Currently, as I try to write this blog post, I have a Chihuahua under my feet and a 7-year-old leaning against my arm. One term into my journey to become a nurse practitioner and I’ve already had moments thinking, What did I get myself into? and, What was I thinking? Balance is not easy. Coffee has become my best friend. But a balance for dealing with school, family and life is achievable, and I have found the following to be helpful in achieving my symmetry.
When dealing with school, it helps to be organized. I try to have one space designated for studying that is clutter-free. Though not much in my life can be classified this way, it helps to eliminate distractions when studying. I make sure I have a visual of due dates and reading assignments, and I highlight my calendar in different colors. I never leave the house without a book in my hand. Even at work or a soccer game, there is always down time to read a few pages.
It may sound odd, but I try to keep my family involved with my school work. I set goals and post them where everyone can see them. If I hit those goals, I reward everyone! Go get that Slurpee or have a movie date at the $1 theatre! Rewards tend to fare well with little kids. When you tell them, “I have to finish this and then...” they tend to give you those few, precious minutes you need. To save time, I pre-make our dinners and freeze them- the crockpot will be your friend. Take a few hours on Sunday and prepare meals for the entire week. Above all… make sure you have healthy snacks on hand to avoid that ‘freshman 15’ again.
Remember you are part of keeping that balance: Make ‘me time.’ Exercise while listening to the lecture recording. Take a bubble bath and brain storm essay ideas. And sometimes I need to step away from it all for a day and just re-collect myself.
You can achieve balance while in school. Take a deep breath. Remember there are lots of us on this fun journey too. A little preparation and organization can go a long way.
After becoming a nurse practitioner and then deciding to obtain my doctor of nursing practice, I have been asked this question many times by patients, friends, family members, and even strangers. My short answer, which truly sums it up, is, "because I like the nursing aspect."
But what is the ‘nursing aspect'? In 1860, Florence Nightingale defined nursing as "the act of utilizing the environment of the patient to assist him in his recovery." 106 years later, Virginia Henderson modernized Nightingale's definition and said, "the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible."
Both women describe a profession skilled in the act of caring, not just treating.
McMillan Dictionary defines doctor as "someone whose job is to treat people who are ill or injured; someone who has the highest degree given by a university." In contrast the term nurse is described as "helping someone to improve or become more successful; to drink slowly over a period of time; the act of feeding a baby."
These definitions illustrate the helping, caring, calm, thorough and nurturing nature of nursing... of a nurse. These are the reasons I don't just become a doctor. As a clinician, I do treat illness, but as a nurse I treat the whole person. I want to improve their health condition. I want to prevent future health conditions. I want to educate, empower, and encourage them. I want to know what health means to them, what they value, what they need in order to achieve their optimum physical, mental, social, and spiritual health.
So tell me, why didn't you just become a doctor?
Having the right mentor can be a valuable asset for healthcare
students. But selecting the right mentor takes skill and time. Mentors are
never more important to an aspiring professional than today in the healthcare
field where the playing field is shifting. A senior advisor at your side can be
an invaluable asset, so here's how to go about finding the right mentor.
When to find a
The best time to search for a mentor is when you
don't need one. That means ahead of time. There's no time like the present. So
just like studying for exams, procrastination is not the way to go here.
Always have your eye out for that unique mentor
that meshes with your personality and needs. Conversation, experience and
dialogue are the keys to determining if a person is the right fit for you.
It is never too early to start connecting with
your peers and cohorts at professional meetings and continuing education
Establishing an easy rapport with a mentor before you find yourself needing
questions answered and opinions verified is the best time to do so.
This leads us to where
to find a mentor:
You may be lucky enough to find a mentor at your
school or workplace. But often we find them where we find everything nowadays -
the internet. I'm not necessarily suggesting an online mentoring network. But
reaching out to build networks beyond your geographical scope can be a big part
of successfully using the web to build your professional presence. So why not
find a mentor this way? You can start by building your presence with a profile
on LinkedIn. Once you have established your profile here start looking around
and connecting with your peers.
