MERRY CHRISTMAS!

Well, half of my clinicals are complete, finals are finished, Austin was great, and San Francisco was fabulous. What more could a girl ask for? How about a week back HOME. Home has a few meanings. Our house here in Houston could be home, any of the apartments we've rented could be home, my parents house can be home...but nothing is really home until we are all (me, Ry, Mav, Goose, and Tig) back in DFW with our family and friends. It was so good to be back home. We had 3 family Christmases, so we got to see almost everyone! We went back to our home church, and spent some good time with friends. Along with getting to catch up with everyone, we also got to eat at some of our very favorite restaurants. We even had time to go see ICE at the Gaylord Hotel and to take my little sister Aimee out for a whole day-we hit up the donut shop (a favorite of hers) and the zoo. We had a fantastic week and felt so blessed that we got to spend this time with everyone. We made it back home safely, and are looking forward to a low-key new years'. Will post pictures later!

SAN FRAN

Ryan and I have been married for almost 4 years now...and the only vacation (meaning more than one night, not going for school or business purposes, and going without friends or family) we have taken has been our honeymoon. That's sad. A vacay was long overdue. Here's what all we got into:

Sunday: Up at 4 AM for our flight...ugh. Flights went well and weren't even crowded. I have to tell you, we flew Frontier for the first time, and quite liked it. We got into SF at about 10 AM local time so we really had all day there. We got our rental car, which was interesting. We had reserved a full-size car because my 6-foot tall, built like a line-backer husband doesn't really fit well into what rental car companies consider mid-size or smaller. Apparently, with this particular company, full-size means old Lincoln Towncar or Mercury Grand Marquis. No offense here, but those vehicles aren't really age appropriate for us, so we ended up switching a few things around and getting a Ford Edge. It ended up being a great little car! We walked a lot more than we expected, but still used the car a good bit. Anyways...we had lunch at In N Out burgers and dinner at a local pizzeria. I wasn't terribly impressed with either. They were both good food and solid choices, but I'm not sure I'd particularly crave the food they served. While eating lunch, we were introduced to the street performers of SF by way of the man doing magic outside the window of In N Out...yikes, that was...peculiar. And of course, we HAD to visit Ghirardelli. Apparently, they make a dessert called "Hey Lauren, we made a dessert just for you," AKA a Mint Bliss. It's chocolate ice cream, mint chocolate chip ice cream, dark chocolate fudge, homemade whipped cream, and a dark chocolate Ghirardelli square atop it all...it was only missing a cherry on top, but that didn't stop me from just devouring it. And it was delicious. Every single last bite...YUM. Oh ya, I also tripped over a hobo. It was dark, I'm night-blind, and he (or she) was sleeping just around the corner covered in a tarp because it was raining. Sorry, there's just not a whole lot of hobo's where I live! I'm not used to this business!

Monday: We discovered that/got confused by Californians have like 5 different trash cans. There is regular trash, recycling, composting, etc. I wasn't keen on this. I like the idea, but it was just too much. Anyways, after breakfast and being confused by the ridiculous (literally 7) number of trashcans, we headed out for our tour of Alcatraz. It was pretty cool! Colder than we expected and WAY more walking than we anticipated, but we enjoyed getting to see everything. We required a nap after walking around there for 3 hours. I was upset by the crew on a small issue though...I approached the snack bar and requested a soft salted pretzel with a side of cheese. First, they don't have salted soft pretzels, only plain. OK then, can I please have a plain soft pretzel with a side of cheese. The guy asked me if I wanted a cheese pretzel...NO, you are not understanding the words coming out of my mouth. One plain soft pretzel and one side of nacho cheese...PLEASE. His response "I'm sorry, we can't do that." Excuse me, but don't you serve nachos? Yes. Then give me an order of nachos, hold the chips! It's called liquid cheese! And I want to dip my friggin soft pretzel in the liquid cheese! GEEZ! He said that they aren't allowed to do that. I about told him where to put the danged plain soft pretzel. Anyways, we had lunch at a local sports bar, which was surprisingly delicious! I was really impressed. Then we did some shopping and exploring Pier 39 and surrounding area...then we found it. We found the sourdough bread bakery, Boudin's. Boudin's + Ghirardelli = delicious, but bad for Lauren...very bad. All I got was a grilled cheese with tomato soup, but if it wasn't the absolute best grilled cheese and tomato soup I've EVER had...O.M.G. After that, there was no hope, goodnight all. Don't worry, we visited Ghirardelli today, too. We didn't eat anything (besides the samples), but we did go and buy stuff. Of course we did. What else do you expect?!

Tuesday: Tuesday was "explore the rest of SF" day. We spent the first 2 days around the pier and doing most anything within walking distance, so this day we actually left the area. We/I found the actual house used in the full-house episodes and visited the park where they filmed the show's intro. Full House was a large part of my growing-up (and even still when I can find it on TV...guilty pleasure), so this was a big part of my SF visit. We also found the infamous "painted ladies" houses. I feel mislead that I thought all of SF looked just like those houses and the one in Full House. Spoiler alert: it doesn't. Then we tried to follow the map for this "49-mile scenic drive." Problem being that the map didn't say where to start, so I started at one end of the trail on the map. Apparently we did the entire thing backwards, because we kept seeing signs for the trail in odd places, but it was never quite lining up with the way we were going. Oh well, we do things our own, unique way! We went through Golden Gate Park, got some pics of Golden Gate Bridge, drove on PCH, and I finally saw the ocean! Crazy that I'm 25 and hadn't seen either the Atlantic or Pacific ocean yet, but not anymore! We ended our own scenic drive by going down Lombard/Curvy street...now THAT was fun! lol We really had a great time out exploring. We went back to the hotel to drop the car off, then headed off to try out the Cable Cars and visit Union Square in continuing our "explore SF" day. We got lost in Chinatown. Yes, apparently I can get us lost in ANY city. We ended the day by riding the entire length of the cable car line while hanging off the car. I'm still not quite sure why this was so amusing, but it was ridiculously fun. Actually, we really ended the day with another round of dessert at Ghirardelli, but the riding hanging off the cable cars is what got us there.

