digiti minimi, PA-C

Hey tumblr! Long time no see. Heard you’re not cool anymore because you don’t have porn. 

I’ve been gone for a while but I figured I’d come back to the blogosphere to do my traditional end-of-the-year post.

My 2018 resolution was to set healthy boundaries with my family members, who have unfortunately been pretty problematic as of late. Happy to say that I managed to stick to my guns with that. It’s been a little tough, but overall it’s been worth it. 

This is the longest I’ve ever been at the same job (over 4 years). As far as being a PA goes, I’ve really settled into a comfortable routine. I have a great level of autonomy, and feel comfortable independently handling the majority of the patients I see. I’ve also started taking students, and it’s been interesting to be on the flip-side of things. Seems like it was just yesterday that I was shadowing a PA in the ER for the first time; but that was back in 2010! 

What else? I visited some new places in 2018! I went to: Nevada, Arizona, and Utah; Georgia and South Carolina; Louisiana; !!!!!!SPAIN!!!!!! (top of my bucket list since I was a young teen, and my first time in Europe) and Portugal.

Japan had been on our bucket list for 2018, but we decided to move it to 2019 so we could go for cherry blossom season. We booked a two-week trip to Tokyo in April! Really looking forward to that. We’ll also do a big trip in November for my 30th. Haven't decided yet on the location... thinking about maybe a European river cruise. We’ll see!

Honestly, I’ve never been the kind of person to talk like this, but lately I feel so incredibly blessed by everything in my life. This year was one of the first times in my life that I consistently exercised (mostly doing yoga, which has been a lifesaver for me) and also started a meditation practice, which has helped dramatically with anxiety, along with some self-guided cognitive behavioral therapy. I also returned to pescatarianism. Overall, just trying to be more thoughtful of the ways I use my mind and body. It’s been a really transformative year and I can feel a difference just in the way I think about things in my life, and especially how I think about myself. I am truly grateful.

I have a loving and supportive partner who accepts me as I am, but also makes me want to be the best version of myself. We have so much fun together; it doesn’t matter if we’re in some beautiful foreign location or sitting at home playing WoW together. He’s enriched my life in so many ways, especially through his children. I never anticipated having a partner with kids-- as a matter of fact, I previously thought it could be a dealbreaker. But wow, have they taught me a lot about love, patience, and selflessness. Not to mention the simple fact that they provide a whole new arena of FUN that was missing from my life previously! Although they also continually remind me that I somehow became old and uncool at some point. But I’ve learned a lot about meme culture at least?

Anyway, I foresee a lot of happiness in 2019. My resolution for 2019 is financially motivated... since I started paying off my loans in 2015, I’ve paid off nearly 50% of them. I’m going to be even more aggressive about loans in 2019. While I won’t be able to pay them off completely, I think I should be able to get them down to about 20% of my original loan amount. Then I will be slated for a 2020 payoff! Can’t wait!!!

Facial lacs on kiddos are difficult because they can see the tools and the needles coming at them. It’s not like you can distract with the TV or an iPhone.

So for this one, I had her sit with LET on the lac for a while and then came back in.

We engaged in some chatter and distraction for a bit while I got ready. I always set up the lac tray where they can’t see it. The last thing a kid needs to see is you pulling up the lidocaine through a huge blunt needle.

I sat next to her on the bed. I always start with minimal force. The earliest memory I have is being pappoosed in the ER while a doctor sutured my lip. Kind of ironic how my career turned out, considering that it is certainly a traumatic memory.

“Remember how I put that magic medicine on your nose? How does it feel?”

“Better.”

“Cool! Hey, how high can you count?”

“I can count to twenty.”

“Holy moly!!! Can you close your eyes for me as tight as you can and count to twenty?”

While she was doing that, I quickly used a TB syringe/needle (tiny needle, perfect for small lacs in sensitive places) to ensure that the entire lac was numb. LET is great, but the last thing I needed is for her to feel pain when I was in the middle of suturing her. She didn’t flinch and finished counting to twenty.

“That was so good! Do you know the alphabet song? Do you think you can close your eyes again and sing it for me?”

If any of my fellow medical people want to feel some rage, head on over to the /r/opiates subreddit and start browsing.

Quality content includes:

-“Pill porn,” pictures of their monthly narcotic prescriptions after getting them filled.

-Complaining about how the opiate crisis has “ruined things for everybody” and all you ever get in the ER is ibuprofen 800 mg.

-Complaining about strict pharmacy rules and regulations.

-Posting pictures of street heroin and prescription Adderall side by side— prescribers, didn’t you know that the intended use of Adderall is to keep your heroin addict patients awake?

-Suggesting that one should befriend cancer patients as a way to get easy access to opiates.

-Talking about what a great “nod” they got from fentanyl and versed during a procedure (followed up by another user commenting “I always love Dilaudid 2 mg IV when I’m in the hospital.”)

-Pictures of pills stolen from grandparents’ medicine cabinets.

-Pictures of syringes full of heroin about to be shot into someone’s arm, in honor of a fellow user... who just overdosed and died.

-“I just got Narcanned by EMS, how soon can I shoot up again?”

And so on, and so forth.

I understand that addiction is an illness, but when I encounter addicts at work every single day and often find myself being manipulated by them, finding this content really made my blood boil. It was like every bad thing I’ve ever thought about opiate users....... was not only true, but they’re also POSTING ABOUT IT OPENLY ONLINE!

There are also many posts about how their first step toward addiction was being prescribed narcotics by a medical provider, so that was a sobering thought.

On the plus side, I learned a lot of cool new drug slang (never knew “boofing” was a thing...)

Recently I got a patient complaint that was so obviously made up, but somehow STILL got forwarded to me from my medical director as if it were somehow legitimate.

The patient claimed that I made statements such as:

“There’s nothing wrong with you, this is all in your head.”

“You’re a nurse so you should know better than to be here right now” — BUT ALSO — “You need to listen to me because I’m a PA and you’re only a nurse.”

“You’re wasting my time.”

She stated that I “forcibly ripped the IV” out of her arm (side note: discontinuing IVs hasn’t been in my job description since I was a CNA) and told her to “get out of my ER and never come back.”

She also claimed that she spoke directly to her PCP who told her that she would be getting admitted and there was a bed waiting for her upstairs, when in reality, I called her PCP in the middle of the night despite the patient’s COMPLETELY NEGATIVE WORKUP and he said “this patient is texting me on my personal number at 3AM, this is inappropriate, and she can be discharged.”

And finally, her email implied that I had ultimately missed some kind of dangerous diagnosis by discharging her home— when in reality, I was able to review her PCP’s note from her ER followup, where he agreed with the plan of discharge (obviously) and the patient was fine.

I went above and beyond with this patient encounter, sitting down and explaining all of the diagnostic testing, explaining why it was appropriate for her to follow up in the outpatient setting, and offering a variety of different treatment options to help with her symptoms.

And then I get a nastygram from my boss outlining a situation that is clearly confabulated, completely outside of my character, and outside of....... any reasonable person’s view of reality.