Reading and commenting on online journal articles
is a great way to find someone with a common background or interest who may be
willing to take you under their wing. Read everything you can find about those
around you who are seeking a common goal. Then reach out to them through email
or phone calls. Don't be afraid to put yourself out there and ask someone to be
How to know if a
mentor is right for you:
The right fit will be evident when you share an
easy rapport with a more senior person who you respect. Being able to listen
respectfully and converse comfortably are key to a good mentee/mentor
You may read your new mentor's writing and be
impressed by their knowledge and articulate way of approaching a subject. Or
you may work with them and admire their skill set and their easy dialogue with
patients and coworkers and decide that you would like to ask them to mentor
Be sure to tell them where you are in your
educational process and what exactly you are looking for in a mentor. In other
words, what are your expectations? Then they can tell you if they feel
that they can comfortably meet these or not.
Do not be dissuaded from your search if the
first mentor you approach does not prove to be the right fit for you. Remember,
we may all use more than one mentor. One person may help you with the interview
or application process and another may come to your side when you are starting
out in that new position and just finding your place.
So get out there and look for your mentor. And someday soon
you may find yourself mentoring others.
As the holiday season approaches it has become clear to me that
"Yes, Linda, there is a Santa Claus." Registering for the winter
semester it was mentioned by my advisor that in May my clinical time begins.
This day has seemed to be off in a distance for so long. Honestly speaking, at
one point it was looking to be out of my reach and now only one semester
separates my journey into the next place.
Being a student over the past 1.5 years has challenged so many
areas of my life. It has seemed the entire summer went by with my head in a
book or behind a computer screen. Knowing that the end is in sight gives hope.
Each class has also been unique in its own manner and has pushed
me to apply every ounce of energy available. It would be so much simpler if school was the only task in my
life. I also am a pediatric clinical leader in my hometown hospital and have
been trying hard to get items implemented on our unit that will allow for
better assessment of the children that come in.
I have always felt the need to achieve one more thing in life. I
find not setting goals in your life is an easy way to not apply yourself. If
each day went by and didn't have direction it would be simple to accept the
status quo and go forward.
Becoming a nurse practitioner is the push forward that
drives me. I want to be able to make a difference in a person’s life and know
that all of the struggles and lack of sleep have been worth it.
My mother has always been a great inspiration to me. She
obtained her LPN degree and with children she went back to obtain her ADN
degree. She always was striving to have more knowledge and become a better
caregiver. Knowing her time was coming to an end due to terminal cancer she
continued to brighten our days with stories and desires for our lives. She never
wanted any of her girls to settle for anything less that what they wanted to
My father also passed away a few years ago with terminal cancer
and even today I can still hear him talking to me about where my career will
take me. I shared with him the desire to help others and open a free clinic at
some point. I know in his own fatherly way he would be proud.
This blog was written with inspiration from my Mom and Dad,
Margaret and Harvey Spurlin, may they rest in peace.
In conclusion this month, my thoughts for you are to take some
time to reflect on why you are where you are in this journey. Each person
follows a dream, a course or a bigger aspiration for more and over the holiday
season I hope you will take some time to sit and enjoy the lights, tinsel and
mistletoe ... NO TEXTBOOKS ALLOWED.
Happy holidays to all. See you next year.
I'm down to the wire of finishing my PA degree and
the PANCE is looming with a mere 17 days left for me to cram. How do you study
for the PANCE? Because I haven't yet passed, don't take all this advice too
seriously but I'll elaborate a bit on what I think is helpful:
early. My school has over a month of built-in PANCE prep with lectures and
practice exams so we had an earlier start than many programs.
to the blueprint. The NCCPA will become your best friend and I've been told
that really adhering to blueprint content is your ticket to passing.
try to understand, just memorize. If you start early enough, you may have time
to memorize complex patho concepts but the reality is the PANCE is a lot of pattern recognition so if you learn a
lot of key terms it can be much more efficient than trying to re-learn
everything you missed in your didactic year.
practice exams all the time. The biggest thing that has helped me improve on my
Packrat is practice questions because you start seeing the same questions over
and over. I never sit down to study without doing at least 50 practice
questions. I use PAEasy and Kaplan which I bought with 5 other classmates.
