A French Proverb...

"To cure -- sometimes,

To relieve -- often,

To comfort -- always."

- Unknown

This little proverb was given to me by my pediatrics professor near the end of last semester and it has crossed my mind several times since.  The words are so brief, yet they carry such a powerful message.  As a busy medical student and a novice clinician, it is incredibly easy to get caught up in the overwhelming amounts of data that we are constantly taking in and trying so hard to remember, that we often forget the single most important part of our job... truly caring for our patients.  Vast medical knowledge is nice, and often helpful, but not essential in most cases.  There are no magic pills that will fix every ailment, and the wonders of modern medicine, however great, cannot heal all wounds or cure every illness.  Often, the best "treatments" we can give, are not actually treatments at all.  It has been my experience, that those providers who can consistently "comfort" their patients, are they who are the most successful.  The practice of medicine is much more of an art, than a science, and the better we remember that as clinicians, the better we will be, and the happier our patient's will be in the end.

Friday Clinic, Day Three

On this day, I spent the day in the busy family practice clinic and found myself hanging on for dear life.  As family practice will most likely be my immediate home after completing school, I was really excited to see what goes on in a normal, general family medicine clinic... the answer is.... EVERYTHING!  I was blown away at not only the breakneck speed of the clinic in general, but the completely random nature of the patient complaints that rolled in.  Medical roulette is a good way to describe how it felt.  The fun, but ultimately scary thing about the day was the fact that there was absolutely no rhyme or reason to what was next on the schedule.  Here is a brief snapshot of some of the complaints that I can remember: back pain, diabetes, "weird bump on my nose", shoulder pain, bipolar disorder, high blood pressure, new onset stutter, cough, skin rash, depression, "can't loose my baby weight", neck pain, etc... and that was all before lunch!  Needless to say, there is never a boring day in family practice (to a student at least!).  Despite the fact that feelings of crushing inadequacy accompanied me for the majority of the day, I was able to see most of my patients on my own, which was a great experience.  I took four-times longer than my preceptor to do anything, and often had to have him recheck most of what I did, but I was doing it!  However, slow, sloppy, or uncoordinated it was... I was doing it, and it felt GREAT!  Every time I put on that white coat and get to work with patients, I am reminded of the fact that I am doing exactly what I have wanted to do for so many years.  The road has been long and fraught with innumerable challenges, but I am finally getting to do what I love... treat patients.  At the end of the day, I got in to my car dead tired, hungry, and without many functioning brain cells, but I did have a big smile on my face, and that was the best feeling of all...

Friday Clinic, Day Two

The weeks are really flying now that we are only in class four days and then in clinic on Fridays.  My second clinic day started with me following an ophthalmologist (eye doctor).  One of the great parts about my clinical site, is that there are a bunch of different specialties all in close proximity which allows me the opportunity to get exposed to a ton of new things all in the same place.  Although my time with the ophthalmologist this day, was largely relegated to observing him adjust various eyeglass prescriptions, I was able to learn a lot about eye exams, anatomy, and pathology. (Doing a microscope/slit lamp  exam is much HARDER than it looks!)  I probably learned the most about glaucoma, and what a terrible disease it can be.  The Glaucoma Research Foundation estimates that approximately 4 million Americans are afflicted but shockingly, only around half that are aware they even have it.  One more good reason to have your eyes checked regularly.  The rest of the day went by really fast as I got back to my regular clinic and saw the remaining patients of the day with my preceptor.  The highlight of the day was that I got to take my first "solo" history and physical on a patient.  Up until this point, I have been mostly shadowing and doing minimal things here and there under direct supervision.  It was great to feel that little bit of nervousness as I walked into the room alone, and to feel like I was really "doing" something.  I am surprised how much I crave just jumping in and getting my hands dirty with the work.  The nerves only lasted a few moments, and I was surprised by the end of the encounter at how smoothly it all went overall.  I am definitely not afraid to make mistakes, and feel like I am comfortable enough with my preceptor, and my own skills, to know when I am in over my head and need help.  I definitely learned a lot, and am getting more comfortable as each week goes by... I love this stuff!