Wednesday: We started off the day with breakfast at Boudin's. Great start. We walked around the pier and watched the Sea Lions. Those guys were so funny to watch! They act like dogs, and in particular, they reminded us of Maverick. Yup, I'm now convinced Mav is part Sea Lion. Then we had lunch at Boudin's. Then we bought bread at Boudin's. Did I mention that we visited Boudin's? Then it was back to the airport for us. We had a wonderful time, but it's always nice to come HOME. The last leg of our flight home was interesting. I actually got the call I've been worried about since I started PA school. Mid-flight, I hear the attendant come over the intercom and say "If there are any medical personnel on board, we need your assistance in the back of the air craft immediately, please." Well, that's me. Another girl had also gone back to help. It wasn't anything big or immediately life-threatening, so that's good. We took vital signs, then instructed the patient and flight crew on what to do until we landed and signs of deterioration to watch for. An ambulance was waiting when we landed, and everyone ended up being ok. As always, a little chaos. Never leave home without it.

It is SO good to be home now. How I missed all the fuzzy kids, Heather and Jason included :) Next stop: Christmas!!

SUCCESS!

All right folks, I have officially completed all of my didactic year at PA school and half of my clinical year! What a whirlwind it has been, and oh goodness, I've worked hard but had a great time. I'm sure it could go unsaid, but I've also learned quite a bit :) Not just academic-type stuff though...I've learned more about myself during this experience than I thought I would. It has truly been eye opening and has strengthened me individually and in my relationships.

As planned, I headed out straight from finals to Austin for a 24-hour visit. I had dinner with Andrew and Kelly, which was long overdue. It was just perfect! Including Kelly spilling Andrew's drink into his lap. Absolutely love getting to catch up with them. The next morning, Kelly and I had some quality time at Chick Fil A and Target :) Then, I headed out to Concordia's new campus for a visit. I hadn't seen the new campus yet, as I was the last class to graduate from the downtown campus. It's just gorgeous out there! Catching up with my professors was great! They are all doing well and growing right along with the school. I couldn't have asked for a better trip.

I got back home on Friday, just in time to unpack and repack for SAN FRANCISCO!! So in 4 days (Thursday, Friday, Saturday, and Sunday), I was in: Houston, Galveston, Houston, Austin, Houston, Denver, and San Francisco. SF will require a whole new post...we just had too much fun!

PICTURES!

He was tired from all the Thanksgiving activities...a true fan, with jersey, cheesehead, and blanket :)

Even the pups and Tig were worn out!

Hibachi night!

Aimee, Mom, and Dad at Hibachi

Me, Heather, and Jason causing trouble in the kitchen

Horseshoes is a serious sport around here

Well, kinda. Nothing is really all too serious with this one

Heather's after-dinner activity of choice...riding Aimee's scooter in the house while the dog chases her. Notice my mom cracking up laughing-it's not her house, it's not her child, it's not her dog=it's not her problem, lol

Roomies! And yes, Heather, I picked this one just for you. Heather is absolutely gorgeous, but chooses to make faces like this. She said our eyes were closed in other pictures, but my guess is that she just didn't like the way they turned out. She didn't know I had this little hidden gem.

Aimee and Rhyder

Ryan is trying hard to convert Miss Priss into a Packers fan

Me with Daddy-O. We were actually sneaking food and almost got caught.

He makes me sad sometimes. But then again, I'm glad this is his addiction and that it makes him so happy. Come on...look at that grin.

Turkey is done! No explosions, nothing got burned, nobody got hurt. Success.

Mi Familia

A LITTLE CHAOS

We always have a little chaos around here-things would be boring if we didn't! So the week before last was spent on last-minute arrangements for Thanksgiving. Food, finishing decorating the house, and never-ending errands. My parents came to town Wednesday, we had everyone here on Thursday, and Friday was a recovery day. The weekend was dedicated to wrapping up some school work...and a little more recovery from Thanksgiving. Last week, I finished my 13-page paper on gallstones, in addition to my presentation on stroke, and finished my book on oncology from MD Anderson. Monday was rough going back to work-that alarm came WAY too early. Tuesday, Heather got into a car wreck. A 5-car pileup to be specific. She is ok, but having to deal with repairs and insurance. We decided Christmas tree shopping that night would cheer her up. Did you know that palm trees are 75% off at the Christmas tree store? Lauren likes 75% off palm trees :) Wednesday, Heather had a small mental breakdown/impulse buy that I'm attributing to stress from her car wreck and our impending exams, and she brought home a puppy. A little 8-week old yellow lab/Australian shepherd mix. She's adorable, but a puppy nonetheless and keeping us all on our toes. The dogs are slowly getting used to her, and we still have yet to name her. Jason left on Thursday for work and won't be home until Sunday. Today, I've spent running around like a crazy person, but feel like I've gotten nothing accomplished :/ Tomorrow begins the 4-day stretch of cramming for my 3 exams coming up this week (not that it will do me much good as they are basically comprehensive from all of PA school), then I leave for Austin straight from my tests for basically a 24-hour visit. Like they say, I've got places to go and people to see, I can sleep some other time! I'm blessed to know that God thinks I can handle this much :)

GOOD FOOD, GREAT COMPANY

Wow, it's hard to believe that it is already that time of year again. This year has just flown by! And what a crazy year it has been! I am looking forward to sharing the holidays with family this year, and hoping the holidays will be a little easier on us all. Last year about this time is when my Mom's mom (Grandma Hill) passed away from progressing breast cancer. We will always remember her this time of year especially. It's comforting to know she is always with us still, but I'm looking forward to sharing the great memories of her this year instead of the pain we were all going through this time last year.

Thanksgiving was a little more traditional this year than it was last. Last year, I was WAY bogged down with school, so Ryan and I boycotted cooking and went to dinner hosted Moody Gardens. I know...thanksgiving just the two of us and no cooking. See, a bit untraditional! This year, my parents came down with Aimee since I was working again, and we all cooked a nice, big meal here at our house with our roommates. It was perfect! We had awesome food (mainly cooked by Heather...before she broke the disposal. But it's ok, Dad fixed it), the best company anyone could ask for, and the Packers played the Lions that day and won! It was really nice to have a more traditional Thanksgiving with people we love so much. We even squeaked in a little Hibachi on Wednesday :) We all spent Friday recovering and ate leftovers for about a week.

So ER is finally finished. Nights were as difficult as I expected, especially with the rest of our goings-on with Cheeto. This has been the first rotation where I was really looking forward to the end, which I hate to say because every rotation is supposed to have it's good and not-so-good sides, but this one was rough. Note to self: ER full time is not a good option for Lauren.

