“Patient is a 26 y/o otherwise healthy, devastatingly handsome male with a history of PSVT. He presents to the ED with three ex-EMS personnel all equipped in softball attire. Patient states that he’s had 4-5 episodes of heart palpitations for the past hour. He’s attempted valsalva maneuvers with some success, but cannot ‘get out of this one.’ Patient reports lightheadedness and tunnel vision. He relates paresthesias and hypothermia of all four extremities and says ‘walking feels like there’s cement in my shoes.’ He denies chest pain but confirms precordial numbness. On physical exam he’s alert, oriented, and does not display any speech deficits. He’s hypotensive at 88/46 right arm supine and O2 sat at 93%. A 12-lead ECG reveals a regular, narrow complex tachycardia at 180 bpm without visible p-waves. ECG is negative for T-wave inversion, ST elevation and Q-waves. Delta waves also absent…”
In light of my recent trip to the ED, I was reminded exactly how impressed I should be with the human heart. In my chest there it is lubbing and dubbing – autonomically, instinctively, protectively. Normally, I don’t have to tell it when or how hard to beat. But rather, it tells me two things: 1) “you’re alive” and 2) “dude, you’re out of shape” when I take the stairs from the first to fifth floor in the CLSB. When we moved into this spaceship of a building last June, I would have been completely lost in the medical jargon the ER attending and resident were throwing around me during my ED visit. Now, my classmates and I are running the final lap of the didactic 4-minute mile with just over a week to go. We’ve covered the human body from head-to-toe, from preconception to old age and back over again. We ran ACLS megacodes for when a patient’s life is at stake, and this week we focus on how to intervene and prolong life in the O.R. The amount of information that has been crammed into our brains and regurgitated to our professors, clinician mentors and patients is mind-numbing and down right impressive.
Yes, PA school is challenging – anything worthwhile will be. I knew this when I arrived at OHSU’s doorstep in a neatly packed admissions box labeled with prior professional stats and 5,000 characters describing why I believed I’d make a good PA. Everything was laid out, there was a plan, and I pushed pause on other aspects of my life to stick to it. You sit through the lectures, weekly exams and Echo360 videos on 2x the speed. In the grad student lounge, you fight off the vultures masquerading as health professional students circling in on your study room. You put on a fresh, happy face at mentoring even if you’re feeling anything but that because these are the patients that will make you a better PA for clinical year. Nights before your exams, you wish you had just one more day to study the material. And then you wake up to press snooze and do it all over again, five days a week, for 52 weeks.
All things considered, I realized that the daily grind isn’t the toughest part about this process. PA school is challenging because as you unpack that “admissions box” of yours, you realize the different hats you’ve worn are tucked to the side still waiting for you: as a son, brother, friend, sister, mother, father, partner, and maybe even hats you’ve held onto but were too afraid to wear until now. The life events that come from these relationships crop up whether you like it or not, both the good and the bad. It wasn’t in your plan, and you can’t push pause. As you course through the rigor and regularity of this program, time outside of the classroom becomes your most valuable resource. You take mental note of your personal pertinent positives and negatives that make you happy and use them to determine how/who you spend that time with.
So as I sit here reflecting on the past 12 months leading up to clinical year, all I can say is this: didactic year is a plan with not quite enough time. Master the clinical medicine as best you can each day, but take time for yourself too. There will always be a test. There will always be a patient who needs your help. There will be things you’re great at and things you’ll be terrible at. Life stressors like unexpected ED bills may be thrown at you at seemingly the worst time possible. How you deal with those fluctuations is in your court and the positive changes to your life during PA school will carry you through it, too. I’m thankful for the friends on Thursday nights for when we stuff our brains with disease etiologies and our faces with naan-rittos (yes, that’s an Indian burrito with naan as a tortilla). I’m thankful for the PA softball team for transforming my Sunday-self from a stress case into a cathartic second baseman. I’m thankful for the class road bike gang for roping me into 13-mile climbs to clear my mind and get my heart pumping. I’m thankful for whatever guiding force placed me at OHSU with classmates and friends who remind me how to be my best personal self as we all redefine ourselves professionally – as future physician assistants.