A Day I Won't Soon Forget...

Today was a very special day for me. I will admit—I am going completely out of order from telling all about my clinical experiences in order. But this is too great to share!

Dr. Cardwell, my preceptor for my surgery rotation, and I had nothing on the surgery schedule today, which is unusual for us. We went to 9 West to round on one patient. After we were done there, he told me to go down to the OR and find “something interesting” to watch. So, I wandered down to the OR, looking at the large board full of names of patients and surgeons, with different surgeries to be taking place. I wasn’t finding anything that jumped out at me right away. I had done laparoscopic cholecystectomies, hernia repairs, cyst removals, etc. I was looking for something that really made my day—something I had never seen before… And I spotted it. “12:00 PM—C-section of triplets”. I knew I wanted to be there! However, I didn’t know the physician, and I sure didn’t know my way down to Labor and Delivery. I got up the nerve to ask one of the receptionists if there was any way to watch, or if the physician would even let me in the delivery room! I was assured that it would be okay. I watched to clock tick away, anxious to see the surgery…

After talking to the patient, she and her husband had tried to conceive using the typical methods. They then tried fertility drugs—nothing. They finally considered having an egg donor help them. They conceived, using only 2 eggs. However, one of the two eggs split! Thus, three babies!

The time had come. The patient was draped, given her spinal block, and laid back on the table. Show time! The babies’ father walked into the room and took the head of the bed by his wife. He was nervous, but beaming! The incisions were made through the skin, the fat, the fascia, and finally, the uterus was exposed. One incision and a HUGE clear gush of amniotic fluid came out! Within seconds, the doctor was pulling on the head of Baby A—a boy! He was crying a high-pitched squeal from the moment he was born. Next, within 30 seconds, came Baby B—a girl! She had a full head of hair! Finally, just a few seconds later, Baby C was born—another girl! She presented breech, but came out easy. They all cried the high-pitched cry I am assuming nearly all newborn babies cry. I having to admit—I stood out of the way at the end of the table, with a tear in the corner of my eye too. I had never seen any baby that small and healthy—let alone three at once!

I watched as the babies were carried to the warmers, rubbed clean, and folded up in blankets. I was honored when the father of the babies asked me to take pictures. What an amazing moment for this family! I was so happy to be apart of it. All of the triplets were healthy and happy and pink! What an amazing feeling to be a part of God’s glory and grace. Happy birthday, Samuel Dalton, Emily Elizabeth, and Anna Sophia. Welcome to the world!

Rotation #1--Family Practice I

Okay, so I should have been blogging after each rotation. I realize this. If I can post my experiences, then I will have a better feel for what I like when it comes time to graduate. Speaking of graduation, my last day of clinicals is December 15, 2010, and graduation is December 17th. We are looking at six more months. This is exciting!



My first rotation was with Stacy Vienhage in Republic, MO. This was my first famly practice rotation out of two family practice rotations. I really enjoyed this rotation. It was nice to have a good hometown feel. Stacy was really great to work with, and I learned so much about womens' health and chronic diseases, such as diabetes, hyperlipidemia, and hypertension. We had a lot of fun, and we had a lot of laughs. The office staff was really great. Unfortunately, Stacy left this St. John's Clinic to go to work full-time in the St. John's ER. She left a huge hole in this practice, as she has been there the longest out of the three providers that are there. I have a lot of respect for Stacy. She allowed me to shadow her to get into PA school, and she even wrote my recommendation letter for school. And then she was my first rotation! I was grateful to have her. I am not sure that I would be here without her.

Busy is an understatement...