On a happier note, I am absolutely LOVING orthopedic oncology and surgery. This rotation has been my favorite so far. There is some continuity of care, which we all know I like, but the patients aren't generally needy. They may require more attention because of the unique circumstances at hand, but their attitudes are just so different than in any other field. I get some clinic time, lots of surgery time, and even a little admin time built in. Every patient I see has a unique condition requiring precise, personalized care. All in all, it's a little primary care (continuity of care), a little general surgery (getting to close wounds, excising masses for biopsy), a little oncology, and a little carpentry (essentially building new bones and joints for patients when theirs fail). It's a bit of a boy's sport, as orthopedics generally is, but I've never had a problem with that environment. I actually tend to work better because there are fewer girls, which means it's usually less dramatic and involved. We work hard and work efficiently...no fluff. But they also don't have a problem having a little fun every now and again. This is definitely a field I'll be strongly considering when I graduate.

Also, I was discussing this with one of the working PAs there-she was reminding me that finding a good doctor to work with is a lot like dating. You have to get along-on good days and on bad days. You have to be able to communicate well. You have to work well as a team and be able to back each other up. You just have to mesh well. A bad boss, or one you just don't see eye-to-eye with, can ruin your morale, even if you are doing work you love. Something to consider as I get closer to graduation and start interviewing for jobs. Yup, that's just around the corner, too! :)

HIS TIMING, NOT OURS

This post will probably be different than posts you’re used to on here. It will be long, and you’ll have to excuse me as I cry my eyes out while I write. This is a story about timing, timing I don’t understand right now…and about an adorable little orange puffball of a kitten that blessed our family for 11 days.

Looking back, it all started a little over a month ago one morning at church. Ryan and I listened to a sermon about others’ needs, generosity, and the ability to give. It definitely hit our hearts, and we agreed that we needed to make sure we were keeping our eyes open for when others are in need where we can help. We also needed to make sure we reserved some of our selves (our time, our money, our abilities) for when someone else needed us. Little did we know that God would be calling on us to help someone very soon. I went to work later that week, and was struck to find a little grey kitten at my car when I went out to grab my surgery goggles and scrub cap. She was wet and hungry. I called Ryan and asked if he would mind if I brought her home after my surgery that afternoon, and we agreed that her need was one we could help with. I had to go into surgery, and when I came back out to look for her, she was no longer there. My hope is that someone else took her home and cared for her. I went along my way knowing that although I couldn’t give her the care she needed, our hearts were in the right place for wanting to.

About two weeks later, my mom called me with terrible news. As I mentioned in a previous post, my cat back home was viciously attacked and killed by some stray dogs. Our hearts were so heavy knowing what a tragedy it was, and that my mom had to handle the situation while I was away and my dad was out of town for work. After a 12-hour shift in the ER and that news, I was absolutely drained; I can’t even imagine how my mom must have felt. She is so strong, but this situation was more than anyone should ever have to endure.

That evening, Ryan was leaving for work and found a little orange kitten looking for a warm, safe place to sleep out under his truck. He knew the kitten was too young to be away from mom, nonetheless with a wet, cold night ahead. Much like I did before, he called and gave me a heads up on the situation. We agreed that he should bring the kitten home, because we honestly didn’t think he would survive the night outside alone. He brought home this tiny (3/4 of a pound), screaming, hungry, and scared puffball of a kitten. We had to start nursing him with milk because he was just so small. We went to the vet the next morning for a once-over and got the okay from the vet. He may be small, but he was healthy. On hearing the good news, we settled on the name Cheeto. He spent the next week growing…growing in size, growing in ability, and growing in confidence. He could now run with some sort of coordination (i.e. without falling over), he started eating softened kitten food, and he was learning how to play and have fun. The dogs responded quite well to him. Maverick took ownership of him and was always looking out for him. Goosey tolerated him. Even Tigger was interested in him and would check up on him periodically. It was now a morning routine to enter the bathroom and he would run up to you with his little tail sticking straight up as he cried for us to pick him up, pet him for a minute, then feed him. He was definitely growing. His feet turned into little clubs, his legs sprouted, and he was even getting a full belly. We were so happy to have this new, unexpected addition to our family. We were filled with joy just watching him and loving him.

One Saturday morning, I took him out of the bathroom to let him come out and play. He would jump around the bed attacking the covers, chase the dogs, and try to copy the things Tigger did. After a tiring morning of playing, he curled up next to me on the bed and took a nap. I just enjoyed laying in bed on a lazy day, feeling the warm sun, and listening to him pur. He woke back up around lunch and wanted on the ground to play with the dogs. He was using Goosey as a jungle gym…just climbing all over her. She was so patient and understanding, and just let him for a while. They must have been 5 feet from me at the foot of the bed, she was still lying down and I could see him playing by her when I heard her make a strange noise. I looked down, and saw him walking away from her. Then, he stopped and let out a gut-wrenching meow/crying noise and sat down. I went to pick him up to see what was going on, and noticed his eyes couldn’t focus. He couldn’t walk, he couldn’t see, and his little legs just started flailing. I ran out to the living room and cried to my roommate for help. We put Cheeto on the ground, and his condition was obviously worsening, so I wrapped him up in a towel and was headed straight to the vet. He was acting so bizaar, this was absolutely not the kitten I knew. At the traffic light just before the vet, he stopped flailing about, and came to peace. He passed away in my arms at that moment. Ryan was at work and had to meet me at the vet so we could say our good-byes. We were taken completely by surprise, and beyond heartbroken. This is one of the most tragic situations I have ever known. I’m in the medical field and deal with medical emergencies routinely, I have experienced the death of a person before, but this melted me down to a crying mess of nonsense. I asked the vet what could have happened, and the short answer is that we don’t know. He said it could have been a seizure, a stroke, a bleed in his brain, he could have hit his little head on something, or one of about a million other possibilities. He had no signs of trauma and passed within about 30 minutes of showing any signs that something was wrong.

