nurses present their patients and discharge planning is discussed. A social worker, case manager, nurse educator, charge nurse, nursing manager, PT/OT, pharmacist and dietitian may be present for these discussions. We talk about how long a patient is expected to be admitted based on their diagnosis, any issues that have come up during the admission, and anything else that needs to be done to get them discharged safely.

As a dietitian, I usually don't have a ton to contribute. Oftentimes, I'm asking about enteral nutrition, because if a patient needs to go to a subacute rehab or nursing facility, they can't go with an NG, and the doctor needs to discuss with the patient their goals and if they want a permanent tube. The sooner the better, because we need a little time after the tube is placed to ensure the patient tolerates the tube feeding regimen (usually we're transitioning from continuous 24-hour feeding to intermittent/bolus feedings a few times a day). It's also helpful for me to hear when patients are leaving, so I can be sure to complete any necessary teaching.

10:00 - After going to CCRs on both of my floors, I head back to my office for a mid-morning snack and to start prepping to see my patients. I'll get started on chart reviews for my new consults and follow-ups and get my notes started. If I have any patients on parenteral nutrition, I'll review their labs for the day and then either call or instant message with the pharmacist to collaborate on any changes. For example, if I notice that the phosphorus is trending up or now above normal, I'll decide with the pharmacist what's an appropriate lower amount of phosphorus to have in the PN bag. At my current hospital, all PNs are custom, which gives a lot of freedom for dosing the correct macronutrients and micronutrients.

11:00 - I head up the floors, armed with my patient lists, any education materials I need, pager, pen, a surgical mask and goggles. Thank goodness scrubs have lots of pockets! My first patient is an education. This person got a new colostomy during this admission, and I want to review the nutrition recommendations for an ostomy. I have printed out education materials from the Academy of Nutrition And Dietetics that overviews why the patient is on this diet, foods that would be good/not-so-good choices, and a "troubleshooting" section as I like to call it, which goes over foods that may cause problems like gas, blockages, discoloration of stool, diarrhea/loose stools. Yes, as a clinical dietitian I talk about poop A LOT!

11:35 - Next patient on my list is a new consult for "nutrition assessment" and from my chart review, it looks like the patient has lost a lot of weight recently. During this visit, I'll ask about their intake history so I can estimate if they've been meeting their needs, discuss any issues with chewing/swallowing/nausea/vomiting/constipation/diarrhea, and then give nutrition recommendations. Let's imagine this is a patient with liver disease and ascites, which is causing the patient to have poor appetite and early satiety. I'll likely discuss small but frequent meals, the use of oral nutrition supplements (like Ensure or Boost) and the importance of adequate protein. I'll review sources of protein as well, since I find that many people don't even have a good idea of which foods count as protein. I'll place an order in Epic for oral supplements PRN so the patient can start drinking Ensure in the hospital.

During this visit, I'll also complete a Nutrition Focused Physical Exam (NFPE) to look for macronutrient and micronutrient deficiencies. This involves feeling numerous areas on the patient's body for muscle and fat loss, and looking at their hair/lips/eyes/gums/tongue/skin/nails for signs of micronutrient deficiencies. I'll take this information (weight loss, estimated intakes, muscle and fat loss) into account if I plan to diagnose this patient with malnutrition. If I do, I write a second note that will get co-signed by the physician.

12:00 - Huddles! This is when all the dietitians have a quick meeting to discuss any updates and evaluate everyone's workload. If someone is really busy, this is the time to ask for help and give patients away to other, less busy dietitians.

12:10 - Time for lunch! While I'm eating, I'll multi-task and finish the notes for any of the patients I saw in the morning and start chart reviewing for my afternoon patients.

12:30 - For the next couple hours, I'll go see the remaining patients on my list. Here's what I might do:

    Visit a patient I'd previously diagnosed with malnutrition to discuss how they've been eating and troubleshoot as needed, and complete another NFPE on them.
    Discuss a patient's tube feeding tolerance with their nurse, who reports the patient is having frequent loose stools. I'll review the patient's medication list to see if there are meds that might be causing diarrhea and then page the doctor if I see anything that could be changed (like oral solution tylenol that contains sorbital) or discuss starting the patient on banana flakes, a supplement that can provide bulk to stools.
    Complete heart failure diet education with a patient who has been readmitted for fluid overload.
    See a patient who was admitted three days ago but hasn't been eating due to lethargy. I may page the team about placing an NG tube while the patient is unable to take sufficient oral intake, and create a tube feeding plan for the patient. If the patient is at risk for refeeding syndrome due to poor oral intake prior to admission, I will suggest advancing the feeds slowly, monitoring electrolytes and supplementing them as needed, and maybe even giving thiamine.

