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Friday, June 3, 2011

The REAL House of God

A short white jacket and name tag. A black medical bag given to us all by Eli Lilly, when such things were acceptable. Schedules were given, with several rotations I had requested!

Surgery-- my least desirable 6 week rotation, was 1st. I figured that was great, because I would get really good at history and physicals-- or H&Ps, as we called them. My preceptors were both females-- a lady surgeon and PA. How cool. Surgery was not my best experience. The air conditioning went out in the operating room of the now defunct/demolished Doctor's Hospital  and the surgeons were sweating while they worked. Still, I was happy to tie the knots and get experience being on call.

Internal Medicine was terrific at the Martinsburg VA Hospital in West Virginia. I was able to function as a respected medical team member, researching cases, writing orders and taking call at night. I came to hate the smell of stale, strong alcohol at 3 a.m., with new admissions and gastritis/pancreatitis patients, but we had a terrific new drug called Tagamet that helped a lot of people. A farmer came in with recurrent fevers and after a lengthy H&P and later, confirming lab tests, I had my working diagnosis: Brucellosis! My supervising PA and physician were impressed. I loved the quiet, cool autumn evenings in West Virginia and often would clear my head on a motorcycle ride over the rolling hills.

Ob/Gyn was a pivotal experience for me at the huge Washington Hospital Center. Although I did not particularly like surgery, I adored my 2 precepting physicians-- both female doctors. I was well utilized, and showed some of the newer med students how to perform wet preps and KOH slides in the clinic, rather than relying on a wait from the lab.Deliveries were miracles--and at my first solo birthing, I held the infant as it gently began its life.

"Clamp the cord!" I was reminded. I also was permitted to perform my first gynecological exam under anesthesia. It was amazing that I would feel the womb, ovaries and even the tiny fallopian tubes. I recently located called Dr. Stockwell and again thanked her for her kind guidance and teaching so long ago.

 It was during this time, I read a popular book "The House of God". It depicted the experiences of a new doctor, learning his trade in a big city hospital. There were rules: in the case of an emergency, first take your own pulse. That has remained my favorite. It was poignant and funny and sometimes I think about reading it again.

My electives were dermatology and neurology.  Both have served me well and both were in DC so I was able stay nearby for both. I also liked stocking up on the creams and soaps in derm-- I still use and recommend Person and Covey products.

Inner city pediatrics was quite an eye opener for me. I saw baby after baby and got really proficient at examinations and the immunization schedule. One of my young patients was diagnosed with active tuberculosis and after my TB test became positive, I had to take isoniazid and vitamin B6 for a full year.

Spring became summer and I prepared for my preceptorship-- in Ketchikan Alaska. I had written my first article for Medical Lab Observer magazine and won 2nd prize for their contest of unusual lab experiences. I told of how I learned of new procedures by visiting other labs-- and then instituted them where I worked. On motorcycle, in Australia-- hospitals were a big part of my life. That honorarium allowed me to purchase my Air Alaska ticket and pursue my next adventure: Alaska!

A pediatrician friend and colleague was on staff at the Indian Health Clinic. Kindly, he agreed to my working there to complete my PA training with theTlingit & Tsimshian Indian Health Service. What a fine experience that was! Indian culture, a LOT of babies, boats and small town life in a series of tiny communities in Southeastern Alaska! I got to travel to the smaller islands in a light plane that landed on pontoons, with a staff PA who was Tlinget himself. Bernie and I provided services at their satellite clinic and I was welcomed by all.

Graduation came and went! The date changed for the ceremony-- after I had purchased my plane ticket. So instead of receiving my diploma in a ceremony in my DC home, I went to Disneyland!

Tuesday, May 31, 2011

Workin' Woman-- to Workin' Student

Interview. For PA School.

Over 1000 applicants were in the running for the GW PA class of 1978-80. 50 would be selected. Not a gambling person, I was still resolute. I just *knew* this was my year to be accepted into Physician Assistant School at DC's George Washington University.

I had worked night shift in the blood bank before my 10 am interview. I was a bit sleep deprived and had bought a navy blue power suit (a big '70s thing) for the meetings. A coworker brought a scarf and tied it in a frou-frou bow around my neck. Definitely not my style, but for some reason, it was reassuring for this jeans and t-shirt gal.