It was so hard to leave the vet without our sweet little kitten. We instead had this sadness, this emptiness. When we came home, the other animals knew that something had gone terribly wrong; they were very solemn and kept trying to go into the bathroom to look for him. The look they gave us as we picked up his things was absolutely heart-wrenching and Goosey kept sitting with her back to us. I was back working the ER that evening doing my best not to melt back down to a crying mess of nonsense while Ryan was at home attempting to work on things through the night to keep his mind away from the situation at hand. The next few days were unspeakably difficult and I can’t say that either of us handled the situation particularly well, but I guess that’s to be expected. I want to make sure to thank Ryan for being my rock and stronghold during this. He has been comforting and supportive, and I am so thankful for him. We both still feel an emptiness, but each day is slightly more bearable, and I know our God will see us through this and give us the comfort and peace we so desperately need right now. We have to understand that this was not our timing but His, and maybe the reasoning just isn’t for us to know right now. We also have to be confident that we followed God’s will in fulfilling Cheeto’s need at that time. If it weren’t for us, he probably would have died alone, cold, and hungry that night at the golf course at the ripe age of 4 weeks old. Because of us, he had a warm home full of love for 11 days, but to him, he had a warm home full of love for his entire life. We are so blessed to have had him, if even for such a short time. Though it hurts right now, I pray that we won’t harden our hearts to love in fear of hurting so badly again. I’m thankful for our loving family and that we were able to serve God’s will, and I pray for strength, for comfort, and for peace during this time of grieving and sorrow.

Thank you for listening to the story of our little CheetoPuff. I admit that writing this was probably more therapeutic for me than it was for you. He will be so missed. Please remember to keep your hearts open for when someone needs you to be a blessing to them. We will always remember the love we experienced and blessing to us in fulfilling his need.

UPS AND DOWNS

My mom called me on Tuesday and had to give me some terrible news. I was already tired from a long day at work and knew I had 3 more shifts before my week was over, so I probably took it worse that I would have normally. She had to tell me that my cat back home, Scooter, had been viciously attacked and killed by a few stray dogs that morning. They had also killed other cats in the neighborhood and threatened to attack some of the people. I was, and still am, extremely upset about the situation, so please keep our family in your thoughts and prayers. We found out today that the dogs were captured and taken to the local pound, which helped provide some closure; I just hope they won't be allowed access to hurt any people or any other animals.

As if my day hadn't already been physically, mentally, and emotionally draining, Ryan called on his way home from work to let me know that he was bringing home a kitten. Apparently he went out to his truck and found this little guy trying to find a safe, warm spot to sleep, then he followed Ryan around crying to him. He said he wouldn't normally bring home random cats, but this one was really little and we would be getting a cold front that night-he didn't think he'd survive outside alone without any other kittens or a mama cat. So...we got another kitten. And little he is...the vet estimated 4 weeks old and he weighed in at a whopping 3/4 of a pound. He was a bit scraggly looking at first, but he has cleaned up nicely and started putting on a little weight. He's really coming into his own now! He is playing, getting along with the pups and Tigger, and he has this eating thing down. Mav just loves him, Goosey hates him, and Tigger will finally go within a 5 foot radius of him. Everyone, meet Cheeto!

He looks innocent...but he can be a little firecracker!

Goosey is still mad that we have a new kitten. This is one of her ways of expressing how mad she is.

He's already a Packer's fan!

Apparently, he is Mav's kitty. They get along surprisingly well.

My first picture!

LIFE IN THE ER

First, an addendum to my post about General Surgery...to everyone, I know your mother probably taught you to wash behind your ears, but apparently some mothers have been failing to teach their children to wash their belly buttons. The deal is, when you go into surgery, especially anything to do with the abdominal or pelvic areas, the team will clean the area, and it often includes cleaning the belly button. Now, I saw some terrifying things come out of some of my patients' belly buttons. So almost as a PSA, please clean out your freaking belly button when you bathe!

So now ER business...I'm not sure this is quite my cup of tea. I have enjoyed some aspects-mainly the fast pace makes the time go by fast and working 12-hour shifts means I have to work less shifts. Plus, I really have gotten to see and do a lot. However, 12 hour days are really quite long. I'm not sure I'm cut out for that. I work with new staff each day, so each day is essentially Day 1 of a rotation, which wrecks my nerves and I always feel out of place and awkward. I also feel that once I get to know a preceptor, they help me with my weaknesses. In this scenario, I don't quite get that opportunity, so I feel like I've grown in a few small areas, but no significant areas like I did in some of my other rotations. Also being in a very urban ER is much different than my small-town ER where I got my first ER experience. I preferred the small-town vibe :) Now, don't get me wrong, the staff I've worked with here has been quite helpful and generally friendly, but I like to develop relationships and work with people on a more personal and less formal level. Regarding big lessons to pass on to yall...I'm still working on thinking about that one. The cool stories I can't really share for privacy reasons and the rest you'd probably find boring. But I'll keep thinking about it... I've actually finished my days in the ER and am now switching to nights for a few shifts. For those of you who know how much I love my sleep, pray for me and this transition!

FALL FESTIVITIES

I have about 3 days off before my next rotation starts, so we decided to take the pups out for a little fall fun. We went costume shopping and visited the pumpkin patch. :)

We dressed Mav up in the "Land Shark" costume...we thought it was pretty fitting for him! lol But even though we had the largest size (an XXL), it was still too small :(

LIFE IS LIKE A GAME OF DODGEBALL

Well, I survived general surgery! Yay! And I didn't pass out! I ended up enjoying it much more than I expected. What did I enjoy most? Probably the atmosphere. It was a light, relaxed atmosphere, but it was still efficient and productive. My preceptor was also pretty awesome, so I'm sure that had an impact. So what did I learn? First, life is apparently like a game of dodgeball. You'll always have people on your side and always have people not on your side. You may have strengths, but you'll also always have weaknesses. You'll play the game better if you learn to work as a team. You won't get very far by sitting in the corner alone doing nothing or just being scared to play. And lastly, it CAN BE FUN! Granted, I also learned a lot about the surgeries we were doing and patient care...but you'll probably find the dodgeball thing more interesting :) So all in all, I had a great rotation, I really learned a lot, and surgery is still in the running for career possibilities. I also learned/realized how important it is to have a boss that I really get along with if I do choose a career in surgery because of how closely we will be required to work. So ER is up next...yet another foreign environment and new experiences!

