#physician associate

This is, admittedly a month belated. In March, I officially entered into year 7 of clinical practice as a PA. Looking back at past reflections, it is always interesting to see what sort of headspace I was in.

New things for me: more administrative duties related to several parts of my department & having to choose between the PANRE-LA or the normal PANRE.

I chose the PANRE-LA and started my questions in January.

I really had a hard time with this, mainly because I feelt like even thought the longitudinal assessment is more in line with adult learning theory and better supports continuing education, I still feel like I have to sit for a 5 hour exam.

In all fairness, the boards recertification as a PA is absolute shit unless you work in primary care. I haven't cared for a kid in 5 years. Pediatric exanthems? LOL.

Working in adult critical care since 2021, there isn't a ton of detailed stuff related to my specialty. Hence copping out and just doing the LA. Why add stress to my life when I can just do the longitudinal assessment and be done with.

This year, I have mentoring a new hire PA staight out of school. We have a lot of similar interests and a similar personality. We've gotten coffee outside of work and just hang out. She is a reminder of how far I've come. In the ever famous words of Lorde, "it feels so scary gettin' old."

I definitely have a comfort level with my knowledge and that is the kind of thing that can get a little tricky at times. I don't want to get into a rut where I assume I know things.

I am doing a little more hyperbaric medicine and have a conference in Mexico in May. Going with some work people - should be a good time. :-D

Overall, I feel pretty satisfied where I have come and where I am going. Critical care is still an emotional toll. It has impacted my health negatively and I've needed to prioritize self care. A surgeon buddy of mine and I will go to yoga a few times a month --that's been helpful. Though, I think I am mostly just hoping I am putting in good cosmic karma for my next life where I have a stress free job (or none at all) and just paint and make music. :-D

But, in all seriousness, I don't regret a single thing about pursuing PA school and becoming a PA-C. Best life decision I have ever made besides marrying Mr Poppen and adopting our fur children.

2025 was.... a year. I, like many people, found myself a tad overwhelmed with the events around the world and here in the US.

2026 seems to be shaping up similarly with its bullshit.

I am still in the ICU, though I am doing more HBOT these days. I have an administrative gig as well which added some new responsibilities. One of those tasks was formalizing our fellowship curriculum as our program seeks accreditation. That teaching degree is coming in handy!

I am fast approaching 7 years as a PA-C. I registered for the PANRE-LA and that was just...mind boggling. It my head it was further off. I suppose it isn't.

I'm in a relatively comfortable place in my career. I know what I don't know and I know what I know. I have great professional relationships and my work is fulfilling.

I had a patient recently who went from living a "normal" life to getting a metastatic cancer diagnosis. Two weeks ago, things were fine, then all of a sudden they were sick. In actuality, it appears that they were sick for several months prior and either ignored it or wrote it off as something else and did seek answers until now.

I met them in the ICU after they had some complications from a procedure. This procedure ended up marking the beginning of the end for this patient. With the extent of their disease and what little reserve they had, this procedure tipped them over that edge. If it wasn't this procedure, it would have been something else. Knowing this doesn't make me, of their family feel better.

This family had some hope that there was an option or at least more time than just 24 hours. I had to be the person to tell them that their loved one didn't have much time at all and that they were dying.

Nothing prepares you for the expression on someone's face when they get this news and how you can feel their heart fracture in front of you. I feel like a part of me fractures when I see it --- an indescribable level of pain that is just hard to articulate.

The patient's spouse was balling uncontrollably. Apologizing for the crying. That's the weird thing - people apologize for their grief. I reassured them that they had nothing to apologize for.

The spouse looked up at me aghast with a sudden realization: "oh god - how am I going to tell them that they aren't going home? How am I going to tell them that they are dying?"

My response is always the same: "YOU don't have to tell them that if you don't want to. That is something I can take off your shoulders unless you think they would rather hear it from you."

This spouse and their kids unanimously agreed that the news had to come from the family.

The spouse told my patient that they were going to die. I am not certain I could be that strong if roles were reversed.

This patient got put on CRRT to extend the time they had left with family. They thankfully hung on comfortably without needing to be intubated. They passed peacefully with family at bedside. Got progressively hypercarbic and hypoxic and just went to sleep.