I am sorry that I haven't been so prompt with all of my posts. One of my readers reminded me that I haven't blogged since AUGUST!! And for that, I apologize. It's nice to have such great friends that remind me to GET BLOGGING!!! :) I also apologize as the somewhat monotonous nature of my posts. I have a feeling my clinicals will offer some more interesting stories. :)

I plan to finish this post with mainly filling you in about August through December. (I will post about all of my clinical rotations individually.) The fall semester was my favorite. It's quite possibility due to the fact that my learning and training has been building upon itself. Unlike so many of the classes that I had in undergrad, my classes build upon each other, and the learning isn't forgotten at the end of the semester. The classes are so practical. I found myself answering questions about things that, if I had looked at myself two years ago, I would have had no idea what was being discussed. My classes were Clinical Problem Solving, Epidemiology, Clinical Medicine II, Clinical Practicum II, Clinical Procedures, and EKG/ACLS. I ended the semester with 4 Bs and 3 As. I'll take it!!!

At the end of the semester, I had a one week clinical with Dr. Larry Chase at Cox Hyperbaric Wound Clinic. I figured that I would be going to look at wounds here and there and doing some dressing changes. Maybe slapping on a little Neosporin here and there.... Wow, I am impressed with the vast amount of information and care that goes into wound healing. There is so much to learn about the origin of wounds (arterial vs venous), chronicity of wounds, types of skin grafts, wound infections, and types of dressings. I feel that I learned a lot in the week of that clinical. There is so much more to wounds than Neosporin and Bandaids.

At the end of the semester, on December 20, Mike and I celebrated... by getting married! We had such a beautiful day. He looked so handsome in his tuxedo, and I felt like a princess in my gown (first time ever feeling like a princess!). We were blessed with an outside temperature of 53 degrees in the middle of December! The week before had been around 20-25 degrees, and I was checking the weather updates every day to see what was in store for us on our wedding day. We were praying for good weather, and we got it! Mike and I had our closest friends and family with us, and the day was VERY special. I can truly say it was one of the best days of my life.

After our wedding, we honeymooned in Ocho Rios, Jamaica. It was truly Heaven on Earth. I have never been more relaxed and care-free in my entire life. The water was more soothing, colors more vivid, food more satisfying, and people more beautiful than anything I have ever experienced... I can wait to go back...

The only bad part of the honeymoon was leaving. Mike and I returned to a "warm" 27 degrees back here in Missouri. All in all, we were sad to leave Jamaica but happy to return home. It was only two weeks later that I was to be in my first clinical. I was somewhat nervous going into my first clinical, but I was fortunate enough that my first one was with Stacy Vienhage in family practice at the St. John's--Republic clinic. It was close to home, and I was looking forward to it! More to come!

Grab a snack!

First off, I apologize. It's been three months. I realize this is no excuse. But thanks to good friends who hold me accountable, I am getting back on the blog bandwagon. Of course, with three months passing by and an author who is not only in an intense grad program, but also planning a wedding, this might be a long post! Feel free to grab a snack… You might need one...........................

Now that you have a snack in hand, let me fill you in on school. I had just started the summer semester last time I had posted, and it was coming at me fast. I had Clinical Medicine, which was the core class of the summertime. It consisted of eight different sections of medicine, purely focused on that section and nothing else. It was a wonderful class for the fact that you weren't focused on minutia such as where this muscle inserted on that bone, or which ion came out of the cell when the ion channel was opened. The bad thing about the class was the fact that it was REALLY fast paced, and there was one test a week! So, we had a test the sixth day of school and every 4-5 days after that. I struggled for the first little while, not being used to the fast pace of it all. Also, required reading consisted of 2 millimeter tall print in a book that is five inches thick and with pages the thin consistency of pages out of the Bible. It made for some long nights and early mornings! I found quickly that my best subjects were dermatology, OB/GYN, and pulmonology. To my disdain, I found that my worst subjects are hematology/oncology, rheumatology, and orthopedics. Being from a rehabilitation background, I was thinking that orthopedics would have been my forte because of all the patients that I had dealt with. Not so much. Then, I had pharmacology. We had one quiz a week with 25 new drugs to learn. Talk about learn and purge. :) Honestly, it was a good class, and I am going to have Advanced Pharmacology, so I am looking forward to learning some more of that. The best part? We don't have to learn the 25 new drugs a week. Thank goodness. Then there were other classes like Clinical Assessment II and Professional Issues Seminar. Good classes, but nothing noteworthy.