3:00 - Receive a page from an RN that a patient's family is available for tube feeding teaching. I'll provide a printed tube feeding plan to the patient and their family member and review the regimen - what formula will be used, how many cartons of formula to give a day, how it will be administered (syringe, gravity bag, or pump), how and when to flush the tube with water, issues to watch out for, and answer any questions they may have. The RN will then do some hands-on teaching with the family as well.

3:30 - Back to my office for another snack and to finish up my charting! Document any education I completed, provide home tube feeding recommendations for the case manager to use, send off any malnutrition notes to be cosigned, and so on. It's unfortunately a lot of time on the computer, but that's healthcare these days!

4:00 - Decide to stay a little late to print off additional articles for a project I'm working on. I'm creating an online education module and "pocket guide" for indirect calorimetry, that way all dietitians are trained on how to complete and interpret results for both indirect calorimetry completed on ventilated patients using a metabolic cart (with the help of a respiratory therapist!) as well as handheld calorimeters for ambulatory patients. This project has been a lot of work, and with my workload recently it has been hard to dedicate much time to it. Every little bit counts!

It's hard to smile with a handheld calorimeter in your mouth!

4:15 - Pack up my stuff, shut down my computer, and call it a day! While not every day is a good day, I love being in a hospital and continuing to see patients and be exposed to a wide variety of patient cases.

Even though I had hoped I would spend more time studying this summer, I can take some comfort in the fact that I'm always working on my patient interviewing skills, expanding my knowledge (even if it's primarily related to nutrition) and getting more and more comfortable advocating for my patients.

I have sincerely enjoyed being a dietitian but I'm obviously very excited about this next step in my career!

Thanks for reading,
Olivia

No Buy? More like Low Buy

2020-07-11T17:34:00.001-05:00

Yup, it happened. I broke. I bought a pair of shoes.

Which, if you know me, is kind of strange because I'm not really a big shoes person. But I have a bunch of sandals that are old and worn out, and I've been dying to have a pair of Birkenstocks for over a year now (which are obviously too spendy). So I think this longstanding want plus too much deprivation led to me ordering a nice pair of White Mountains (with a discount, of course).

It took me days to actually pull the trigger and buy them. I knew it was breaking the rules. But then I said, "to heck with it!" and here we are.

In my post about June's No Buy results, I mentioned that my friend who is doing this with me and I are really getting sick of this whole thing. We've been at it diligently for 6 months and even though we were both cruising along just fine for quite awhile, we've majorly hit a wall.

A big part of me wanted to say, "well, we did it for six months and that's already a big accomplishment so let's just quit now and be glad we made it as far as we did."

And yes, six months of a no buy is an accomplishment. But I still have a goal to reach and I know that if I don't have rules I will go off the rails. Just being budget conscious isn't enough because, believe me, I can justify spending money on a lot of stupid crap.

None of that stupid crap, though, is worth having to take out more loans down the road.

So, we adjust. My friend and I came up with a plan to have a $40 fun budget each month. $40 to spend on things that don't fit the rules of the no buy (which, I suppose, is now technically a low buy... but I digress). Honestly, $40 isn't much but my spending-deprived self has already come up with a hundred ways to spend that money.

For July, that money was my new shoes. Here's hoping they're worth it! 😆

Thanks for reading,
Olivia

Summer studying: Trial and error?

2020-07-03T12:20:00.001-05:00

As a distance education student, I complete the didactic year over two years. This means I get the summer between my first and second years off. YAY.

But like a good PA student, I didn't want this time to be totally wasted. So I put together a very ambitious study schedule to make sure I reviewed everything I learned over the first year.

*brushes shoulders off*

As it turns out, that was far too ambitious for a PA student who was both tired and no longer operating under the crippling fear of failure. I fell off the wagon just about as fast I got on it. Well, shoot.

I had planned to study a little bit every day, which was in fact not reasonable. So I readjusted. I'd spend a few hours on the weekends and as well as on my one day off during the week. This worked much better, giving me a few days each week to just enjoy the summer and being a lazy lump on the couch.

I also decided to change what I was studying. I have felt like antibiotics go right over my head. So, that needed to be a focus for this summer. I had purchased Antibiotics Simplified based on a recommendation from a pharmacy resident, and so my new goal was to make it through the whole book and take notes. It took me longer than I had expected but... I did it! SUCCESS.

I finished it just in time to go on my socially-distant road trip to Colorado, and now that I'm back at home, it's time to work on what's next. I had somehow gotten lucky enough to grab another awesome book from someone in my neighborhood - Fundamental Critical Care Support - and since I'm super interested in critical care, it's tempting to dive right into that.

