As newly inaugurated president of the United States, Barack Obama has already signed off on some policies that will forever change the way our military works. One of those policies recently was the signing of the order to close the terrorist prison found at Guantanamo Bay, Cuba. Now this prison has been the source of much criticism for years because of the reported use of inhumane torture and other techniques that tarnish the reputation of the United States. Along with that same order came the order to follow the military handbook on the proper techniques of acquiring information, which means no more torture: threats of torture, coercion, physical abuse, or water boarding. Now I haven't studied the Army's Field Manual so I don't know what other ways of obtaining information are but I'm sure there are some quite respectable ways. Along with the closing of "Gitmo" and the no more torture Obama has also set up a task force to evaluate how we are to handle the now current residents of Gitmo and the future terrorist that might be taken into custody. He also has organized a task force to investigate new, non-torturous ways of obtaining essential information from terrorist. Here's where I see the problem. Shouldn't you already have a plan in place ready to begin before you scrub current operations? Why is he closing Gitmo before even coming up with a solution to prosecute it's current residents? I know he promised this during his campaign, however, I feel he should already have a plan in place to compensate for Gitmo's closing. What will happen in a year when Gitmo is supposed to be closed and this task force hasn't quite finished it's suggestions? Once these suggestions are finished then they're going to need to go through the House and Senate for approval (and we all know those things take longer than a year). Now if this new task force comes up with a great idea to house the now Gitmo prisoners and also new great ways of getting information from the enemy I'm all for it. However, I stand by the fact that you already have a plan ready to be implemented before you even consider stopping the current one. It just doesn't make sense to do it any other way, especially when you're talking about the future of our nations security. Just a thought. I hope his other official acts as president come with a little more thought involved.
The San Francisco Chronicle released an article this week talking about the amount of money being donated to the upcoming inauguration of president-elect Barack Obama titled "Obama inauguration very much a Hollywood production."As I read through the article I was surprised at how much money would be put into next weeks inauguration, over $42 million. California leads the pack with its citizens donating around $6.4 million with New York following at $3.9 million. Now the Obama campaign has put a cap of $50,000 per individual and has also made public those names who donated. Among them are top Hollywood directors and actors, university professors, physicians, professional athletes, and more. Barred from donating are corporations, labor unions, and registered lobbyist, however, individuals from these groups may donate not representing their organizations. Isn't it great to see that, in this time of financial crisis, so many "respectable" people are donating their money to a single event that will do absolutely nothing to stimulate our economy? Especially surprising to see is that Californians, who recently have been considering asking for part of the bailout check due to the bankruptcy of their state, are found as the top donors. Wouldn't it be great if those same people would instead put that money into paying off their state's debt instead of helping to fund an event that could easily be televised to the whole world without costing $42 million? ANd why are these people donating? Tax breaks, public recognition, personal gratification, and every other self absorbed reason. Why does this inauguration, or any for that matter, have to cost so much money? Do people really need to attend in person the swearing in of our elected officials? Why can't the nation just sit at home and watch it on television. I guarantee it is not costing $42 million to broadcast it. But it will cost $42 million to accommodate the more than 2 million that are expected to attend, security to enforce the crowd and calm the masses, and of course, the huge party afterwards. Now there will be some jobs created for the hosting of this event and some of that money will trickle back into the community but its effects will be short lasting. Maybe instead of limiting each donations to $50,000 or less the Obama campaign should tell its constituents, especially those from California, to donate their money back into their own state to help it out of its own financial crisis. I thought our president-elect had a plan to help the U.S. out of its current financial crisis. This doesn't seem like a step in the right direction to me.