I struggled a little bit, but there were good days too. There's nothing like the feeling of cooping yourself up in the library from 8 AM to 6 PM and doing extra work at home to go in and have a good test on a Monday morning. Yes, there were some tears again this semester, mostly for Clinical Assessment. I believe I psyched myself out about the first test in that class--that, and I should have studied rectal and prostate exams a little more. For the first test, I got a C. Dang. There were only two tests in that class, so I knew I had to do well on the other one, which turned out to be a harder test. For that reason, I'm still puzzled how everyone else did so well on their first test and so bad on the second test. I got a 91% on the second. Sure helped to bring the grade up. :)

One of the best experiences this summer was doing a one-day clinical at St. Louis University. MSU has a partnership with them so that we are able to perform pap smears and breast, rectal, testicular, and prostate exams on live patients (as opposed to doing them on our classmates, like all the other physical exams). Those live patients are also instructors who guide you through the process. It was really a GREAT experience to get to go up and perform those kinds of invasive exams. Yes, even the rectal exams. Not only that, but it was nice to get to hang out with some good friends at the Hard Rock Café at Union Station in St. Louis.

Here are the grades for the summer semester. Looking back, it went super fast! You'll notice there is a class with an Incomplete grade. I'll explain.

After we got out of class on July 24th, we still had to do two weeks of clinicals for Clinical Practicum I. This is where the real fun began! I can't believe that I wasn't the least bit nervous AT ALL! We were assigned to one week in one setting and a second week in one setting. I had volunteered for Hospice, and I was really hopeful that I would get the position. We have 26 students who needed two weeks each. The possibility that I would get a week in Hospice was pretty low, but it happened. That's where I was headed for my first week. However, when I called to confirm five days ahead of time, I was informed that the physician would be flying out of town for a family medical emergency out of the country, and he would be leaving the day that I was supposed to be there. I was then placed with Teresa Barr, an intensivist PA at Cox Hospital. Luckily, she was in pulmonology. Having a good knowledge and confidence about this subject, I was STOKED about this rotation. I began early on Monday morning, and I was introduced to a lot of people on my first day. Everyone's response to it being my first day of my first clinical was, "Wow, and you got thrown into ICU? You're brave!" Was I? Was I that brave? It didn't hit me that it was such an 'honor' to be in ICU for the first day. I was proud AND stoked at that point! Before I knew it, I was looking up labs, performing physical exams, and writing up assessments and plans for patients. These were the kinds of patients I had never come into contact with either. It was exciting, and with ever SOAP note I wrote, I felt more confident. I had my white jacket and name tag on and my stethoscope around my neck. It felt SO good to be out of the classroom, working with patients, and making connections with those in a field where I am soon going to be working.

Told you the snack was going to come in handy. I'd like to share a few stories with you...

One of the first patients that I saw on Monday morning was a little elderly African-American woman who was in her very last stages of life. She was intubated and in a coma. Her daughter was nearby, and she had a history of barking orders to EVERYONE on the staff about her mother's care, whether or not it was what she truly needed--and according to my precepting PA, it wasn't. The patient had a perforated bowel and free air in her abdomen. Her lungs, kidneys, and liver had failed. Her abdomen was the most firm abdomen I had EVER felt. She badly needed dialysis because of her failing kidneys, but she was too frail to be a candidate for the long procedure. Teresa had explained to me that there was a strange phenomenon that some patients may do when they are near death. She described it as a "fish head" movement. Basically, the patients head starts small upwards jerks that are uncontrollable. Every three seconds or so, the patient's head would nod up just a small bit. It was very interesting. I knew that the patient was in bad shape. However, I was slightly taken aback when two nurses wheeled out a green covered cart later and started clearing out her room. Just like that, she was gone.