Friday Clinic, Day One

After an altogether terrible night of sleep, I crawled from the warmth of my bed, tripped over a few diapers and other remains of an angry 6-month-old who had thoroughly exerted her dominance over the hours between midnight and six a.m.  Her authority is not to be trifled with...  However, despite the rough beginning, this day was meant to be a special one.  My first experience with "real" patients and day one of the clinical portion of my training.  Up until this point, I had been spending countless hours cooped up in a windowless classroom under a constant barrage of power-point slides, graphs, and endless lectures.  This day, however, I was going to break free of the constraints of the classroom and venture into a whole new world where I was going to interact with actual patients and start applying the ridiculous amounts of information that I had so diligently tried to cram within the limited confines of my brain.  In the classroom, our professors have been indoctrinating us with not only raw medical knowledge, but instilling in us time-honored ideals and principles of medical practice from such medical legends as Sir William Osler and many others who have paved the way of modern medicine.  Our "classroom" world has been one where time was not an issue.  Meticulous medical histories and physical examinations were performed, and careful, often painstaking thought was given to diagnoses, medications, and treatment options.  Details of the history and physical exam were explained and carried out in great detail making sure not to leave any information unexplained or left out.  Needless to say... my expectations were high, perhaps too high.  To my surprise, this new clinical world was light years away from the comfortable classroom atmosphere to which I had become so accustomed.  It was really strange to me that I was actually surprised by this since I had spent so many hours working in busy hospitals, clinics, and emergency rooms before entering PA school.  Yet, there I was, feeling slightly overwhelmed by my current situation.  Perhaps it was due to the fact that I had never actually followed a patient from check in all the way through the actual visit and was used to doing procedural type exams and tests and then moving on to my next patients... Or maybe it was the fact that I was now standing on the other side of the fence, stepping into the role of provider which allowed me to see things from a completely new perspective that was previously unknown to me.  Time was one of the things that really shocked me... the sheer speed of the entire encounter was less than a fourth of what I was accustomed to.  Parts of the history and exam that would have taken me thirty minutes or so individually, were done in less than five minutes all together.  "Semi-controlled chaos," I believe were the words of my preceptor when describing the usual pace of normal clinic life.  This being my first day, things were actually pretty slow compared to normal due to some of the logistical things that had to be done such as HIPPA training, orientation to all of the areas of the clinic, and meeting the majority of the staff that I would be working with over the next 24 weeks.  I was however, able to work with a handful of patients throughout the morning and afternoon, just enough to ignite my curiosity and desire for more in the weeks to come.  I was not overwhelmed... (yet), and was at least able to get comfortable enough in my surroundings to prepare me for times when that would definitely not be the case.  All in all, my first day was exciting and a great first experience in this new "clinical classroom."  I am really excited to see what the next 24 weeks will bring, and am anxious to see how much I will grow this semester as I move ever closer to the end of my didactic training, and enter the full-time clinical rotation phase beginning later this August...  I did learn one very important lesson by the end of the day... I have a LOT to learn!

One of the "Old Breed"

"After I finally got out of the water, I ran forward, and saw two Marines--both badly hurt--laying out in the open ground.  They must have been ammo carriers for machine guns because right next to them were open metal cans of brightly colored ammo, which I was afraid would make an easy target for the Japs.  They were laying out in a rather open area with very little cover around them.  There I was, seeing my first battle casualties and knowing that they needed attention.  I remember one of them was named Edward, who had a lot of wound fragments in the lower abdominal area as well as his private parts.  He was laying on his back with his face turned up into the sun--moaning and groaning in pain, his helmet was still on with the chin strap pulling his head backward.  It is funny the things you can still remember about your first casualty...     I remember jumping over holes to get to him.  He was very badly wounded with a bullet hole right through his neck.  He was very tall, thin, blue-eyed fellow, and he was sticking up above the ground in a very dangerous position.  In order to treat him, I had to crawl down to his feet area and pull him down into the hole further to get his head and shoulders low enough that I could examine him closely and see if I could do anything for him.  I will never forget those big blue eyes which were staring at me.  He was trying to talk, but of course he couldn't with the wound that he had.  It was obvious to me immediately that he appeared to have a fatal wound.  Blood was pouring out of his neck in a stream.  You can't put a tourniquet around someone's neck.  I knew that he could hear me, so I kept assuring him that he was going to be okay, and I would do all I could for him.  While I was holding him in my arms, assuring him he would be okay, he died right then and there.  I can still remember those deep blue eyes, begging me to do something for him."

