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Nothing exciting to post because nothing exciting has happened! I had the free institutional turkey dinner at the hospital on Thanksgiving and hung out in the lounge 'till midnight waiting for some trauma to come in. There was one pediatric trauma blue which thankfully turned out to be nothing. Other than that, people seemed to be not driving drunk, or at least not crashing, and not assaulting each other. All things to be thankful for in reality.

"If you love what you're doing, why would you go to school to do something different?"

I have come to a dilemma in my career. To PA or not to PA? That is my question. I am currently a Surgical Technologist (certified) and a Surgical First Assistant. I had the notion in my head to go to PA (Physician Assistant) school. For the first time in this life of survival on my own, I will have the financial means to pay for tuition and go to school full time. PA school is very intense and no amount of time can be spared for a j-o-b.

But for those of you who don't know (!). I love surgery. If I go to PA school I will have spent approximately $50,000.00 in tuition and my best bet at a position after graduation will be in a clinic. Maybe an Ortho group or General Surgical group sure, but everyone knows that PA's generate more income in clinic than they ever will in the OR. Of course there will be days that I actually get to assist but most of my time will be filled with H and P's, (physical exams actually touching the outside of patients, argh!) and patient teaching and follow up visits and rounds and fielding phone calls and all sorts of other patient contact chores that I have absolutely no desire to do. The only way cool thing I can think of in this position is diagnosing. I would love the investigative portion of medicine. I even think I have an intuitive aptitude for this, but beyond that, why would I want to change my current situation?

Emergency medicine might be a venue to explore. I am unsure what a PA's duties might be there. The ER is the only other place that intrigues me as much as the OR, but I fear I would constantly be yearning for surgery.

I had originally thought that being a PA in the OR would make me more valuable. Surgeons often have a hard time finding an assistant for Medicare patients. Go figure. Right now, I do it for free because Medicare does not recognize an SFA. Medicare reimbursement is minimal. How long would it take at Medicare pay rates to compensate for 50k in tuition and two years lost income? My guess is a very, very long time. If I don't want to do all of those PA things, why spend the money and "waste" the education?

In the innocent words of my sister, "If you love what you're doing, why would you go to school to do something different?"

Why indeed. I believe that I have the best job in the world right now. It allows me the financial stability to be self employed. I get to do all of the fun stuff and none of the horrible. I don't have a lot of emotional interaction with the patients. I try to be comforting and reassuring when they enter the OR before induction. After the surgery my follow up consists of inquiring about their condition from the surgeon. This is all the patient interaction I care to have. It sounds callous, but I have had to admit that I have come to realize that this is self-defense, protecting me from the emotional roller coaster of being involved with sick and/or dying patients and their families. I cry at Dove soap commercials. I have become softer as I age, I used to only cry over animals.

I have heard legend that there are surgical PA's that only do surgical assisting and related post-op activities. Is this true? Can anyone reading confirm this? Now that might be a dream job.

To all of you ER, or if you insist, ED Docs, are there PA's in your department? If so, in what capacity?

I could sure use some help on this one.

Uncalled Forth

Apparently I have become the white cloud. Even worse, I seem to have turned the Trauma Surgeon with the biggest black cloud into a white cloud also. I'm sure he appreciates it, but I am having physical cravings for some trauma surgery. Hell, I'll even settle for any open general surgery. Nothing laparoscopic thank you, it just doesn't fill the void like actually getting your hands on some organs. (photo credit)

Last week's call for me.

Monday- Ortho.

Tuesday-Trauma and Ortho.

Thursday-Trauma.

Friday-Ortho.

Saturday-Ortho and ER (with the same doc I take trauma call with).

Sunday-Ortho.

Total number of cases, 0, that's zero, zilch, zip.

Last night I was on Ortho call again. Nothing. Tonight I will hopefully have better luck, I'm on ER call again with the trauma surgeon.

Tomorrow I will be available for trauma with a different trauma surgeon, maybe he will be the new black cloud.

This week I assisted one of the general surgeons on Monday morning, three scheduled laparoscopic cases, he mentioned he was on ER call this Friday and Sunday. I volunteered my services. He programmed my number into his phone. A good sign.

Free Cell?

One of the Ortho surgeons had given me a coffee card for all of the free assists I do for him. He's a great guy. Today I had an hour in between cases so I went to Starbucks. As I got out of the truck a street person approached me and asked if I could spare 50 cents. I told him when I came back out I would give him my change. Standing at the counter, I gathered up two one dollar bills as I waited for my hot beverage, with full intentions of giving them to the "dude". As I walked back out to my truck, he was still standing there but his back was to me and his attention seemed to be on a group of three girls approaching the store. I opened my truck door assuming he would hear me there and come to collect his free money. When I looked back at him I realized that he was not soliciting the three girls that had approached but rather he was talking on his cell phone! I got in the truck fully expecting him to tap on my window, but as I started to back out I saw that he had taken off across the street pushing his empty shopping cart ahead of him. Apparently street people are now networking.

Very Superstitious?

I am normally not a superstitious person. A black cat lives with me (the feline variety), the mirror on my locker is broken, and I love the number thirteen. Give me a Friday the 13th and I feel lucky. But in the operating room, there are several superstitions that must be strictly adhered to!

Many OR's have a large magnetic dry erase board on which to display the days schedule. Individual magnetic strips about two feet by two inches are used to write the individual cases. Start time, patient initials, procedure and surgeons name are the typical information written. Then the strips or cases, are arranged on the board by room number in chronological order. Anaesthesiologists, Techs and RN's have their own little magnetic strip with their names on them. When you are assigned to a room your name magnet is placed next to the corresponding case.

When a surgery is complete and the patient is transferred to recovery, the individual strip comes off the board and the information is erased. Different story if a patient dies in the operating room. Should this unfortunate incident occur, the magnetic strip upon which the procedure was written is left in it's place on the board and turned upside down. This informs everyone, especially those who may be wondering why their case to follow is delayed, what has occurred without anyone having to say a word.

What is the superstition, you ask? Never, ever, let someone turn your name magnet upside down! If you see it is so, immediately upright yourself and any of your friends. If you have enemies you may turn their name strip upside down, but I shudder to think what Karma may have in store for you

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Another strip superstition. If it is the last case of the day, and the patient has long since gone to recovery, maybe even been transported up to their room, under no circumstances should you remove or erase that strip. Unless of course you want to bust open the flood gates and have several add-ons rain down upon you. Typically three at a time.

Emergent procedures come in threes. If you do one lap appy, you can bet two more are to follow in the same evening. Same with hip fractures. Some procedures like Crani's and AAA's may occur once a day for three days. If you exceed five in a consecutive time frame, you just have to plan on doing six.

When you are scrubbing a case all instruments that have been opened for that case MUST remain sterile on your back table. If you are sure that the surgeon won't use a particular instrument, or set of instruments, or any item of any sort, and you hand it off to unsterile territory, the surgeon will immediately request said item.

If your instrument string has an uneven number of like instruments, for instance, three Kochers or seven hemostats, you must either remove or add one Kocher and one hemostat to even up the numbers. If you insist on tempting fate, and remaining unbalanced, your case will not go well for you.

There is no OR number thirteen.

If you are on call and you don't want to work all evening and night until the sun comes up, then never, under any circumstances, utter the words "Quiet" or "Slow." If you use them in a sentence such as, "It sure is quiet tonight." Or, "It's been so slow lately." You will invoke the jinx pixies and you will not see sleep's bliss until tomorrow night.

These are just a few of the superstitions I know of. If anyone out there in the medical world have any I missed, I would love to hear them!