PRIMARY CARE

Well, I can hardly believe it, but I've finished my Primary Care rotations! Wow! One block of rotations down, three left. I enjoyed primary care because of the variety of cases, the (sometimes varying...) continuity of care, and because you can really get to be a part of some of the families. I appreciated being the provider that helped people be proactive in their own care, the provider that helped patients cope with what will be life-long illnesses, the provider that patients could confide and trust in. Primary care really re-instated that "patient-driven" kind of practice in me and I learned very quickly that relating to and communicating with the patients is where good care starts. My last rotation wrapped up really well! It was another great rotation where I learned more and more each day, got new opportunities, and enjoyed the preceptor and office staff. I'd have to say, I had some really great rotations for primary care! The final exam was...umm...challenging. Not challenging in the sense that it was biased or unfair, but it was extraordinarily comprehensive, which I didn't quite expect. And sometimes I'd have an internal conflict of what the textbook says to do and what experience/actual situations would guide me more towards. It was also challenging because I haven't taken an exam in about 3+ months! I think my brain almost forgot how to take these PA-school exams! I did just fine on the exam, but it helped point out some weaknesses I may have developed while away on clinicals instead of in a classroom. C'est la vie...live and learn! So here are some highlights of what I learned in Primary Care:

1. For my first job, I want to work for someone who wants to teach and encourage me to grow.

2. My idea of an "emergency" and someone else's can be quite different. I learned how to gently, but effectively, express this and how to tell someone that (only in an appropriate situation...) their complaint would probably be better managed in an office rather than my ER.

3. Pain is entirely subjective. Relief of pain is also subjective :) This can be influenced. Some people think they will experience an entire lifetime without ever having pain-I think this is naive and dangerous.

4. Learn to communicate with your patients. They have to TRUST you to take your advice; they can't trust you if there is a communication deficit. This will involve actively listening to the patient.

5. It's all about confidence. Not being arrogant or cocky, but confident. A smile doesn't hurt, either.

6. The nurse or MA in the office is my best friend. Special thanks to the nurses and MAs on my rotations who helped show me the ropes, saved me when I needed help, and taught me so much!

7. I can do a whole lot more than I ever gave myself credit for.

I'm not sure if Primary Care is my calling in healthcare, but it's definitely still in the running. So what now? Four weeks of general surgery, four weeks in an ER, and four weeks in surgical oncology. We are about to find out if I have a future in surgery or not. While, from the little experience I have, I've enjoyed surgery, I'm a little worried about my pesky "passing out" issue. I haven't had a big episode in a little over a year, so I'm afraid I'm about due and the OR just might be the trigger that's been missing. I had an "almost" episode a few weeks ago while in surgery...I guess we'll find out soon enough! Regardless, I'm looking forward to new adventures and new experiences. And when this block is finished, it will be Christmas-time! YAY!

ADVENTURES WITHIN THE ADVENTURE

First, my little sister started kindergarten on Thursday! I can't believe how quickly she is growing up!

So that was the main thing...this next one is just a funny, "typical Lauren" happening. So I finally had some time to myself on Friday, so I decided to go for a run. I haven't run in a solid 6 weeks...there's always been something stopping me. Whether it's personal stress, my 52-hour "shifts," the stupid heat, the move, or whatever else...always something. So I set out on my run and decide to go 2 miles; it's a good enough distance but still about half of what I was used to running-it's a good start. First of all, WHOA, I got seriously out of shape in those 6 weeks. That was brutal. Second, I acquired a friend in the form of a chihuahua. I carried him around for a while and asked anyone and everyone if it was their dog or if they would please take him...there was a busy street nearby and I didn't want him to get hurt. Third, I had a few run-ins with a certain goose by the pond. The first time, he jumped out and tried to ambush me. I did what any normal person would do, and I pointed my finger at him and told him no. Which obviously worked. I guess I don't speak goose after all. So he starts lowering his head and spreading out his wings and trying to bite me, so I stick my foot out so at least he gets my shoe instead of my leg...while still pointing at him and yelling no. Again, this is working terribly well. Dang, where did I put that chihuahua? So I try to just go around him and continue my run, when the little devil starts chasing me and honking at me. Now, you all know I wouldn't purposely hurt any animal for no reason, but this was do or die, so I gave him a little flick in the chest with my foot. He made a really weird noise/honk and ran away. I got to the end of the trail and turned around to head home...the danged goose is back! He tries to ambush me again! I took a different approach this time and yelled mean insults at him...he yelled/honked back, but he didn't chase me. So note to self-if a goose attacks you, call him names and say mean things to him and he will stop. No need to tell him "no" or to try to defend yourself...and that's how you speak goose :). So my 2 mile run which should have taken about 20 minutes turned into a 45 minute run/try to find a dog a home/defend myself against the evil goose adventure. Maybe I'll stay in tomorrow...

ROTATION 2

I just completed my second rotation! So excited! This one took me a little longer to get into a groove because I had a different preceptor every week and I lost a lot of sleep covering the ER at night while still doing clinic during the day. But in the end, I definitely enjoyed myself and I learned so much. My preceptors were absolutely fantastic! I rocked my presentation at UTMB yesterday and was quite pleased with my improvements during this rotation, so I took today off to treat myself. I slept in, had breakfast at ChickFilA, then hit up the Galleria for some retail therapy. Success! Now for a nap before dinner with the hubby. I'll get to enjoy my weekend break and rest up for my next rotation which starts on Monday. The new class starts orientation on Monday...it's hard to believe that was really a whole year ago for me! I'm not sure if it feels like I've been here for years because I've worked so hard and gotten so much accomplished, or if it feels like it was just yesterday that I turned in my notice to UT Southwestern and we packed up for the move. Wow, what a whirlwind. Sometimes, when you get such an awesome opportunity, you just have to go for it! #SoBlessed.

EVERY ONCE IN A WHILE

Every now and again, I do manage to get out and have a little fun...I know, believe it or not! Here are some pics from an adventure Ryan and I took one Saturday to a vineyard. We helped harvest grapes, browsed the shops, did some wine tasting, and even got to watch how they process the grapes. Pretty cool!

ROUND 2

All right, here goes round 2 in Primary Care. This time, I'm kinda out in the boonies. And by kinda, I mean definitely. Population here is about 2200, and they don't have a single traffic light. I'm in clinic Monday thru Friday, plus I've been covering the ER some nights. My first weekend at this site, I worked Friday 5 PM til Sunday 8 AM in the ER...which is 39 hours straight. I thought that was a bit much, until I got to Wednesday of the next week and worked Wednesday 8 AM til Friday noon...which is 52 hours straight between the ER and clinic. Granted, I get to take a nap here or there while in the ER because it's not usually constantly busy, but yall know how much I love my 3-hour naps and my 9 hours of sleep every night! I'm having withdrawals! My first night in the ER started with a bang, too. I guess it's go big or go home! Everyone here has been super nice, and although it's primary care again, I'm seeing a whole different side of practice. I think especially one preceptor has really helped boost my confidence, too. It's been a learning experience just like my first primary care rotation, but it's been completely different.