The last thing we did on Monday was a consultation for a physician back in CCU. We had a 43 year old female patient who had been admitted to the CCU after a suicide attempt by insulin overdose. She was a Type I diabetic who had an insulin pump. When EMS found her at her home, she had a blood sugar of 13. She had once before attempted suicide in January, but had failed. The patients family slowly trickled in, shocked by what had happened. Long story short, I was taking care of her all week. Her durable power of attorney was in the hands of her two daughters, ages 14 and 17, and they were left with the issue of withdrawing support on their comatose mother. It was hard to watch. They decided to donate her organs as well. The patient has a completely grim prognosis, having a positive Babinski reflex, no blink or corneal reflexes, and no response to painful stimuli. I think the hardest part for me was watching the woman's father cry. He would stand by her bedside and simply cry. I think that was hard for me because of the fact that I am so close to my daddy. The patient ended up going down to the OR for organ donation, where the ventilator was turned off and she was allowed to breathe on her own for 90 minutes if she could. After that point, she was extubated and taken to her own room, still with a grim prognosis. It was sad when I looked in the newspaper and saw the woman's obituary the next weekend. To the stark contrast of her appearance in CCU, the woman was ABSOLUTELY beautiful in her obituary picture. I couldn't understand HOW or WHY it had happened. As my preceptor pointed out and I totally agreed with, we failed her in January when we didn't get her the help she needed then.

We also had patients that were in car accidents, those that had surgery, and a few other patients. I learned SO much with Teresa and the Nurse Practitioner who worked as her counterpart on Teresa's days off. I was grateful for the experiences there and the encouragement that I got from both of these care providers.

My second week was spent with Dr. Chan Ngo at the Jordan Valley Health Clinic. I was slightly apprehensive about being in this clinic. I wasn't sure why. I think it was the fact that I was going to have to do patient interviews and then present to my supervising physician about each of my patients. I was seeing a completely different patient population. All of those things put together made for a slight apprehension. It all faded when I talked to my first patient. I had a great experience at the JVHC. I was amazed at their clinic because of the fact that they have the ability to do labs, x-rays, and dental care on site. I didn't think that I would want to go back to work there after clinicals, but seeing the relationship between providers and patients and the ability that the clinic had to take the best care of their patients, I would welcome the opportunity to serve back at the clinic.

One story that sticks out from my mind at the clinic was one that took me by surprise. By Thursday afternoon, I was into the habit of looking at my patient's chart before I went to see them. I immediately recognized the name of a patient who I had had during my time as a nurse assistant at St. John's Inpatient Rehab. I didn't know if she would recognize me or even remember me. I took a breath and started down the hallway to see her. I stepped into the room. Before I even said hello, she gasped and said, "Oh my goodness! Ashley!" I was so happy to see her--she was one of my FAVORITE patients I ever had in rehab. Before I even started the patient interview, I asked her how she was doing since she had left rehab after her stroke. She told me that she was doing great. She was an African-American preacher who spoke with fervor about God. I asked her if she was "still preaching the Gospel," to which she responded with a grin, "Honey, I baptized a girl last week, and I'm preaching again next Sunday." We both sat there with tears in our eyes. After we finished the medical interview and I had to move on to my next patient, she grabbed my hand and told me she was proud of me. You see, this woman was with me in rehab a year ago when I got the interview to go to PA school. She would pray with me about getting into school. After she was discharged from rehab, she would come back in for outpatient therapy. I happened to see her after I was accepted, and when she saw me she asked about school. I was happy to tell her the good news! It made my day to see her in the clinic. We had literally come full circle!

That's actually a perfect lead in for my next point... It was exactly one year ago that Mike and I were in Chicago, sitting down to dinner at Uno's Pizza. My phone had died, so I used Mike's phone to call my voicemail. I knew it was a good sign when I had a message from Cynthia, the secretary of the MSU PA program. When I called her back, she was calling to set up an interview for school. That was August 13th. My interview was September 13th, and I got the acceptance call at 10:44 AM on October 8th, 2008. Aside from the application process, this journey started one year ago. One year later, and I can't believe I am here. It has absolutely flown!!! Tears and smiles. Ups and downs. I can't believe I am one semester away from starting one full year of clincials. One and a half years away from the rest of my life. After two weeks of clinicals, I can honestly say that I made a good decision. I wanted to be a PA from the moment I read about the career back in 2005. I knew that's what I wanted to do.