Half way through November and halfway through my third rotation. I spend most of my days in the ER in Pocatello seeing a lot of urgent care stuff but not a lot of emergent care. In the ER here the PAs do a lot of the easy stuff seen in the ER and the docs cover the really emergent situations. I get to work with the docs sometimes but usually I spend most of my time with the PAs. To tell you the truth most people couldn't care less if the student was there or not. You have to make yourself known and volunteer/ask for different assignments. I've got to see some pretty cool stuff in the past two weeks though. Probably the most exciting was participating in a "code." For those that don't know when a code is called in a hospital it means that a person has crashed and is in need of resuscitation. I was part of the CPR team. Unfortunately for the pt it was an unsuccessful code, but that's part of the business. Other things I've been a part of have been simple suturing/stapling, splinting, and saving lives...one sore throat at a time. In the off times I've been out playing flag football with some classmates (see pic above), going to Jazz games, watching Bond movies, and enjoying my sleep. While on my journeys through the ER I have come across some interesting information. Apparently the space shuttle has been docked with the international space station for quite some time and, if you catch it at the right time, you can see them pass overhead. Right now it passes overhead every two hours or so at night, but you have to catch it just at the right time because if you don't it will be eclipsed by the earth's shadow. If any of you are interested here is the website to follow the path http://www.n2yo.com and to check the times it flies over click on the 5-day prediction with graphics link. My preceptor is the one who actually showed me this website. It's actually quite exciting to watch as it passes overhead and then fades away as it passes behind the earth's shadow. The following videos were taken this evening and last night. In the first one it passed behind some trees before disappearing and in the second one it's kind of hard to know that it's moving, but you see it fade away. So that's basically what's been going on. Not a whole heck of a lot to report on. Thanksgiving is just around the corner and most people I know will be heading home for the holidays...except for me. From my experience back at McKay-Dee I've learned that the best times to see interesting cases weekends and holidays so I figured that I'll take a shift in the ER for Thanksgiving. I'll make it home for Christmas though. "Yo man let's get outta here!" "Werd to ya motha"
Over 400 years ago there was a group of people who left their mother country in search of freedom, freedom from religious persecution. They braved the frigid waters of the Atlantic and settled in a land unknown to them. Coming from an industrialized nation such as England these people had little knowledge and skill when it came to tilling and taking care of the land. Had it not been for the indigenous people of the time, these early settlers would have perished. But providence wouldn't have it, so this people flourished in the land. Years later they would rise up in a declaration of independence against that same mother land whom they still paid tribute to. Again the battle cry of freedom was raised; freedom from wrongful taxation, freedom from an oppressive monarchy, freedom to live how they chose to live. The war progressed and many feared that this little nation would easily be suppressed by the powerful English infantry and navy. Again, providence wouldn't have it and this nation prevailed against all odds. As history looks back on this war there are many who still marvel that these thirteen little colonies could defeat the most powerful nation in the world. An thus the United States of America was born. Over the years the United States gradually turned into a land of opportunity, a land of hope, a land of new beginnings. Millions would immigrate from their homelands, where their families have lived for thousands of years, in hopes of obtaining a better life for their children. Many came to escape oppression from their government. Despite their situation these people came to live the "American Dream." This concept continues this day with thousands of people immigrating every year (be it legally or illegally). However, what is this "American Dream"? The Declaration of Independence states that "…held certain truths to be self-evident, that all Men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are life, Liberty and the Pursuit of Happiness." James Truslow Adams, who coined the term "American Dream" in his book Epic America (1931), states the following: "The American Dream is "that dream of a land in which life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement. It is a difficult dream for the European upper classes to interpret adequately, and too many of us ourselves have grown weary and mistrustful of it. It is not a dream of motor cars and high wages merely, but a dream of social order in which each man and each woman shall be able to attain to the fullest stature of which they are innately capable, and be recognized by others for what they are, regardless of the fortuitous circumstances of birth or position." If you were to look up "American Dream" in Wikipedia you would find this statement: "The American Dream is belief in the freedom that allows citizens and residents of the United States to pursue their goals in life through hard work and bravery. Today, it often refers to one's material prosperity, which is dependent upon one's abilities and work ethic, and not on a rigid class structure." I ask you this question...do you still believe in the American Dream? Do you believe that through hard work, personal sacrifice, and personal responsibility you can achieve your goals? Do you believe that each person is "innately capable" of making their own progress? Or have you abandoned this dream and sought out a new one, one of entitlement and "I deserve"? Unfortunately it is my belief that the people of this country are living that new dream.