But, I think I need to get back to the basics and review what we've already covered in my coursework. Then maybe when I feel like I've sufficiently reviewed that, I can reward myself with the FCCS book?? Wow, that was like the nerdiest thing I've said in awhile...

So how do I plan to review my year-one content? Smarty Pance! There's 14 different courses broken out by system, and each includes a ton of information. While I don't think I'll have time to review everything (trying to be more realistic!), I plan to first focus on the courses that have the greatest percentage of exam content (cardiology, pulmonary, GI, musculoskeletal) and then review a couple sections I struggled with during first year (hematology, dermatology).

And on that note... there's no better time than now to start studying! I have the day off thanks to the holiday weekend, so I hope to spend a couple hours digging in before I grill out with a couple of friends. (We've decided to keep our social circles really small so that we can hang out and feel safe and I'm so happy to have friends taking this virus seriously!).

Anyway, thanks for reading!

No Buy 2020: June Review

2020-07-03T11:36:00.000-05:00

I don't want to talk about it.

Okay, fine. I'll talk about it. But I went off the rails a bit this month. Big time. I spent 112% of my average spending from 2019.

And you know what? I blame my vacation. But you're supposed to enjoy yourself on vacation so I guess I just need to suck it up and deal with it. Here's some of what happened:

$325 on hotels. The drive to visit my sister was 17 hours each way and I wasn't about to do that alone in one stretch. So I had two hotels for that. Plus, we stayed in a hotel near the Rocky Mountain National Park with a balcony and a great view of the mountains.
$300 on gas, an oil change before I left, and a car wash. Sh*t, that was a lot more than I anticipated it would be.
$280 on restaurants and dining. Meals on the road, lots of fun places to eat in Colorado, and a few times I ate out this month with friends before I left. Adds up quick, doesn't it?

I also bought some souvenirs, because no travel for me is complete without a clothing item and a coffee mug. Sorry, not sorry. And we cancelled all our flights, which means I didn't get refunded that money. Instead, it's in my airline account waiting to be used by this time next year. Definitely wishing it had been a true refund...

I'm doing this No Buy with a friend, and we're both, well, really sick of it. I felt like I was doing fine with this whole thing and then I woke up recently and was like, this is a load of crap. I want to buy things without feeling guilty or having to rationalize it. I want new summer clothes and seeing my sister's new apartment makes me want some new decorations for my home.

Maybe I just need to remind myself why I'm doing this. Because I want to be a financially responsible student. Because I don't want to take out more loans than I already need to. Because I will be jobless for at least a year and there will be bills to pay and I don't want to sell my house. That's big, heavy stuff. And that requires big, heavy sacrifices.

And sure, the vacation busted the budget this month. But I felt safe by driving instead of flying. We did a lot of socially distant activities like hiking. I loved seeing my sister and her dog and new place. It was good for my soul to breathe in that fresh mountain air. So yeah, it was worth it.

No Buy 2020: May Review

2020-06-09T18:05:00.001-05:00

Something went wrong. Something went terribly wrong in May. Was it related to being done with school and finally having free time? Must have been. Because I spent 89% of my monthly average from 2019. Not exactly a big accomplishment this month.

Here's where I think I went awry:

I barely spent anything on groceries in April, but I definitely made up for that in May. Pantry needed to be restocked, apparently.
Home maintenance. I purchased a ceiling fan and an above-range microwave that both needed to be replaced, so that was $300 right there. Luckily, my dad was able to come out and give me some assistance with installing both. Okay, he installed them. I just provided moral support.
Eating out is a thing again. My friends and I have, a few times now, gotten drinks on a patio or food to-go since we're (safely) meeting up again. I also cheated once and got to-go food just for me, so I need to be careful not to make excuses moving forward. Slippery slope!
Amazon got me. Granted, I bought things I needed (color catchers for the laundry, new Brita filters, etc), but it was a little spendy. Oh, and mother's day gifts. Can't forget that.
I bought myself an end-of-first-year-of-PA-school present and I didn't exactly hold back. I got myself a Chemex coffee carafe, a nice gooseneck electric kettle, food scale and coffee grinder.
To stay active, hang out with friends, and keep somewhat socially distant from others, my friends and I have taken up hiking. So, I purchased a park pass. We're getting great use out of it already though!

These blog posts are probably pretty boring for people to read, but I think it's a great way for me to review my spending and see where I need to be more cautious. Groceries, eating out, and gift for myself combined with some necessities quickly brought me back up to my usual spending habits. It's a good reminder that if I'm not careful, I can easily spend more than I intend.