Kaplan is really tough and I highly recommend it if you can get some folks to
split the hefty $200 cost. Another good option is the Lange practice questions
either as an iPad app or in book/CD-ROM form. Our school has a Packrat built in
every week and I've improved each time.
to podcasts when you work out or drive.
your practice book everywhere. My favorite is A Comprehensive Review for the Certification
and Recertification Examinations by
O'Connell. I also use First Aid for the Family Medicine boards. I have a couple
others but you really just need a few. If you memorize everything in these you
would totally pass.
stuff down. This helps me because it makes me slow down and realize what I'm
reading. I have a notebook I have taken all my PANCE notes in from said review
books. I overdosed on flashcards in
didactic so I gave up on that medium.
a life and don't freak out. I'm a super busy person and the looming PANCE
hasn't stopped me from going to see Hunger Games, spending time with friends,
enjoying the holidays or cooking comfort foods. It's just a test and the worst that can happen is I fail and lose $400
and have to wait 90 days. That's really NOT
the end of the world.
One of the first things to know here is that it is all about
priorities. And we know schoolwork comes first.
So here is a step-by-step guide to getting through the last
couple weeks of classes, final exams, Thanksgiving and the pre-holiday season.
Step 1: Sign up early
for those holiday pot-luck parties.
Always volunteer to bring the cups and plates! This is why
it is essential to sign up early. You don't need to be stuck cooking mac and
cheese or brownies when you have an exam in the morning. So sign up to bring
the disposable cutlery, plates and cups NOW! You will be thankful later when
you make the quick dash to the dollar store and to run right over to the party.
school holiday get-togethers will provide you with a welcome lunch or dinner
when you most need it - right in the middle of studying.
Step 2: Save time - study now, do laundry later.
Stay focused on your work by cutting back on doing laundry. This
will yield countless found hours to devote to your studies. No need to do
laundry now - it's cold outside and everyone dresses in layers anyway. Remember
it's ponytail and sweatpants season for all students right now. Just bag it all
up in a black trash bag and bring it home for the holidays!
Step 3: Make gift
giving a snap when you procrastinate.
There are two alternate strategies here. You can either shop
early and online or you can procrastinate to the very last moment. I recommend
the latter. If you shop online you may be tempted to be distracted from your studying
while at the computer. And there are actually advantages to procrastinating
with holiday shopping! Markdowns will have already begun and the crowds at the
stores will probably be thinned out - especially if you wait until Christmas
Eve. There is a real art to this. So don't procrastinate on studying,
procrastinate on shopping and be sure to reap the benefits.
Step 4: Smile extra
You will need to perfect this step. Remember, you are
wearing dirty clothes, bringing plastic cups to a party and you have no gifts
to give (yet)! So smile big, keep your chin up, your nose in your books and
pass the cranberry sauce! There will be plenty of time for cleaning up and
P.S. Tell Santa Claus that you want new highlighters for
Christmas! It's never too early to stock up for the spring semester, it's right
around the corner.
As the holidays fast approach and the year is quickly coming
to a close, it seems natural to look back at times. Although looking back at
times can help you see how far you came over the past year, it can distract you
at times from where you are headed.
Often we become overwhelmed at what we have not gotten
completed. As 2013 comes to an end, I am able to see so many milestones
covered. The biggest accomplishment to see is how very close my clinical time
is from here. With each class I find myself becoming more excited about the
time when I can become the provider.
been asked many times what I have planned after graduation and the ability to
see that far ahead still escapes me. I realize each class that is behind me
will only build on the base that I have and provide me with a better
Online classes can be a challenge at times, especially becoming
disciplined to meet all the deadlines. I feel pressured to turn in assignments
and also may have pressure from work or family. The ability to clone myself
would come in handy at this point in my career.
hope each of you take the time to enjoy the holidays as much as you can. November
10 was my birthday and the agenda of the day was working, then homework. I know
this will pay off in the long run.
a brilliant patient. She was exactly who I want to be when I'm 91. I met G.F.
while on pulmonology consults last month. She was sitting up in bed with a CPAP
machine on. Her daughter was sitting in the room, so kind and matter-of-fact,
explaining how her mom was suddenly short of breath yesterday and was brought
came off her CPAP long enough to explain that on Sunday she was at the church
potluck, and the day before that she took the city bus to go shopping because
she, "hates waiting for rides." And then she just felt so bad all Monday and
called her daughter to come to the hospital.