THE BEST ROOMIES EVER!

I came home one day to be reminded how wonderful Heather and Ryan are. Ryan got me beautiful flowers and a really sweet card; Heather got me more pretty flowers (she put the bouquet together herself), a giant cupcake, and a beer! They know how tired I've been lately and how much stress I've been under, so this was their way of trying to cheer me up a little and making sure I knew that they support me through all of this. How sweet! Also, my parents sent me Mrs Fields cookies and a bear dressed up in surgery gear! Too cute! Yall are all so sweet, and I'm blessed to have such a strong support in my family and friends.

HOME SWEET HOME

So maybe from my last post, you were wondering why my weekend wasn't very restful? I mean, I was plenty tired! It's because that Thursday, we got the keys to our new house. That meant that all week, we had been working on getting electricity, gas, tv, internet, water, etc. all turned on, working with the realtor, and getting our condition forms all completed. So we did all that along with the usual schedule of my clinic, studying, and working on my paper and Ryan's work schedule. We offered to help Heather get moved in since it would only be her and her mom, so we spent most of Saturday doing that. Then at about 2 AM on Sunday morning while eating a healthy pizza breakfast, we came to the conclusion that Sunday would be a good day for us to move into the house, too. Heather had a truck and we all had each other's help...so why not? :/ So we went home, got a few hours of sleep, went to church, then attempted to pack up our apartment. We packed stuff in suitcases, plastic bins, and left-over boxes from Heather. Probably the most interesting packing job I've ever done-and yes, it beat out the time I packed our kitchen after consuming a bottle of wine. LOOONNNNNGGGG day, but we did it! We got most everything into the house, and Jason and Ryan finished up on Monday. We have all been so busy, that we didn't get the gas turned on for a week (which meant cold showers and no stove or oven) and didn't get the cable on for about 2 weeks. We also just figured out how to make the alarm system stop beeping at us all the time and how to program the garage doors so we can actually put cars in the garage. We still have the apartment, so we've been periodically running over and cleaning it out so hopefully we can get our deposits back. I guess life's just not fun without a little chaos...because apparently PA school just isn't enough! But the house is working out really well, and I'm glad we decided to do this.

ROTATION 1

The most important thing is that I SURVIVED! I'm still working on how to explain just how emotionally exhausting it was. I got to see quite a few patients with a pretty good variety. I even got to assist in a few procedures and work on my suture technique. I worked with one doctor and 2 PA's who were recent grads. The doctor was nice and always teaching me something; the PA's really understood where I was coming from, so they were always helpful. Between the 3 of them, there was always a patient to see, which was great. All in all, I really enjoyed this rotation and think it was the perfect first rotation for me. I even got my paper turned in on time, even though I started it (and got 4 pages into it...) on the wrong topic! A not-very-restful 3 day weekend, then it's off to my next site!

THE END?

Most certainly not-we are just in the thick of it! Ok, so you probably think that I've about fallen off the face of the earth. And I did. But I'm back now and GEEZ, I have some serious catching up to do! Stay tuned!

WEEK ONE: CHECK

Well, I survived my first week of rotations! Monday, I was just pretty much scared and anxious (mainly because I was headed into the unknown), but I did perfectly fine. After seeing about 3 patients with my preceptor, he sent me out on my own. The routine is: I go in and do my history and physical, I present my findings to my preceptor and tell him what I think is wrong and what my next actions would be, then he goes back in with me and he usually does just a little more history and physical just to cover all the bases. Tuesday, I pretty much felt like an idiot. Most of the stuff I saw, I just wasn't familiar with. Whether it was the illness, the medications, or whatever else...I just felt like I didn't know much. But I guess that's why I'm here-to learn! If I knew everything, they'd have already given me my degree. The rest of the week was a little better, and I even got to help with a few procedures. I saw about 50 patients last week! I've also been trying to find one thing everyday that I see that I'm not very familiar with, and I look into it more when I get home and make some notes about it in my log-it's proven pretty useful so far. This is so completely different than anything I've done yet...when I used to see patients, it was 1 at a time and I had to do these super long write-ups and I spent the first year sitting in a classroom...I think just adjusting in and of itself has been one of the hardest parts. One week down, tons of learning and 47 weeks left :) It's amazing what they don't manage to put in those textbooks!

:)

This picture just makes me smile! Mav actually has his arm around Tiggy, and both are resting their heads on a pillow! I caught them like this on the drive home last week. I love these little monsters...

OUR NEWEST ADDITION

Please welcome the newest addition to the Miller family! And no, it's not another dog! Haha Ryan's truck had just about had it and kept having issues, so he went to play at the dealership, and came back with this-a 2012 Ford F150. So far, we really like it! They made a lot of changes here recently, and I must say, they've all been for the better thus far. The EcoBoost engine is great, SYNC is awesome, and the new truck drives so much smoother than the 2005 did. Plus, my beepies (AKA reverse sensing system) are now standard! They must have read my mind!

!!!!!!!!!!

The subject of this post is like that because I seriously can't find the words to express what I'm feeling...I just finished my first year of PA school! OMG! I even tried to make up a word to express myself, and even that didn't work. I can barely believe it, but yes, I'm half-way there. I'm now finished with the didactic (AKA classroom stuff) year, and will begin a year of clinical rotations starting the last week of June. I get to go to a new clinic every 4 weeks-it's gonna be exciting! We also took a practice board exam, and I'm right where I'm supposed to be for the training I've had thus far :). I am relieved, happy, excited, somewhat intimidated, and I feel strong and ready to tackle the next step after some rest and visiting some of my favorite people in my favorite place on earth-HOME. It's times like this when I just sit back and it brings me to tears thinking about how blessed and how happy I am. God is so good! Thank you for your prayers and support. Get ready...the next adventure begins in t-minus 9 days. YAY!

COMPROMISES...

Ok, so remember that hot-spot I was talking about on Mav's underside? The reason for needing a collar and thus our fieldtrip? Well, I'm putting some meds on it daily and really don't want him licking the spot or the meds, so the e-collar was what was suggested in that scenario. I put it on him the correct way and the poor dog just freaked out. He wouldn't sit still, was running into everything, and was scared to pieces. But I knew if I took the collar off, he'd just lick! So this was our compromise...