I recall walking into the conference room of what was then the PA office, to a big oval table with several serious faces scrutinizing me. Hours later, I was shifted office to office, asked more questions and floating in time. "Why did I want to be a PA?" ("Umm. I want to help people.") "What did I do to prepare for the rigorous coursework?" ("I took all the prerequisite classes, knew all about PAs-- and I had SAVED almost $20,000 for the first year's tuition!") An all-time odd interview questions was asked by the clinical director: "Do you date?" she inquired. Unsure how to answer,  I slowly articulated "Yeeeeeeeeeees". I still ponder the reasoning of her peculiar query even these 30+ years later.

Weeks past and I received the acceptance letter. YEE Haw! I was on the way to being a PA.

My tuition was $6606.00 per semester, a sum I for which I would write a check 3 times a year for next the 25 months and declined thinking about meaning of the number. I enrolled in a pre-PA medical terminology course that was offered. There, I reviewed -itis vs -algia and -oma. I was grateful I took that first step towards learning the new language that was to become central to my life and existence.

That first 26 hour semester was THE worst. I had never attended college full time. Mine was a part time while working experience since I moved from my family home a week after I turned 18, almost eight years previously. Books were expensive and the fees mounted-- labs, those nebulous "student center fees" and whatnot. I envied those 4  classmates on military scholarship. Everything was paid for them: tuition, books, housing, food.

Certainly not starving, I ate lots of ramen noodles, mac and cheese and peanut butter, although not usually together.I worked weekends as a lab tech and got a second evening job bartending on "The Spirit", a tour boat that had private parties on the Potomac River. I would eat frugally all week long and come home Saturday evenings with wonderful meals. One time, I received Lobster and a bottle of Pouilly-Fuissé (a wonderful, expensive chardonnay) bequeathed by the caterer to me. That particular time, the very French chef told me in a thick accent, "Take this home and enjoy it with your lover". Since I had no boyfriend, my lab friend Tracy shared the meal with gusto. But we DID have fun!

Sometimes there were tips when I tended bar.  My coworker bartender scoffed at a party of bowling teams one evening-- not our usual high-dollar customers. "How low-brow!", he exclaimed. At the conclusion of their cruise, their organizer handed both of us a $100. bill. That was a miracle from heaven in those lean times.

So I paid bills and went back to studying in the laundry room of my roach-infested building on GW campus, or sometimes the library at the medical school, where classmate Mike had a permanent cubbie. Rent controlled, my apartment was 2 blocked from the Foggy Bottom Metro and the Medical School at Ross Hall. $315/month was worth the aggravation of the nosy landlady, repairs done eventually and those creepy cockroaches I could hear gnawing in the dark, all.night.long.



German Cockroach-- my constant companion



Classroom, studying, working and an occasional celebratory toga party and were my life for that first year. I still played and wrote  music, often with an assembled group of friends. One song I wrote to the tune of "Ballad of Jed Clampett" was titled "Ballad of the PA Student". ♫ The lyrics follow:

Let me tell ya'll a story of my PA class
Exams every week/we're afraid we wouldn't pass
Then the profs started posting all the grades
That terror that we had-- all began to fade.  Sort of.

At first it seemed it was us agin' them
Them bones to memorize, those pathways of Biochem
It could scramble up the braincells if we took time to reflect
There was too much yet to learn and no time to object
'Cept between classes. and on weekends. And lunch breaks.
Doc Cassidy informed us we should learn every nerve
I couldn't help but wonder if we're graded on the curve
Kept wishing Dr. Tidball would show us all some heart
Cause looking over notes, I could not figure where to start. 
Lemme see. Again. Ooo-ee.

Well two years from now I suppose we'll graduate
Running from Ross Hall we won't even hesitate
As for weeks and months, we have spent in haulin' ass
It's all in a  DAY for 1980's PA Class.

(note: the professor names are real! whether they are still there is another question.)

PA and Nurse Practitioner students took basic science courses with each other, but then joined the medical students for the specialty modules, such as nephrology and cardiology. We also took physical diagnosis class together and despite our reluctance, practiced on each other-- and later, our family and friends. I called it "playing doctor". And I was getting GOOD at it!

During one history practice session, I was pretending I had mononucleosis. As medical student kept asking me a barrage of questions. I vigorously nodded and shook my head in reply, while she studied her notes intensely. The instructor stifled at laugh when the med student finally looked at me and stated, "Well, I am certainly glad nothing is wrong with you!"

One pivotal memory in the huge lecture hall was an orthopaedic session, where the professor interspersed photos of naked buxom women with his teaching slides. I slunk back into my seat as the guys snickered and guffawed. One woman stood and announced, "We women would like to be entertained by pictures of naked men, too!" The professor stammered a response to the effect of "I didn't mean anything by it", although I truly wish I'd had the courage to stand with that brave 2nd year medical student.