G.F. had pneumonia and by the time
I saw her, she was being treated but just couldn't seem to keep her O2 sats up.
We, as the consult team, decided that perhaps if we cleared out the pneumonia
we could take her off the CPAP and her breathing would resume to normal.
G.F. the next couple days, always so pleasant in the morning, and her lung sounds
improved each time. She just still couldn't wean off the CPAP. And she was
having a hard time eating in between breaks from the machine.
primary team had established G.F.'s code status. G.F. had decided that she did
not want to be intubated or get chest compressions, only the defibrillator.
Then on Thursday rounds, my attending had a frank conversation with G.F. and
her daughter: "She's 91. When we get pneumonia things are different. When
someone like your mom gets pneumonia, we worry. We will do the best we can, but
she can't seem to tolerate room air and these are bad signs."
surprised at his tone. She seemed so well, relatively. Last week she was just
living her life. People get over pneumonia all the time.
her on rounds the next day. She was chugging Ensure like a champ -- still on
CPAP. I went home for the weekend. I make it a habit to check on my patients
Sunday night before I go back to see the events of last week. I pull up EPIC,
click on G.F.'s chart and this message pops up, "The patient whose chart you
are accessing is deceased."
Where you study can be as important as when you study and
who you study with. I never realized this until recently when I attended a
study skills workshop led by a behavioral psychologist who enlightened me to
the importance of the actual location of study time.
Apparently, our bodies take subconscious cues from our
environment that can affect focus, attention and even hormone secretion. These
are factors that we can get working for us with little effort if we know how to
harness them. And I'm all about little things that mean a lot. Little effort,
By going to a designated study area that is a "sacred grove"
of studying, you can condition yourself to maximize your time and focus and retain
material more efficiently. Naturally, you will need to personalize and perhaps
alter some of the following steps to make this happen for you.
STEP 1: Find a
location where you will only study and not perform any other activities. So
it's best if it's not your bedroom or your kitchen table. You want a special
place that the only task you participate in there is schoolwork. You may have a
favorite study carrel or corner table in the library - make this your study
home. You can branch out to secondary
locations later, if desired, once you have mastered "getting in the zone."
STEP 2: This is
an important step! Get down to work in your designated study spot. Do not
"pollute" your study place by checking Facebook, email, texting or chatting
with friends. Make your study grove a place that you focus and stay on task. Schedule
your study time here. Designate 45 minutes to pharmacology, then take a 10
minute break and then do 45 minutes of say, pathophysiology. Your time will be
used effectively when you stay on task.
STEP 3: This is
the rinse and repeat step. Return repeatedly to your study spot or spots.
Though it is best to have one or two places to study, sometimes circumstances
dictate that we have three or more. But go to this place each time and get to
work. (Though if your favorite library table is taken, you will have to select
another place or risk an unpleasant confrontation!) Soon, your brain will be
conditioned by the sights, sounds and smells of your chosen location and be
ready to focus on learning as soon as you sit down.
Once you have mastered the above steps, you can train yourself
to put your mind into study mode in other locations as needed. So you can train yourself to do flashcards on
the bus effectively once you have conditioned yourself.
I have found that I do not study well at the library at the
college where I attend PA school, though we have a beautiful library that is
airy and inviting. I discovered through trial and error that seeing my fellow
classmates working on other material around me makes me anxious. And anxiety
hinders learning. So I have a favorite table at a small public library down the
block and a favored weekend study place at another nearby small local college.
This also eliminates the possibility of too much chatting with fellow students
taking up valuable study time.
So go find your own unique study area, make it specific for
studying and maximize your brainpower!
A new semester so soon. October 5 marked
the beginning of the fall semester. The classes to be covered are care of
children and care of the childbearing woman. Pediatrics shouldn't be such a
challenge, as this is what I do each day. Several of my fellow classmates have
already crossed the finish line which serves to show that the end is in sight.