Now, the next day, he wouldn't wear the collar like that again. Our compromise that day was to have him wear it the correct way, but he could lay up on the bed and watch tv. Normally, the dogs aren't allowed on the bed or couches...so I guess he saw this as a treat. Plus, he couldn't really run into anything up there.

I am interested to see what day 3 holds as far as compromises go...I can't believe I'm bargaining with my dog! Oh well, I guess you gotta pick your battles. And I'd much rather give a little and have him get better than be a stickler and he'd still have those spots.

THE LOOT

The pups and their loot from our fieldtrip to Petsmart...

MY FUZZY, 3-RING CIRCUS

I ventured out on a field trip to Petsmart today with 2 of my 3-ring circus entertainers. They whined the whole way there-I'm pretty sure they were upset about where we were going because last time we got in the car, we moved to Houston. I can't say I blame them. So we get to Petsmart and Mav jumps out of the car and poops right in front of the store. He obviously couldn't have done that at home when I gave them the opportunity to potty. To make it better, I went to get a bag out of the station, and there were no bags so I could pick up! Arg! So we go inside, and Mav is of course sniffing every single display, treat and toy. I turn around, and Goose has spied the birds and small pets...and has started stalking them. We investigate half of the store, then make it to the back of the store. I see the stuff I need for Mav (a collar so he won't lick a hot-spot he has) and head that way...he apparently thinks it's acid and acts like I'm murdering him when I try to try it on him. While he is having a spaz attack, Goose is running circles around me and wrapping me up in her leash, then she hits up the cardboard box with stuffed toys in it and decides that having one is a top priority. We re-organize to try to make it through the rest of the store and peruse the toy and treat aisles. Goose has already picked her prize out, and Mav picks up his...my 90-pound guard dog picked up a 4-inch squeaky, stuffed football. I swear, it was one of the smallest toys they had, and it was the last one they had left-he literally dug it out. Oh well, whatever makes that crazy guy happy. So we go check out, and the nice cashier lady offers both dogs a treat. Mav is scared to pieces, won't take the treat, and instead takes shelter behind me. Goose on the other hand (mind you, she is my sweet-natured, calm, quiet, ever-trustworthy little girl) GRABS the treat out of the lady's hand! I deal with her, then turn around to check on poor scared Mav who is still plastered to my backside. I turn back around to find that Goose has cornered this poor cashier into her station and is basically executing a hold-up for treats! I reprimand her, release the cashier from her being a hostage, and find that Mav has been scared even further into my backside by the innocent lady placing her items on the belt behind us. I nearly threw my credit card at the cashier and told her just to sign it for me so we could LEAVE! Then, she spouts of with "Aw, apparently he (meaning Mav) is the quiet, calm, and subdued one." OMG. Anyone who has ever even met my dogs knows how backwards that is. He may be sweet as can be, but to say he is the calm and subdued one and my sweet Goosey is the demanding, not-scared-to-be-social one...seriously, who traded out my dogs for these guys? These are not the dogs I know. Time to load up the circus and head back home...

WHAT DO YOU EXPECT?!

We have been working really hard at school lately on some very practical stuff, so I've started to go a little looney again. As I started to tell you in the last post, we have been working a lot on our research project. We finally finished our proposal including some serious review and editing-HUGE thanks to our mentor Holly West on help getting that into working order. We should have our IRB forms completed and submitted by the end of next week, which is actually exciting for us research geeks! In addition to the stuff I mentioned in the previous post, I spent some quality time working on my suture skills. I now have my very own suture kit! That's right, next time I get into a fight with a sharp object, Ryan doesn't even have to take me to the ER! I could totally suture myself right up if it weren't for that "I pass out with needles" thing. I got to go to clinic last week, which is always nice. It always brings me back home to why I'm working so hard right now. So it's just been an assortment of stuff to do each day and a different schedule that changes literally by the minute, but I'm loving it all! You know I love a little chaos... We start finals next week and take a practice exam for our licensure certification! EEK! I have to admit, I'm a bit freaked out about that. Week after next is the rest of our finals and presenting our research proposals to the faculty. Presenting isn't the hard part; defending your study and fielding the questions will be the "fun" part... Time is just flying by! I emailed my preceptor today to get the necessary info for my first clinical rotation. I told you-I'm a big kid, now! I can't believe it's less than a month away. I'm looking forward to all the hands-on experience and getting exposed to the different areas of medicine I could practice in one day. Let the adventure continue...

Oh, on a random note...my study group got a little distracted one day and assigned each of us characters from FRIENDS. They gave me Phoebe. They said it was because I'm independent and always have something unexpected to say...I think that's code for I walk to the beat of my own, unique drum! Haha

MAARRRRCOOOO?!

Poloooooo! I know, I know...I've been MIA here recently. Sometimes, I just don't know how stuff like that happens! But anyways, we're back on track now. So where did I leave off? Oh ya-Great Syndromes coming to a close! Ya, it definitely came to a close alright! I survived, and that's about all I can say about that. The problem wasn't the class-I really didn't mind the class; it was just that stupid test at the end of the class that beat me up and made me say mean things. I got my grade and wasn't happy with it, but I'm also confident that no matter how much more I studied the material that was presented to us, my grade wouldn't have improved to my liking...which means that I'm perfectly pleased with myself and I know I grasped the material that was presented to me, but I'm still not pleased with that stinkin test. I'll get over it one day. I'm a little beaten up, but I passed just fine and one day hopefully the words "great syndromes" won't give me a twitch any longer.

So our 6-week minimester started pretty quickly right after great syndromes ended, and it has been keeping me busy. My research project is off the ground, and I'm getting my stuff together to submit for my IRB approval. Sounds easy, right? First, we had to come up with an idea. If you have ever had to start a research project at a Master's level, you know what I mean. That first step can seriously be the hardest. Then sometimes you find an idea, but hate it once you do all the literature reviews, so you trash everything and start anew-which I had to do this time. But now, we have an idea, a good literature review done, and am working on my proposal to convince someone else that 1-it's safe and 2-it's worth their time and mine for me to do my research. I am also now ACLS certified, which I am super proud of! That means not only am I "basic" certified to do stuff like CPR and use an AED, but now I am certified on drug administration, cardioversion, pacing, and other fancy stuff involving EKG analysis in more advanced scenarios. I told you-big kid stuff now! In the past 2 weeks, I've also been to the operating room, passed a clinical exam review, and got a briefing on catheters, wound care, IV starts, and injections. By the end of the week, I will have added some serious suture work to that list, too!