Wow... Now what about the next biggest moment in my life? December 20th is getting ever closer! I am 129 days away from marrying Michael Brandon Schnell. We have finished so much of our wedding planning! I bought my dress July 3rd! Trying it on made me tear up. It was the PERFECT dress. It made me wish it was my wedding day every day! Just a few weeks ago, I bought my bridesmaids dresses! I love them too! It made me wish I was a bridesmaid in my own wedding, which is totally impossible! On a slightly sad note, Megan stepped down as one of my bridesmaids. I completely understood when she told me her reason, and I had actually considered it already. Megan and Nathan are due to have their baby girl on December 8th. They were concerned that they would be so involved with their baby girl that they didn't want to take a chance of "messing things up" for me. They would NEVER have messed things up for me at all! I was concerned that I would be taking Megan away from their girl. I'm glad Megan is a good friend that she can come to me with her concerns instead of worrying about them for six months. Megan, I love you! I asked Andria Gibb to be one of my bridesmaids, and she was absolutely tickled! And I am tickled to have her too!

My biggest things I am looking at right now are flowers, cakes, and wedding favors. I need some ideas! Help me out! Winter weddings are a little hard to find flowers for! I will TRY to keep everyone updated!

Okay, if you're still reading, KUDOS TO YOU! I can't believe that I have made it this far myself! I PROMISE not to wait this long to blog ever again. It makes for long reading, long typing, and lots of M&MS, chips, or whatever it is that you snack on! Ciao!

Remember to breathe...

Wow! It's been a while since I've sat in this same chair to write!

So much has happened last time! Spring semester is OVER! Summer semester began today! And... Mike and I are engaged! Whew!

Mike and I got engaged at J Parrino's on May 6th! It was a beautiful dinner, but we hadn't even ordered dinner, and before I knew what was happening, Mike was on one knee! It was amazing. He's amazing, and I'm SO lucky. :) Little did I know what he had up his sleeve! Andy's Frozen Custard was for dessert, so we headed over after dinner. He had invited all our family on both sides and all our friends. I'm telling you--he's good. I SQUEALED more than I ever have, and I cried so many happy tears. We decided, when we got home that night, that we have the BEST friends and family ever. EVER.

Mike and I would get married tomorrow if we could. Is this going to happen? Is it even reasonable? Ha ha... NO. So far, we still don't have a date. We have a venue, colors, a guest list, and a photographer. But that's all the planning I have gotten to do so far! Mike and I agree that we would like to get married anytime we could, but we are keeping practicality in mind as well--that includes timing. Mike is going back to school this August, and I am going to be full-speed-ahead until December 2010. We will see what happens. But for now, this makes for some good writing! I'll keep you posted!

Speaking of school, I am DONE with one of the hardest semesters of my life. Spring 2009 is one for the record books. I finished with a beautiful 3.13 GPA. Amazing? Spectacular? Perfect? No, no, and no. But--there are no Cs on my grade report, and I simply didn't think that was possible. I got all the points I needed by spending some late night staring bleary-eyed at books. No coffee past noon. You know what I mean by that. :)

Summer semester started today, and this is what they is one of the best semesters. It's pedal-to-the-metal all the way through the semester. On the other hand, I am going to be learning some amazing things that I will see in practice. If there was ever a time for ABSORBING all the information I learn and NOT purging it out of my mind, now is the time. My classes--pharmacology, clinical assessment II, clinical medicine I, and professional issues seminar. Honestly? I'm excited. Unless I am completely ignorant about what may blind-side me this semester, this looks GREAT!!!

Well, back to the dermatology. Nothing like folliculitis, dermatitis, pustules, vesicles, Herpes, and telangiectasias. :)

So..... You're Saying There's a Chance?!