Looking ahead at the calendar, my clinical
rotation begins in only 7 months. One of the biggest challenges that I have
encountered is being able to step across the line between the nurse and the
healthcare provider. Having been a nurse for the last 27 years, it is hard to
separate the two roles. Each day that goes by I see more clearly the pieces of
the information coming together.
My advice so far is to stay very, very
organized with your class work. Until next time, I will continue to study hard
and keep everyone informed of life as a student.
I just returned from Uganda 5 days
ago -- a harrowing 43 hour journey with a more than a few moments of thinking
we might not ever get home, but I did. And I wanted to recount a day with a
problem we as NP/PA students don't face much in the U.S.: malnutrition.
Bugabero is in the Manafwa
District, a sort of rural suburb of the city we are staying in, Mbale. It is
about one hour on rough roads from where we stay and not far from most of the
villages we visited. Kissito, the organization sponsoring our time in
Uganda in concert with the government, has developed a malnutrition clinic
which runs every two weeks.
Parents of malnourished children
come to get their child assessed, get them medications, vitamins/minerals and
food supplements. A lot of times, the malnutrition in kids is not necessarily
due to poverty, but it is due to lack of education. Mothers feed their
children posha (cornmeal) too early, do not provide milk or eggs, and when
their child loses their appetite or gets sick with malaria, Kwashiorkor or
Marasmus quickly follows.
It is a heart-breaking
problem. Many of the times, fathers abandon their malnourished kids as they
become sicker and weaker. Moms give up on feeding. Children die.
We arrived at the clinic at 9:30
and it was already very hot. Bugabero is always very crowded because it has the
reputation of having the supplies it needs. There are families camped out
on the grass around the compound, laundry drying on the grass, kids playing,
cows and goats and chickens make their home anywhere they please in Uganda.
A Ugandan health educator came up
to us as we were milling around the mothers sitting on the grass waiting for
things to get started. She asked us in Ugandan English if there was anything we
PA students wanted to educate the mothers about. I jumped in, "We will listen
to what you say first and then we can add information after? So we don't repeat
what you say?" I don't think she understood. Fortunately, Matt jumped in and
said he would educate on breast feeding. Uthman translated.
Then the "health educator" spoke
to the 50 or more families squished together on the grass. Her lecture was
tragically unhelpful. Most of these children have protein malnourishment. She
did not speak about protein. What I do remember her saying was, "When your
child gets sick and is unhealthy from malnourishment, fathers leave child
because he is sick. Feed your children so the father doesn't leave."
After the "health education," the
chaos ensued. Dana, my classmate, and I were paired off with the clinical officer
(like a PA) named Ephraim. We went into the hospital building and there was a
table and a bench for the patients.
A mother came in with her child
who had a fever, diarrhea, and was malnourished. Ephraim was going to
send the child for a "BS" (blood smear) for malaria but apparently the lab was
locked that day so we wouldn't be doing any blood tests. He seemed to take too
long with all the patients without finding out much about them or even doing
much of a physical exam. If you only have 3 ways to treat a patient, there
can only be 3 problems. Is it malaria, HIV, or pneumonia? If it isn't one of
those, then there's no point in finding problems you can't fix. It's reasonable
in this setting, but not the way I was trained to think.
In this small room, there were
three mothers with babies on their laps. All the children we saw Monday were
sad. So weak, so skinny. They looked like stick figures with their big
round heads, poky arms and legs and large bellies -- a picture of a person a
kindergartener would draw with unrealistic proportions.
The saddest case was a child who
initially I thought was convulsing from cerebral malaria -- malaria gone so far
it causes swelling in the brain and neurologic deficits. The child's jaw was
open and its head would nod back and forth, and it was having decorticate
convulsions with its arms curling up into its chest. The child was very hot to
the touch, clearly febrile.
Lindsey, a Kissito worker, kept
asking Ephraim why he wasn't attending to this child. Ephraim then explained
the child had cerebral palsy since the age of 3 months and was now 2 and a
half. He would refer her to Mbale (the hospital from my last post). It's
scary seeing a kid that skinny and convulsing and no one seems to mind. I
wonder who gave the diagnosis of CP. Perhaps the 3-month-old little girls
did have malaria then and had deficits that never remised. There's no way
I wrote the history of present
illness in her "chart" (a flimsy notebook the mother carries around) and the
physical exam. Ephraim commented, "Wow, wow, this is nice." I would've
gotten an F on that note in the U.S. I left out so much. All I could think
was, "Any pediatrician would've spent 1 hour assessing this child and it
would've had 10 referrals."