Now I don't want people getting confused with my motives for that last video. It was not in any way an attack against President Elect Barack Obama, but more against the mindset of miss Peggy Joe and the millions of other Americans out there that have that same sense of entitlement about them. There are many who believe that the government owes them or should regulate all aspects of human life; healthcare, education, business, oil, etc. With the government running everything these people, like Peggy Joe, believe that all their problems will be solved. "If I help him then he'll help me," she says. Our founding fathers did not believe in this principle. Those Rights that they (and we) believe in are 1)Life 2)Liberty and 3)Pursuit of Happiness and they established this democratic government to protect those rights. You have the right to life and liberty and our government must and will protect those rights. However, you do not have the right to be happy but rather to pursue after happiness. That right to pursue happiness is protected by our government but it doesn't guarantee it, nor will it ever. In essence what this means is that you have the right of protection from your government, but not to free handouts. Why wouldn't our founding fathers establish a government that helped offered more programs to its people, or offered more help? Because they knew that if the people depended upon its government to provide for them then this people could never become self sufficient. It's the whole "Give a man/Teach a man to fish" concept. Another important lesson to learn here is that if there is a problem, then we the people need to step up and fix it. We should take care of the poor among us, not the government. A colleague of mine wrote about this in his blog about Universal Healthcare. In a nutshell he states that the spirit of charity and gratitude are taken away with this type of believe. To finish my ranting and raving, live the American Dream! Live it to its fullest potential but realize that you have to pursue after it, it's not going to be given to you. Don't let a sense of entitlement persuade you into thinking that the government is going to make everything all right, because it won't. Socialism didn't work for Russia and it surely won't work for us. President Benson counseled back in 1977 that "the people should support the government but the government shouldn't support the people." Abraham Lincoln coined a "government of the people, by the people, and for the people," a urged the American people in his Gettysburg Address to work and make every effort possible towards maintaining that government and our American Dream.
2/4/09 I was perusing the Glenn Beck Page and found this article. Read point 6.
Congratulation to Utah Jazz coach Jerry Sloan. On 11/7/08 he got his 1000th victory with the Utah Jazz making him the first coach to notch over 1000 wins with one team (career total is about 1092 wins). To lead a team to that many victory means that you have to spend a long time with that one particular team. In Coach Sloan's case that's 21 years with the Jazz. Now those years haven't been all fun and games but his coaching style has made the Jazz offense one of the best in the league. Over these past years he has been criticized by many Utah fans for not letting the Jazz players play basketball like the rest of the nation. His game isn't about show boating, fancy passes, live-or-die by the three, and many other style of play that's been growing in the NBA. His style of basketball isn't fancy and many times doesn't aesthetically appeal to the average viewer, but it wins games. It's fundamental basketball at its best. Setting plays for each other, constant ball movement, pick-n-roll (it worked beautifully with Stockton to Malone and now it's back with Williams to Boozer), high-lows, all lead to one thing; team play. Everyone touches the ball and has an opportunity to score. If the Jazz lose a game it's wasn't because the all-star of the team was didn't perform well but rather because they didn't play together as a team. In other words, they didn't play Sloan basketball. Two years ago when the Jazz got blown out in game 3 against the Warriors in the second round of the playoffs Sloan told the team, "OK you played the way you wanted to and lost. Next time we play my game." Anyone remember what happened next game? The Jazz blew out the Warriors at Golden State. They would later go on to win that series 4-1. So even though his coaching style might not be what the fans want to see, it gives the true fans what they want...a winning season. When talking about Sloan you can't overlook one of the qualities he's most known for, his temper. All though it has become more under control over the past couple of years, it's still a treat seeing him up and yelling at the refs. You know he's about to get a T or thrown out when Phil Johnson gets up to calm him down. Now
Now Coach Sloan did get his 1000th victory tonight, however, those of us who went to the game knew it wasn't the victory he would've hoped for. A win is a win yes, but when you let a 31 point half time lead slip away and only win by 7 against a team that had one of the worst records last year, and only scored 29 points in the first half of this game then you know that temper of Sloan came out in the locker room. A career changing moment, a first timer in NBA history, and thousands of fans cheering his name as the seconds ticked away, Jerry Sloan walked off the court like it was just another game. That's the way he plays and coaches and that's the way he will continue to coach. It's a winning combination. So congratulations to Coach Sloan for becoming the first coach in sports history to achieve 1000 wins with one single team. The following are a few pics from that game.