Life During COVID-19: Update 2

2020-05-17T15:01:00.000-05:00

I, like many people I talk to, am frustrated and confused. Government regulations are constantly changing, we're hearing stories of nurses going out to crowded bars the minute they re-open, and I have spent more time than I'd like pondering whether cloth masks are worth a crap.

So here I am, writing about my frustrations, because I really don't know what else to do.

I care deeply about my family and friends. I want my aging grandparents with heart failure to stay well. I want my immunocompromised friend who is going through chemotherapy during a dang pandemic to be safe. I want my friends and family who are nurses to work safely in hospitals that aren't overrun with sick patients.

I've "snoozed" more people than I care to count on Facebook, because it pains me to see what they're posting. In one of the latest, an old co-worker shared a post that essentially said, "if you don't feel safe, then you can stay home. I shouldn't have to be isolated or wear a mask to protect you."

That breaks my heart.

I keep coming back to this thought that we as a country haven't always behaved this way. Now, we think wearing a mask is an infringement on our rights and haircuts are more important than public safety and hoarding hand soap and sanitizer is somehow acceptable behavior.

In 1918, there was the Spanish Flu. And when states issued mandates for people to wear masks, people pretty much followed the rules. It was a patriotic thing to do.

But it's not just about masks, specifically. It's about making sacrifices for the greater good. Think back to when "Meatless Tuesday" and "Wheatless Wednesday" became a thing during the first World War, to ensure soldiers overseas could be fed. More than 11 million people pledged to take part in this effort.

And sure, maybe we weren't always the most obliging folks. During WWII, voluntary rationing wasn't going to cut it. Along came the Emergency Price Control Act and war ration books, which discouraged hoarding and helped ensure that everyone got their fair share. It wasn't a perfect system, but it was an effort to help all Americans get the food they needed. To keep everyone healthy.

Don't forget, also during WWII, women went into the workforce to fill the gaps in the industrial sector, aiding especially in the aviation and munitions industries. I don't know about you, but I probably wouldn't love the idea of throwing on overalls and helping build planes, but they did it because it was what needed to be done. We banned together to make sacrifices for the greater good.

Where's our Rosie the Riveter now?

I don't want this to be a political post. I want this to be about public health and people and caring and compassion -- things that seem to be in as short supply as toilet paper these days.

I'm mentally and emotionally exhausted. I don't know what the right answer is, and reading the latest news and research seems to just give me more anxiety and a headache.

Early on in the pandemic, I shared an article which showed that cloth masks are pretty ineffective (surgical masks didn't fare much better either). But now I'm seeing that experts are saying universal masking of any kind really could help flatten the curve. It seems that wearing a mask and practicing social distancing would allow us to safely go out and for more businesses to reopen, at least in some capacity. Isn't that a good compromise?

If there's a chance that a cloth mask does offer some amount of protection, shouldn't we do it? Sure it's annoying but if it could save a life, isn't that what matters? Because, remember, wearing a mask isn't just about protecting yourself, it's about protecting others if you're an asymptomatic carrier. Or not yet showing symptoms.

And seriously, it's just wearing a mask. No one is asking you to work in a factory and make ammunition or build planes or stop buying butter and sugar and beef. Just cover your face. Is that really so bad?

Plus, it's not like this is the only public health effort out there right now. Here's an example. Smoking inside bars and restaurants used to be allowed. But then we decided it wasn't fair for people to be exposed to carcinogens like that, so we outlawed it. Yeah, smokers weren't thrilled about it, but we didn't just tell non-smokers "hey, if you don't feel safe, you can just stay home!" No. Some businesses made adjustments to keep customers safe and happy, like building patios for smokers. But we made the necessary adjustments to keep people safe.

Admittedly, I'm struggling to know how to behave or where to draw the line between caution and crazy. What I do know is that COVID-19 is killing people. And I think I'd rather be safe than sorry.

I'm not an epidemiologist or research scientist, but I am trying to find the most reputable resources I can. We're all learning as we go.

So you'll see me shopping at Trader Joe's with a mask on (a store that's done a wonderful job limiting the number of people in the store and doing their best to enforce social distancing). I'll wear my mask if I need to buy something from Menards, without complaint. I will probably still choose takeout over dining in if given the choice, I likely won't be going on any in-person dates any time soon, and I'll likely continue to limit my contact to my family. I'll continue to shop infrequently, keep my distance, and wash my hands.

It sucks and it's lonely but I think it's important. And it's not forever.

In my opinion, we should take a cue from Rosie and make choices for the greater good. Just in case.