As we all know, I've battled. And I've cried. And I've prayed. And I've been given encouragement. And I've studied.

I have struggled with my physiology grade since... well, pretty much the beginning. I got a 50% on my first test. I wasn't ashamed to cry. I was, in my mind, out of the program. It was the WORST feeling in the world. In fact, I think there's a post about it here somewhere...

Just to refresh some memories, my second test was an 82%. I was pretty happy with that. That got me into C range with my grade, which is where I need to be to stay in the program at the bare minimum. I would settle for a C. Settling for a C is WAY better than the alternative. :(

Our third test was last Wednesday. So, I studied like crazy on Monday and Tuesday nights before the test, at "late" as 2 AM, only to turn around and get back up at 5 AM and study some more. Those were a rough couple of days!

Let's digress a moment for a funny story. On Tuesday night around 9:30 PM, I made a pot of coffee because I knew I still had about 5 hours worth of studying to do. The house was quiet because Mike was out of town. Sitting there, with my wonderful cup of coffee, I studied away. Finally, after I was mostly bleary-eyed from reading for nearly 12 hours straight, I got up, took a shower, and headed to bed, stopping to read about ten more pages before then. I turned off the light... and I heard a noise. I froze. I KNEW someone was outside my bedroom door in the hallway. After I got over the initial fear, I jumped out of bed and grabbed the baseball bat behind the door. Whoever was out there wasn't getting to me! I listened at my bedroom door, knowing there HAD to be someone there. I didn't hear the cat moving around, and I didn't hear any other noises for that matter. My heart was beating so hard. I noticed Mike's MagLite by the door, so I grabbed it, ready to use it like a club! After a couple minutes, I finally eased myself into bed, with my trusty bat and MagLite beside me, of course. I heard the noise again! I ran to the door again, MagLite in hand. I listened, said my prayers, unlocked the door, and flung it open!..... Nothing. Not in the hallway, office, office closet, hallway bathroom, living room, or kitchen. I had been imagining it! The cat just looked at me like I was crazy. Scolding myself, I headed back to my bed. I NEVER act like that. I came to learn a serious lesson that night. A string of late nights and early mornings don't mix well with a late night pot of coffee, even with the purpose of staying up to study.... Stupid coffee.

Okay, where was I? Oh, yes. Wednesday--test day. It was pretty much anti-climactic, but everyone else kept freaking out and asking a lot of questions during the test. When we left, they told another professor they thought they were out of the program. That bad, huh? I just didn't think so. We got our grades a week later. I looked at the grade with a little bit of cautious optimism........................ 92%. :O I know! I couldn't believe it! I was nearly in tears--AGAIN! This time was for a completely different reason. My class grade has risen from a 58% after the first test to a 77.5% after this exam. So, there's a chance that I could end up with a B. It's the perfect comeback story for me and physiology! So close.........

So, for all the encouragement--thank you. The prayers, studying, coffee, and tears are worth it!

Midterms and a Baby Boy

Good morning! It is a BEAUTIFUL day out already, and I will be honest--I have Spring Breakitis. It's only Wednesday, and I think my brain is shutting down, knowing I have the next full week off. :) In fact, would it be so bad for me to skip lab on Friday afternoon?! ;)


So, I survived midterms. I had mostly As and Bs, and here's how the midterm grades came out--4 As, 2 Bs, and 1 C... The physiology class is getting better, but it's going to take a lot of butt-kicking to bring up my grade. Unfortunately, that butt is mine!


Off the subject of school, I want to say a BIG Congratulations to Tim and Tonya Schnell, who had their first son, Deacon Maddox Schnell, on Friday, March 13, 2009. He was 7 lbs, 3 oz, and 19 1/2 inches long. He is absolutely gorgeous. Mike is officially an uncle! We were able to go to Warrensburg the evening Deacon was born, and it was an awesome experience. I was SO glad to be a part of it!



One more quick note, I can't believe it, but there are only 7 weeks of school. We have finished 10 weeks of school. Amazing! It's gone so fast!



More to come, hopefully soon!