We're almost done with 2008. Is it just me or do the years seem to get shorter and shorter? It's kinda hard to believe that over a year ago I started PA school and now I'm half way done and already working in different clinics. Many friends have moved out of the state and are attending their respective graduate programs, everyone's married off (I know I'm a slacker, but I'm O.K. with that), my little nephews are growing and picking up on new things every day, and, unfortunately, the boat is being put away (if Daniel is reading this the boat being winterized early is not my fault. Dad decided that since I wasn't going to be down until the end of October he was going to get it out of the way. Everyone knows if I had my way I'd try to hit the lakes one more time this year. Se la vi.) So here it is, first few days into October and one week into my second rotation. I'm working out of an outpatient family practice clinic in Idaho Falls. It's a community health clinic funded by the government and so it serves a lot of people who are financially troubled. Because of the increased Hispanic population I get to use my Spanish a lot more. It's been over a year since I used my medical Spanish in an every day setting and I can tell you it has gone quickly down the crap hole. Words and phrases that I used to use in my sleep now take some actual thinking on my part and it's not as fluid as it used to be. That really is a disappointing thing to come to terms with. I don't think it will ever be as good as it was while I worked as an interpreter. This switch to outpatient medicine from psych has been a challenging one. The interview process and questions are different and I actually have to perform a physical exam. That's probably been the best part of the change. Even though my exam skills are rusty and I'm still learning the nuances and intricacies of the physical exam, that hands on medicine is quite satisfying. I'm not going to lie when I said that I was a little scared and nervous going into this rotation because of my lack of the vast amount of knowledge required in this field. However, as I said back in my psych rotation, going through the history and physical exam usually leads you to the next question that you need to ask. It's amazing how everything seems to fall into place. For it being my first week I've got to do some pretty simple, but still exciting, procedures. My second day I got to remove an ingrown toenail. Not that difficult or exciting of a procedure, but I was still pretty excited to do it, it being my first one and all. It truly is something else to forcibly remove the nail from the nail bed by simply jamming and blunt ended instrument between the two, all while the person has no feeling whatsoever because of the lidocaine injected into the foot just minutes earlier. As I sat there ramming this tool under the nail to clear it away from the bed so I could cut it out I was amazed at how much pressure I actually had to apply to get it up there. It wasn't a simple push either; it was a shove, pull out, then shove again maneuver, like picking away at ice with an icepick. At one point I pushed hard enough to get completely through the bed and under the cuticle. As I heard the popping sound and sudden release of pressure as the instrument freely flowed under the nail until it came to a stop just after going under the cuticle I for sure thuoght I was going to be kicked by a screeming teenage girl. Nope, she didn't feel a thing. Her father was even amazed at the proceedings and he also thought she was going to screem. I cut the rest of the nail out, debrided the wound and then bandaged it up. A simple procdure that I was excited about for the rest of the day. Other simple things that I was able to do were cut off a little kids cast and trim some pretty horrific onychyomycotic (fungal infected) toenails. After a couple of days I was feeling pretty confident about my history and PE skills but still pretty shaky on my assessments and treatment options. With the help of a couple good preceptors, good advice, study, and practice that has all changed. By then end of my fourth day I was pretty confident about my findings and treatment plans of all my patients except for one difficult case that needed some extensive work up. Even my preceptor agreed with me that this was a difficult case and he didn't know what was going on either, hence the extensive work up. So that's what's been going on in the professional life. The personal life is still there and chugging along. I was down in Ogden a couple weeks ago. Unfortunately I wasn't able to partake of the pristine waters of Pineview because of lack of a boat crew. That's what happens when everyone moves off to college, the boat suffers. So instead I hung out and played with my little nephews for a little bit on Saturday. I also attended an 80th birthday party for my grandpa. The man doesn't look or act like he's 80 so I was a little skeptic of the party but all the paperwork checked out. It was good to see some family and enjoy of their company for a while. After that I took a girl I've been dating (yes I still find time to date with all that's gonig on, contrary to the rumors believed by my ISUPA classmates) out and we saw a play down in Salt Lake. The next day we took a drive up Ogden canyon after church to see the changing of the leaves brought about be the fall weather. Then it was back up to Idaho for me. I took the bike out one beautiful Saturday afternoon up Gibson Jack canyon (one that I've previously done) again to see the difference in colors due to the weather. It was a great, challenging ride that I enjoyed even more this time due to the change in scenery. While up there I got to thinking about the beauty that this impending death brought about (if you want to read more on those thoughts just check out my other blog site here). And then the rest of the weekend was spent studying. So that's the update for now. Things are going well and I'm liking this current roatation a lot. One thing I forgot to mention was the constant Spanglish used at the clinic. All of the staff know Spanish and many of the patients uses some type of English in their speech so it's not uncommon to hear "ayer cuando me fui to work me fijaba que my arm was doliendo," or, "dice que you need to give la paciente something para relajarse." It's great!