And for some reason, I was perfectly convinced that having all this on my plate was not enough, so I've been taking horseback riding lessons. For those of you who aren't familiar, I quite enjoy horseback riding and have since I was little, but it's always been an "enjoyment" thing, and I've never really had much proper instruction. It was just one of those thoughts I had (kinda like how I took the MCAT the weekend before my wedding...I get an idea and just jump on it!), so I contacted a local place and we started working pretty quickly. This was entirely new for me-horses I didn't know, horses that were trained in disciplines I'd only seen on TV, a different kind of saddle (i.e. I had to find a new balance!), different steering mechanism (direct vs neck-reining), etc. So my first day, I was really just glad that I didn't fall off. I progressed and improved on some of the basics, then my instructor upped the ante...and I realized how much I didn't know! I jumped a small fence one day. I wasn't supposed to. My goliath of a horse was supposed to step over the little rails and box, but he knew I was in foreign territory and apparently thought it would be funny to pull a fast one and just up and jump the things...but I stayed on! He and I had to have a discussion after that. My instructor is starting to get a feel for me, so we are communicating better and I'm definitely leaps and bounds ahead of where I was when we started. I'm more confident, more balanced, and stronger now. This was definitely one of my better "spur of the moment" ideas! I really want to continue working, but I'm afraid clinicals are going to keep me too busy. I'm able to take a lesson every week now, and I just don't foresee that happening once I'm in clinic for an unlimited (not really, but it will feel like that...) number of hours every week. Oh well, you never know! BTW, if anyone was wondering what to get me for my birthday, Christmas, or just a "hey, happy Tuesday" present, you can definitely get me that pony I've been wanting since I was like 2. :)

What else...?

I tried Nutella! It's basically peanut butter (only it's made with hazelnuts instead of peanuts) and chocolate...only better. You know how on the commercial, it says "with just a hint of cocoa," well unless hazelnuts taste like chocolate, they lie. I swear it's more chocolate than nuts, but that's not a problem if you ask me!

My Earth day tree is still alive! I haven't killed it yet! Yay!

My little sister completes Pre-K this week. I can't believe it...she starts Kindergarten in August. That's just absurd.

I guess that's about it for now...I'd better get back to that IRB proposal anyways...don't be too jealous of this exciting life I lead, hah!

DRIVING ME CRAZY

Ok, sorry for my soapbox, but I've about had it...Crazy may not be the right word, but I seriously just don't get some people. The topic up for discussion here is driving in this crazy place called Houston/Galveston and surrounding areas. Let's start with a few announcements to the drivers around here: 1) Please leave your ego at home. I do not care about you or your ego, and I will not be catering to either of you. We all get to play by the same rules, so don't get all grumpy when you don't play fair and you don't like the outcome. Contrary to your twisted view of things, you are not king of the road! 2) Please wake up before you hit the road. Being completely oblivious while you are operating that machine capable of killing someone is entirely unacceptable. Wake up, stay in your own lane, and pay attention. 3) Please hang up the phone. Actually, just don't get on it in the first place. I'm not saying that it's impossible to talk on the phone and drive a car well at the same time-I've done it too, but I've found that around here, most people seem incapable of such feats. If this principle is ignored, I've found that principles #1 and #2 often get ignored as well, which makes for some seriously superb drivers...insert sarcasm. 4) Just because your vehicle is bigger, doesn't mean that left lane with the shoulder is meant for you. That lane would be meant for passing. If you want to pass people in the other lanes, please use that left lane to do so. If you do not wish to pass people, please get your "too big for you to be driving" vehicle out of the passing lane. I haven't encountered this in the other cities I've lived in, but around here, vans, school buses, and big work trucks/vans just seem to flock over to that side. There are 3, sometimes 4 lanes going either direction-it's really not necessary to camp out over there! You probably think I'm just being ugly, but the drivers I've encountered here in my 9 months here have really been a different breed. I saw a lady today that really just epitomized what I see on a daily basis: this lady lives in my apartment complex, so I recognize her car. To begin with, she can't park her SUV. I see her more often than not in two parking spaces rather than one. I have actually seen her parked in the middle of the street a few times. Not in a spot-actually parked in the fire lane blocking traffic through our complex. No hazard lights...and no, she didn't move it quickly. I've seen it left in places like that for hours on end. She has a handicap license plate, and I have yet to see her in that nice, wide handicap parking spot. So there's issue one. I've seen her drive, and let's just say that I go the opposite direction she's going because it's always ugly. But today was a new low for even her. I watched her pull up to our apartment gate, then as it was opening, she drove right through the gate-breaking it and doing some nice damage to her car. Really? Just run plum through the gate with your car? I have to say that I've never seen someone do that before today...and I couldn't believe my eyes. She didn't hit it accidentally or something-she went straight through the thing and continued out to the main road like nothing ever happened. And she was not in any hurry-you can ask the cars she cut off to get onto the road to go far less than the posted speed limit. I can tell you honestly that I see stuff like this probably on a weekly basis. Whether it's this nutcase, or the prick that STOPPED to ogle a car accident scene while they put a lady on a stretcher and into an ambulance. If that was your daughter in a terrible car accident clinging to life, would you want some random stranger stopping traffic so he could stare at her? CREEP. Yup, I get the joy of witnessing the abundance of stupidity around here...and seeing stuff like this so routinely, I'm seriously terrified of my ER rotation. The people I see get to walk away from their episodes of stupidity; I don't even want to think about the people that are going to be brought in to me by the ambulances and how they got into that situation. I'm going to have to do some anger management courses before then or something. And you may be thinking, "if you hate it so much, why don't you just move somewhere else?" Well, you see, I'm in this thing called a Master's program and I can't just up and transfer to a different school. It's kind of a big deal. Even if I could do that, I love my school, my classmates, and my professors. I can honestly say I am getting the absolute best education for me here at UTMB. But after I finish-and I do literally mean AS SOON as I possibly can, don't worry, I'll be in my moving truck headed back north with Ryan, the pups, and Tig! Until then, can we please try to keep the stupidity, the egos, and the oblivious-ness to a minimum? I would really like to make it back home to my family. Thanks, I greatly appreciate it...