I owned no car. I rode a BMW motorcycle, because of the relative ease of parking in downtown DC and low fuel costs. One of the Nurse Practitioner students and her husband also rode Beemers. We became fast friends and often studied together. Lucy Anne and I kept in touch long after PA/NP school until her death from breast cancer many years later.

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One snowy day, I crossed 23rd Street from class to home, with a 40 lb backpack slung over my shoulder A man ran the traffic light and just missed hitting me. I thumped my fist on the back of his car in protest. He slammed on his brakes, got out and this 6 foot tall male pushed all 5'1"of me into a snow bank at the corner. Another man witnessed this, strode over and pushed HIM down into the same icy mush as I scrambled to regain my footing and scurried home.

"But she HIT my car", he whined, as the other guy stood over him menacingly, fist coiled.
Here I was learning to save lives and someone almost took mine.

Next: The Clinical Year or Learning First Hand about the House of God.

Monday, May 30, 2011

Memorial Day, 2011--a day of firsts, and rememberance.

Good morning! For several years, I have thought about a blog describing my experiences as a PA (Physician Assistant http://www.aapa.org/about-pas/our-history) in rural Family Medicine. Today is the day I will begin the journey of recollections, stories and the adventures of being involved in the health care of a tiny Coastal NC community.

My first posting today is on the 2011 Memorial Day holiday. Because of many US men and women, we in our nation continue to enjoy the freedom of speech and ability to pursue our own paths. Very few countries can boast that and yet the citizens of small towns across the nation were indeed many of those who answered the call to defend our core values and beliefs, in times of war and conflict.

From the medics and corpsmen of Vietnam era, came the first graduates of the physician assistant program at Duke University in 1965. Although first pitched to nurses by Dr. Eugene Stead, test case students were ultimately Vietnam War veterans, chosen for their interest and previous medical experience. In the 1990s at MCAS Cherry Point's Clinic, I had the pleasure and honor of meeting Vic Germino, one of that premiere 1965 class of PAs-- or Physician Associates, as we were first called.

PA Germino was soft-spoken and humble. He told me he loved medicine and continued to work several jobs, as many of the earlier PAs certainly did-- and still do. I felt as if I had touched the face of history, when I shook Vic's hand!

In the mid-1970s, I was finding my own path. Working as as initially a laboratory assistant, then a technician handpicked by the supervisors of the time and ultimately, a Medical Technologist at DC's George Washington University, I was foundering.

Should I pursue a Specialty in Blood Banking (SBB) or travel another path in medical practice? A colleague in the chemistry department persuaded me to consider another journey. Kevin had been in the Army and recently completed PA training at GWU's program. He worked with a Family Physician in Maryland, and excitedly told me how he loved seeing patients and their families in the office every day. Still working weekends in the lab to support his 6 children and repay his tuition, he told me he saw in me a desire to be with people and thought PA was a perfect course for me. I read, asked more questions and requested the colorful GWU PA program brochures. Another lab colleague was accepted to the PA program a year ahead of me, so I tracked his struggles and triumphs.


For over a year, I prepared for PA school: I diligently saved money for my year's tuition. I volunteered at the DC Free Clinic to witness and participate in hands-on patient care. My bumbling attempts to check throats and ears is now a kind and distant memory.

Until that time, my experience with patients was to draw blood, also called phlebotomy, and sometimes perform special tests, such as bleeding times. It was during those encounters, I realized I enjoyed talking with people-- the first open heart surgery patients, those recovering from various illnesses and sometimes, celebrities who occupied the halls where I pushed my rattling cart of needles and test-tubes!

Arthur Crudup died a poor man on the 2 South wing at GWU Hospital, despite his writing some of Elvis Presley's biggest hit recordings, one of which was "That's all right Mama". Still, Mr. Crudup was a kind person and a guitarist who had me in awe of his experiences. He laughed easily and his gravely voice even sang for me one morning at 6 a.m!

Arthur Crudup-- musician and bluesman
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In further preparation for PA School, I requested and was assured a weekend position at the lab to pay bills, should I be accepted. I took additional courses to prepare me, included the dreaded Organic Chemistry, in which I received a solid B and the medical school parasitology elective. Then, I did apply and received an interview for the 1978 PA class at GW!

Thank you veterans-- for serving in US conflicts and wars! Not only did you assure and protect our nation's values and security, your progeny medics and corpsmen trail blazed the profession I call my own today-- over 4 decades later!

Next: My PA interview and college experience.

Charlene McClure Morris, PA-C
5/30/11