"My War Years is a detailed, first person account of Pharmacist Mate Paul W. Smith, who served in the United States Marine Corp in the Pacific Theater of World War II. He intimately describes the hardships, horrors and humor of nearly four years of service to his country. Paul Smith took part in the invasions of Guam and Okinawa, where he was wounded in action. His rating as Pharmacist Mate brought him to the front lines of the conflict, providing medical care to the maimed and wounded in some of the bloodiest battles of the war. He begins and ends his narrative with personal recollections of family and friends that he left behind in Salt Lake City, in particular the long-distance love affair with his eventual wife of over 60 years, Alice Buckmiller Smith. The story is a personal triumph of faith and commitment from a generation that will soon be without a living testimony." (Randall Smith)  

Paul W. Smith, my grandfather, is not only a decorated war hero and talented doctor, but the single reason that I am where I am at today.  He is a huge inspiration to me and one of the biggest reasons that I have always wanted to learn and practice medicine.  The medics and corpsmen during and after WWII and Vietnam paved the way for the emergence of the physician assistant profession.  Their sacrifice and compassionate dedication to the care of their comrades laid the foundation for the core values of physician assistants and doctors alike.  I am so proud to come from such a rich heritage, and am grateful to my grandfather, and all those who fought along side him during the most bitter fighting our world has ever seen.  We are losing these brave men more and more every day, and unfortunately, their stories are dying with them.  As a member of a new generation, here due to their sacrifices, may we never forget their service, and always remember the freedoms that we now enjoy thanks to them.

("My War Years" by Paul W. Smith, is available from the above link as a paperback, or a free PDF download here.)

Behind every good man...

They say that "behind every good man, there is a better woman..."

Well, in my case, I have three!  So, before things really get rolling this next semester, I have to pause to take a moment to thank my family, and especially my beautiful wife for her support, strength, and patience with me.  She takes such amazing care of our two little girls at home while still managing to keep up the rest of our busy lives in order while I am gone.  (and I am gone a LOT)  Were it not for her tireless efforts, I would in no way be able to put in the long hours of classes and studying that it takes to make it through this challenging PA program.  She is my best friend and the best companion anyone could ask for.  I love her more than I can express and want her to know publicly how appreciative I am of her efforts and hard work.  To my baby girls, your smiles and hugs when I get home are the greatest joy and motivation of all and nothing makes me feel better, than having you both in my arms.  I literally feel like they were made to hold you!  I am the proudest husband and father in the world and am so glad for the love and support that ALL of my girls give me everyday.  You are my heart and soul and the motivation for all that I strive so hard to achieve... I love you!

...and so it begins

In seven days, I will be attending a white coat ceremony signifying the beginning of the clinical portion of my training as a physician assistant. I will raise my hand and recite the Hippocratic oath and together with my friends and colleagues, join the ranks of thousands upon thousands of medical students who have been given the unique opportunity to learn to practice medicine hands-on. This past year has been filled with countless hours of lectures, power point slides, libraries, graphs, tests, diagrams, and more stress than I have ever experienced thus far in my life. I have, however, learned more in these last months than I have in all of my other years of college combined, and hopefully have started to form a solid framework upon which to build a successful clinical experience and career. But starting January 15th 2010, the game changes... for the first time I will be putting my hands on actual patients and delving into an exciting and thoroughly intimidating new world of "real" medicine. My patients will no longer be volunteers, classmates, or my poor wife whom I have examined (poked and prodded) so many times. These will be living, breathing patients coming from a myriad of different places with genuine complaints looking for sincere counsel and compassionate care. I am nervous and uncontrollably exited all at the same time. I know that I have come a long way, but have so much more to learn making the feelings of inadequacy sometimes overwhelming. Yet, I am excited for the opportunity to learn, and finally take on the responsibility to care and serve patients. My purpose for writing is to document this journey, as it is the only time that I will have the chance to learn clinical medicine for the first time. I hope that by sharing my own experiences, I can learn and grow as a student, and a provider, and laugh at the mistakes that I am sure to make along the way. I hope to provide and interesting commentary on my experience, and also share some of my own random thoughts about life, family, medicine, and anything else I find interesting as I go. So here's to good times and new adventures...

...Just don't look stupid (that was my inside voice)