No Buy 2020: April Review

2020-05-11T20:22:00.000-05:00

"I haven't blogged about April's spending yet," I thought, as I lounged on the couch after a long day at work. Wondering how things netted out, I opened my credit card app and navigated to the page that showed my monthly spending totals.

WHAT IN THE WORLD. I shot straight up, apparently thinking this would give me a better look at the total. I spent just 33% of my 2019 monthly average.

I think a few things played a major role in my spending dropping so significantly.

The Safer At Home order has been in effect since the end of March, meaning I was trying to limit my trips out as much as possible all month long.
To reduce the number of shopping trips, I was definitely more cognizant about using food items I already had on hand.
No dinners and drinks with friends. No coffee or happy hour dates. And since that was a major loophole in my No Buy (being able to spend money when I was being social), I'm sure this was a big factor.
With the end of the semester approaching, I was hunkering down and pretty preoccupied. Apparently too preoccupied to spend!
No birthdays, baby showers, gifting holidays. Except my own birthday, ha.
Nowhere to go? No gas to put in the car!
The hospital where I work was very generously providing free meals for all front-line staff for most of the month.

I do genuinely think this was a fluke. I'm already well on my way to spending more this month -- had to restock the pantry and freezer, spent my birthday money (and then some, oops) on a end-of-my-first-year present for myself, I need to replace a very broken ceiling fan in my bedroom, and I'm working my regular hours again (and therefore putting gas in the car for the first time in awhile!).

And don't get me wrong. There's a small part of me that thinks, "oh you did such a good job. You deserve to spend a little somethin' on yourself!" but I'm really resisting the urge! Instead, I try to remind myself that this is more I can throw into savings to make clinical year a bit easier.

One other thing I've noticed is that my credit score has been going up! My credit card app shows me my FICO Score and updates on a monthly basis. Compared to May 2019, it's now 65 points higher! Not going to lie, I don't totally understand how those scores are calculated, but I must be doing something right.

With my No Buy year already one-third of the way done, I'm feeling pretty confident that I can finish the year strong. Have I been perfect? No. But I'm thinking about spending so much more critically and I've been able to work toward a really nice clinical year nest egg. And I'm really damn proud of that.

Thanks for reading,
Olivia

P.S. I posted on Instagram that I was so shocked at how my spending during social isolation had changed, and I wanted to know if my friends had seen something similar. Of those who voted, 72% said they also spent less, and a couple people messaged me to say that nothing really changed. Interesting!

Milo and I documenting our isolated life

And that's a wrap: Year one is complete

2020-05-07T16:46:00.001-05:00

At approximately 9:00am this morning, I shut my laptop. My last final exam, complete. And perhaps the most anticlimactic end to a school year.

No celebration with classmates and friends to mark the end of an important year. I know a lot of students who are at an even more pivotal point in their journey -- graduation, or the completion of didactic -- are feeling this even more. I'm sorry that there won't be white coat ceremonies or traditional graduations or clinking glasses or hugs.

And while I'm sad I can't celebrate this accomplishment how I would like, I think it's worth a peek back at the last 353 days of this journey! Here's some of the things I've learned.

Minimalist living is surprisingly comforting. At least until the cockroaches come...
Bonds are built over the "tanks" -- bonds you can't break!
You know you're busy when grocery shopping counts as your time to relax.
Good friends and family will be there for you, even after you blow them off for the (seemingly) millionth time.
It's important to have someone you can vent to. Maybe a professional.
You do have to cut yourself off from coffee at some point during the day.
Popcorn and Twizzlers does not count as dinner.
It's truly amazing the amount of information our brains can retain.
Moms are the best because they will help you move long into your 30s!
Love is your grandparents making a three hour trip so your grandpa can be your practice patient.
It's okay to cry. It's okay to ask for help. It's not okay to give up.
Failure is probably going to happen (screw you, dermatology pharmacology...). But it's not the end of the world.
You can't survive on coffee alone. Water. Definitely also drink water.
A pandemic can take away your coffee shop study dates. But it can't take away Facebook messenger video study sessions!

I know this is a quote about being a parent, but I also think it fits here: "The days are long, but the years are short." It's wild that I'm here, having survived an entire year of PA school. I know there's still a lot ahead of me, but it feels so great to be here right now.

Looking ahead to the future, I'm hoping to enjoy my summer break. I may need to re-learn what it's like to be a normal human being who isn't juggling PA school plus a job! I seriously don't know what I'm going to do with all this free time!

So, I'll enjoy summer as best I can. Two more semesters of didactic while I continue to work as a clinical dietitian. Then, clinical year! I'll be at the finish line in no time.

Thanks for reading,
Olivia