Later in the morning, I saw the
mother pouring orange coke into her open mouth. She apparently can't
swallow well. I suppose any of us would look completely wasted if our
primary nutrition was liquid sugar.
Dana and I next rotated and helped
weigh the kids. Imagine two trees close together with a strong stick nailed between
them creating a bar. Then there's a grocery-store like scale and a harness. You
put the child in the harness and hang it on the scale to get their weight in
kilograms. We helped weigh and document the weight on the patient's log
for 30 minutes. Ugandans are nothing if not resourceful.
We briefly tried to help assess
the arm circumference. It was very confusing to understand which patient was
next in line. Basically, we would just wait for the health worker to tell us
and then tried our hand at checking for edema and arm circumference.
If a child has edema, you tell
them to go straight to weighing because the swelling from protein imbalance
will ruin your arm circumference measurement. There were many kids with edema.
Also, if the child's arm was "too fat" they didn't qualify for the program. I'm
ninety-nine percent sure they were all malnourished. Resources are slim however
and you have to turn some people away.
By this point, about three hours
into the morning, most of the patients had been weighed; they were just waiting
to get their medicines and nutrition. The scariest part of the day was
when I was assessing patients with Uthman translating. I saw three
babies. The mothers would hand me their books and I'd try to see if the
patient was gaining weight, was their symptoms were. As Dana clearly put
it, "These mothers all say the same thing: my child has been coughing for 1
month, has diarrhea, and has been vomiting."
It might be true but it
becomes difficult when literally all the stories are identical. I would
listen and poke the kids. All of them seemed like they had malaria and
anemia secondary to that. To play it safe I wrote "anti-malarials" on
most of the plans. It's horrifying to "prescribe" when you have no true
clinical picture of your patient. I didn't want them to leave
Uganda is nothing if
not confusing. There is so much lost in translation and lost in not
understanding how people work here. But after a day like this you do know
one thing: kids need food. And maybe
that will change something.
To group study or not to group study? That is often the
question. The age-old question that Hamlet pondered while gazing at a skull may
not be at the forefront of your mind as you wade through physiology, anatomy or
pharmacology. But here are a few guidelines to help you know if studying in a
group may be helpful for you and how to organize an effective study group.
Your study time is valuable. You're paying for your
education with your time, effort and tuition. Getting the most out of it is vital
to your success. So you don't want to waste precious study time bouncing around
to different study groups or working in one that is ineffective for you. You
must be self-centered in your study approach. In other words, you must do what
works for you. The trick is finding out what works for you and doing so
When to opt for a
Keep in mind that you may not need to form a study group for
each of your classes. Only consider using a group study format when you need
the support in a class. If the class is a breeze for you and you have a firm
grasp of the material, then put your energy on forming a group to study for a
topic that is challenging for you. This can be especially helpful in high
factual content courses, like anatomy, or in classes that require solving problems
such as statistics.
Some rules of the road
for selecting a study group:
Look for students in your class who come early or on time,
who pay attention in class, sit at or near the front, participate and who seem
engaged and on task. We want star players on our team! Then approach your
classmates to organize a study group.
Forming the group:
Keep your group to a manageable size. Three to five members
is usually a good size. If the group gets too large, it can become unwieldy and
difficult to keep meetings on task. I once started a study group of two that
ended up having twelve members by the end of the semester, and it was no longer
effective. Too many voices and varied opinions bogged down our work with this
large of a group. So keep the size manageable.
Structuring your meetings:
You should plan to meet about twice a month. Set firm times
for your sessions and stick to them. Schedule your meetings so that you have a
few days before big exams. Break up the material so that each person in the
group is responsible for being an "expert" on a certain area or chapter that
they will then present to the group at the next meeting.