Well it's been almost two weeks now since I've been back in Pocatello and have started my first rotation in my training as a PA. For those of you who don't know my second year of PA school will not consist of classrooms, or long, boring lectures, but will be based off of five week rotations to different sites where I can get "on-the-job training" and practice. There will be eight rotations in all and they range from outpatient/inpatient, ER, surgery, OB/GYN, etc. I will be doing a few in Pocatello and, if things go to plan, my last few will be down in Ogden. My first rotation is at the Idaho Department of Health and Welfare working in an outpatient psychiatry setting. Luck has shone down on me because it is the same place where I have been doing an internship since January and so I was already prepared for the environment and what I would be doing. I felt bad for some of my classmates because they had surgery first thing Monday morning and have never been in that situation. However, ask me in three weeks when my second rotation is about to start and I will probably feel the same way they did. I go in Mon-Fri from 8am-5pm, weekends and holidays off, and have participated in a variety of things. The majority of my time is spent seeing patients who are clients of this clinic and managing their medications, but when there isn't another provider there with me I have to find other ways to fill my time. I've decided to use that time to gain a better knowledge of the resources these patients have that don't pertain to the medical part of psychiatry; individual/group therapies, crisis evaluations, and so on. These are all different parts of psychiatry but they all are involved in the armamentarium that is used to help maintain these patients stable or to help them improve their situation. Literature has shown that medication alone isn't sufficient for most of these problems because it's not always just a "crosswiring" if you will of the brain. Patients with these problems need to learn skills to help them adapt to their situation, and medication just won't do it. It's been said, "...therapy solves problems, medication treats symptoms." I've enjoyed what I've learned by sitting in and participating in these different treatment options. I've even taken notes and am trying to apply these principles in my own life, not just use them as suggestions for my patients. I've also had and will have the opportunity to work in child mental health. What a completly different setting from adult mental health. Many of the disorders present in adult mental health cannot be diagnosed in childrens mental health so it's like going to a whole new specialty. Today I had the opportunity to attend a court hearing of a person who is going to need institutionalization. I was asked if I wanted to attend to see how procedings went and what the courtroom setting was like. The psyhcologist that I went down with was called as a witness because of a screening that he did on this individual over a year ago. I read through his report and it was quite detailed. He was asked about certain situtations that he talked about in his report and what his opinion was as to the outcome for this individual. While on the way home he took time to explain this persons history in a little more detail so that I would have a better understanding of why he put in his report what he did. He also used this opportunity to stress the importance of careful, and judicious charting. He told me that a year ago when he was writting this report he "knew" that this case would eventually end up in court and that he might be subpoenad for his testimony. With this forsight he said that he detailed his report so that he could remember it later and to also leave no room for ambiguation as to his findings. Now this was something that I've been taught all year long, "chart everything!" but sometimes it really doesn't sink in until you experience its importance for yourself. I'm just glad that I saw it in this context and didn't have to live through it myself. So I've been able to see a lot of patients in these past two weeks. Some of them are stable and have mild problems, while others aren't so stable and have some pretty amazing stories to tell. It takes a lot of self control to not react to some of these situations, even when deep down your thinking "Really? Are you kidding me?" There are so many diagnoses that overlap eachother that sometimes it's hard to diagnose on the first visit. I've had the oportunity to give initial examinations to a few patients and I have had to sit back and think "how do can I differentiate between these three possible diagnoses?" Sometimes patients can have co-ocurring disorders but you have to be really careful to get all the information that you can so can give an accurate diagnosis. The wrong diagnosis will lead to the wrong treatment, which will not only lead to prolonged suffering, but can also be dangerous depending on how the treatment works. I'm grateful for the staff that I work with and that take the time to help me learn and understand. The chief psychiatrist is very knowledgable, patient, and willing to take time to give me little pointers here and there. She also acknowledges fairly constantly when I do things well, which is always appreciated from a young PA. All the staff that I've worked with so far have been very helpful in helping me understand the way things work and give pointers here and there. So that's how my rotation has been going so far. I feel that I've learned more in the past two weeks then I learned all last year sitting in class. Class room learning is important but acutal experience is when things really start to sink in. Not much else going on around Pocatello right now. I haven't gone mountain biking since I've been back, mainly because of time but hopefully I can get a couple of rides in before the weather gets too cold.
As newly inaugurated president of the United States, Barack Obama has already signed off on some policies that will forever change the way our military works. One of those policies recently was the signing of the order to close the terrorist prison found at Guantanamo Bay, Cuba. Now this prison has been the source of much criticism for years because of the reported use of inhumane torture and other techniques that tarnish the reputation of the United States. Along with that same order came the order to follow the military handbook on the proper techniques of acquiring information, which means no more torture: threats of torture, coercion, physical abuse, or water boarding. Now I haven't studied the Army's Field Manual so I don't know what other ways of obtaining information are but I'm sure there are some quite respectable ways. Along with the closing of "Gitmo" and the no more torture Obama has also set up a task force to evaluate how we are to handle the now current residents of Gitmo and the future terrorist that might be taken into custody. He also has organized a task force to investigate new, non-torturous ways of obtaining essential information from terrorist.
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