That's all the spouse wanted - "Make sure they don't suffer, make sure they aren't in pain."

I think we managed to do that for them.

It is both humbling and strange to be so intimately involved in someone's life in this way. It was the kind of experience that I am honored to half as an ICU provider but it is also the kind of thing that rips my soul in half.

I came home with emotional support pizza, shared my grief over this situation with my own spouse who I hugged I little tighter that evening.

Hey there.

You passed your boards, you got that job, and you have that badge that says PA-C. There is so much excitement at this time but also a lot of anxiety. There will be a day where it will hit you: "Oh shit, I have to make a decision. This patient's care is actually in my hands." That can be a scary feeling.

Please know that I see you.

The first 6 months is so hard for so many reasons. You'll feel dumb. You'll wonder why you're allowed to practice. You'll make mistakes.

You'll also have many successes. You'll learn a lot.

Keep asking questions. Keep learning. Keep seeing every patient as a learning opportunity. Take time for yourself. Breathe.

The more you experience, the more confident you'll be. It just takes time.

I believe in you.

Hang in there.

If you had asked me in 2012 if I would be posting a "Year 6 as a PA-C" entry, I would have thought you were off your rocker. Truly. I had so little faith in myself that I could do the thing that, had it not been for sheer grit, I probably wouldn't have.

As I pass this milestone, I have a lot of thoughts. This blog, for one, was the origin of making me feel like I could, in fact, do the thing. Our little Pablr community has grown and the people I interacted with on here were a major part in making me feel like I had a shot. While I post relatively infrequently (because life), I value what this forum has given me. I probably could make a year 6 post without to be honest.

So, about that Year 6.

I survived July 1 or "hell day" as a I call. I wasn't in a resident pod so I was mostly spared from all the nervous energy that happens. We do have a new fellow I got to work with but he is from our institution so he knows the system, which is honestly half the battle.

Finally finished reading The Body Keeps The Score. Honestly should be required reading for all medical trainees.

Well with nice weather comes all the traumas. It has begun.

It's fine - entering my 6th summer as a PA, I have a good barometer for the crazy shit that comes our way. At this point, it is fair to say that I've seen just about every weird fucking thing you can see.

I'll be picking up more HBOT than ICU over the next several months. Usually, I do 18 shifts in 6 weeks and 7 of those are HBOT. I'll be shooting for 9-12 for the time being.

Truth is, I am a little burnt out. And, if I am honest with myself, I have not really organized or processed some of the things I have seen and dealt with. Compartmentalize, yes. 110% great at that. But it's like my foggy ass brain is full of boxes that I need to unpack. I feel like a sponge that has soaked up too much.

We do an AWFUL fucking job at this in my specialty. Like, a horrible job. It didn't occur to me that this was a problem until recently when I had a difficult family. The patient came in brain dead and no matter how I tried or the approach I used, this family didn't believe their loved on was gone. I found myself rather angry and ultimately took a day off of work because I didn't want to interact with them or be around the situation. I had completely lost sight of the pain and grief these people were going through and was just...completely pissed at their ignorance. And while it is ok for me to feel frustration with the ignorance (truly, it took almost 2 weeks for them to get it), the intensity of that anger was...not normal.

I've been doing some version of critical care for 5 years. I love my job. I love the clinical complexity. I love the stories. But it has cost me mentally and emotionally.

I am so tired. All the time. I can't sleep enough if I tried.

I am bloated. Puffy. I feel alien in my own skin.

I am foggy. Exhausted. Apathetic. Blank. It's just...not ideal.

Honestly, if my work would let me be 0.8 FTE or something that would be great. At least temporarily. They won't do that (we are short staffed all the fucking time) but less time there would probably be good. Hence why my option to do less ICU is to do more HBOT.

My department would LOVE a straight HBOT person. Like, they are hankering for that. But lord that would be SO boring. I could not go from the continual excitement of ICU to...that.

Hello! Apologies for the delayed reply, we just got finished with finals 😖

For my personal statement, I started by writing out different “stories” I wanted to include, then worked to piece them together from there. For example, I highlighted my experience with a transgender patient which were especially important to my deciding to pursue the PA profession (as I hope to work with the LGBT+ population one day). Looking at examples of successful personal statements also helped me get a feel of the format! There are many helpful guides out there as well.