Let the members know that to be effective at your study
group meetings you will limit socializing, texting, Facebook and any non-school
work. This allows everyone to focus and get to the job of studying. After all,
getting your work done and learning the material is your study group's goal and
the more efficient you are at accomplishing this, the more time you will have
for every student's favorite activity - SLEEPING!
As the end of this
semester was clearly in sight, I was feeling really good about the grades I had
and the pace of approaching the finish line. Then out of left field, life
entered my school life.
Often, as students, we
get so involved in deadlines for assignments, studying for tests and getting
things organized into our schedules that we fail to remember that there are more
people in our lives than our instructors.
As I write this month's
blog, my husband is recovering in a rehab center from having a stroke two weeks
ago. In the early morning, when I was studying hard for one of the last few
test of the semester, his stroke hit.
Quickly, my life went
into chaos. After all, how could this happen? I am not supposed to be the
patient's wife, I am supposed to be the person's nurse. Becoming "the family" truly
humbled me. I realized that even when we think school life is under control, it
only takes one person to start a wave in our ponds.
As a student, I was
taught a valuable lesson. My instructor and counselor at Frontier University
were there to help. Deadlines for exams and assignments are not so set that we
can't ask for help. This lesson didn't come easily for me. I felt at first I
had to submit the due items. After all I am a student, right?
Long sleepless hours
in ICU are not very conducive for study. After a horrible grade on a case
study, my instructor told me to take time for the next test and to know they
can help arrange extensions for assignments. They are there to help.
A huge lesson as this
semester rounds to a close on Friday: be prepared for whatever life
throws. Just being a student doesn't excuse me from the added stressors of
Just in case you are
wondering, the next test was a 90 and I will finish this semester on
Friday. Then a long break ... of 1 1/2 weeks.
Greetings from Mbale, Uganda.
TIA stand for "This is Africa." I've been in Uganda for 7
days and will be here for the rest of September on a global health rotation. I
have spent four days in Ugandan healthcare facilities, a Mzungo (white person).
It is difficult to call them "hospitals" because of the
conditions. Take any perceptions you have from reading about third-world
healthcare and its impoverished conditions and multiply it times 10 and you get
Ugandan public health. Dirty, squalid, outdated, no medications, smelly and no
modern equipment are just a few adequate words.
Here is a day in the life from this week:
The nine PA students and I arrived at the hospital a bit
earlier and Margaret, my buddy for the day, and I waited for our attending
doctor to arrive -- Dr. Assem, a beautiful 24-year-old intern who knows more
than I ever will about internal medicine.
She was late, so instead we began rounding with Dr. Boddy
O. (pronounced "bod-dee" I think). He
was 24 as well and a "walking Harrison's" (the famous medical text book). We
rounded the whole morning, going from bed to bed deciding what to do to manage
these very sick patients with so little options.
It would go something like this: Dr. B. would walk up to
the bed and one of the young nursing students (complete with small white caps
pinned to their cropped hair) would hand him a "chart." It had maybe the
results of a CBC or ultrasound (read by a radiology student) and a flimsy
He would tell me a little bit about the patient, "Carol,
this is a 30-year-old with ISS who had been vomiting and having diarrhea for 2
months. Here is his CBC." I would see he was severely anemic. I would
listen to the patient and do as much of a physical as I could, usually find
about five things very wrong and then we'd make a plan.
The problem at Mbale is they have no medicine, no imaging,
no specialist surgeons and the patients can barely pay for food. It limits your
options. We'd mainly give antibiotics or fluids. We couldn't check electrolytes
or most other common labs.
Common conditions today included: pneumonia, TB, PCP,
heart failure, renal failure, hydronephrosis, stroke, paraplegia and probably
about 100 things we missed because we have no diagnostic tools except chest
X-ray and ultrasound. There is one CT machine in the entire country and it
costs hundreds of dollars in a place where most people live on a dollar a day.
The doctor kept asking questions about what we see in
America & if we had TB. I explained it was very rare. He wanted to
take me to the TB ward but thought better since they all have MDR TB (drug resistant)
and I don't really want to get that.
I learned so much from Dr. B's bedside lectures! He
was so kind and gracious and very kind to the patients and their families (at
least compared to a few other docs here). The nursing students followed us
around and I joked with Rose and Rashika.
They seemed so sad and unexcited but I got them to smile
a few times. Dr B wanted a blood pressure and I ran off to grab one, "Rose,
I beat you! You lost the race! Haha." She smiled! Victory, in a place that
contains so little joy.
There was one patient I can't forget. Dr. B said she
should be in an ICU. She was 30 years old, breathing 40 times per minute, ISS
positive, multiple bouts of pneumonia, diarrhea for days, wasted, in
respiratory failure, and probably other things I missed. She couldn't much
respond but she looked like she would die soon and her mother was by the bed. I
used Rose to translate to her mother
"Are you her mother?"
Got a yes.
"What order is she in the family?"
attempts from Rose, I gathered she was sixth born out of nine brothers and
sisters. I then found out mother was also sixth in her family. The conversation
ended. I took the patient's blood pressure: 95/44.
Later on rounds I looked over and saw other female
members around the bed. Sad eyes. Everyone in the ward has sad eyes. There
is little joy when there is little hope, I think.
Dr. B let us go to lunch around 1 after seeing at least
25 patients that morning.
There was little to do in the afternoon. Margaret got a
photo of her patient with shingles and we consulted a woman who is now probably
dead from respiratory failure secondary to fluid overload. Her family couldn't
get her medicine and she was in the fetal position in the bed gasping, in awful
This is Africa's internal medicine. So few options, yet
patients still come. They must be desperate. And if I spent a whole month
with Dr. B and Dr. Assem I would be an American infectious disease expert.
Many questions and few answers arise in a week of
medicine like this and I don't have to answer the problem of pain in one blog
post. Instead I will learn and see and be thankful to be in a place so few
Americans will ever have a chance to touch.
I'm always looking for a better mousetrap (I won't say a
better way "to skin a cat" since I am a cat lover who had to endure dissecting
cats in an undergrad anatomy class). So the better mousetrap I'm looking for is
the most efficient study strategy for the vast amounts of knowledge that I must
somehow accomplish to be a PA.
And since I do not excel at brain stuffing, also known as
short term memory packing that undergraduate classes sometimes reward and
otherwise known as the pump and dump (you pump your brain full of information
and then dump it immediately after the final exam), I am in particular need of
a better way to master large masses of facts.
I'm pretty strong at getting the "big picture" and grasping concepts
and the WHY of things. It's the thousand little details that I have to hang on with
these concepts that challenge me.
So I'm constantly looking for that better way to study. Well,
spaced, timed card recognition seems to be a good place to start. As is often
the case, I discovered this from reading blogs. I rarely invent the wheel but I
sure like copying it.
I figured I would look to my medical student friends for
advice on brain stuffing. And I started gleaning some of my favorite "Dr.
Will-be" blogs. Again, why reinvent the wheel when I've got these super smart
guys out there showing me the way!
Well, here's what I found. It's called Anki. Anki is like a flashcard nanny. It is free
software that organizes your flashcards for you and then spits them back at you
at timed intervals according to how well you were able to answer the question
on each card.
So Anki manages your review for you. And like any good
nanny, it syncs itself across multiple platforms, too! They looked at how the
brain recalls and learns information and designed the program so that it
presents cards to you at spaced intervals in such a fashion as to cement them
into your long term memory.
You can download other people's card decks or create your own
from your study material. It holds and takes care of all your study cards while
you are off doing other things like going to class and sleeping (because isn't
that all you do anyway!?).
Then when you sit back down to study, Anki will show you the cards that you most
need to practice in a timed format that elicits the best long term learning for
you. I won't talk about HOW it does this because this is a computer thing and
there are other super brainiacs who have figured this out for me.
But it's easy to use once you get it set up -- though
admittedly there is a learning curve involved. There are several "how to Anki"
videos on YouTube that are helpful. There is also a phone app for Anki so you
can utilize those spare moments waiting in line at the coffee shop or grocery
There are other programs out there that utilize spaced time
recognition of flash cards. There's Firecracker
and Pathoma to name a couple that seem to
be popular with our medical student brethren. So my advice is pick a card nanny
and get cracking!