I Can't Believe It's [Over] [Just Beginning]

I GRADUATED LAST FRIDAY.

Yep. After 13 years of pre-college education, 4.5 years of college, and 25 months in grad school, I can officially say I’m a master.  A Master of Science. A Master of Science in Physician Assistant Studies, to be exact.

Now that you’ve paused for about 10 seconds to let that fact soak in and realize the monumentous amount of work that went into those four words I bet you’re dying to ask me the most natural next question. Nearly everyone always does.

“Now what?”

But first, before I comment on the future, let me briefly reflect on the past.

Over the past 25 months, I’ve earned 129 graduate credit hours, spent thousands of hours in class and studying, took more notes than I have space to store in my tiny room, and drank enough caffeine to officially reach gold star status at Starbucks. Was it a rewarding experience? Of course. Would I want to repeat it? Of course not.

(L) White Coat Ceremony, June 2013
(R) Graduation Ceremony, June 2015

My love of medical learning and humanitarian serving found a perfect blend in the profession I chose. Not only did I HAVE to study medicine, I GOT to study medicine; how many people get that privilege? I am perpetually amazed at how incredibly the human body is designed. The day I lose that wonder is the day I should change professions.

I have many happy memories of school – fun conversations around our dissection table in anatomy, meeting with friends at Café Crema to study, card games during lunch, line dancing in Des Moines with a classmate, rooming with some pretty spectacular classmates-turned-roomies, exploring new locations throughout Iowa, traveling to Boston to represent our program at the AAPA conference, doing p90x with a classmate, running a half marathon.

Then there were the hard times too – wrecking my car the first day of surgery, missing the once-an-hour evening bus and having to walk home in the rain, smelling like formaldehyde and latex the entire summer, forgetting my tennis shoes and having to wear dress shoes all day in the OR, waiting for 4 hours to be picked up from the airport in Tanzania because our host forgot we were coming, being exhausted ALL. THE. TIME., picking up my life and moving every 4-6 weeks during clinical year.

But it was worth it. And now it’s time to enter the “real world” again and be a productive member of society J

And now, to answer that burning question: now what?

Well, after a few weeks of travel and studying, I will be taking the PANCE (Physician Assistant National Certification Exam, pronounced like “pants” and equivalent to medical school board exams) on July 16. Then I will be starting a full-time job with the QuickCares (urgent care/acute care) here in the area.

I’m sure it’ll be challenging transitioning from student to provider, but I’ve been well prepared. And who says life is easy? Here’s just another opportunity to #DoHardThings.

Medically Minded

I am one of a rare breed. The kind that is fascinated with medicine and the human body. Since being in PA school, we have been demanded time and again to hone our observation skills. And when you think of medicine for a majority of your waking (and sometimes sleeping) hours, it starts to seep into everything you see and do.

For instance, I saw this license plate the other day. 

Now, this is not the first time a license plate has caught my attention because of a medical acronym. Medicine is literally a language in itself. We were told we would learn 20,000 new words during our two years of school – and I think I have. (Taking medical terminology in college has been a lifesaver. Thanks Dr. T!) 

Or, take for instance, this true (and somewhat embarrassing) moment, when I commented on a friend’s arm veins after he had taken off his sweatshirt. I mentioned his veins would be great for an IV stick. FYI: sometimes it’s better to keep one’s observations to one's self.

I could tell story after story about things like this, but let’s move on…

Sometimes I feel like Dr. House – always seeing medical diagnoses in people I don’t even know  (e.g. at the airport in season 2 episode 10). Like today. I was running my scheduled 5 miles at the student recreation center and a girl walks in on legs that are reminiscent of toothpicks. Red flag #1. She then proceeds to take off her sweatshirt, revealing a t-shirt and emaciated arms. As she used the elliptical in front of me, all I could think about was her size. My brain was screaming anorexia, but I keep trying to push it aside. Sometimes it’s easier to not face the ugly truth. I start streaming through a differential. Cancer. Probably not. She wouldn’t feel well enough to exercise. Malabsorption issue, like Crohn’s. Again, probably not, for the same reason. And then I was left with only one other obvious diagnosis: eating disorder. Which totally fit (no pun intended) since she was at a gym.

When I was younger, I caught this made-for-TV movie at home one night while flipping channels. I’m not sure why my parents even let us watch it, but it stuck in my memory for years. And when I was studying eating disorders in my psychiatry rotation, I re-watched it. 

Seeing the girl in the gym today was like watching a clone of the lead actress in that movie. And all I could think about as I’m pounding through mile 3, 4, & 5 is that this sweet, sick girl in front of me is killing herself and could go into a cardiac arrhythmia any moment due to an imbalance in electrolytes. I glance around for an AED, but I don’t see one. Maybe behind the desk where the staff is sitting? Then I start thinking about whether I should do something or not. Talk to the girl? Notify the staff? I struggle through what my role should be as a medically informed person in the public. (Any like-minded person who has come upon a cardiac arrest or a severe car accident when emergency services have not yet responded likely has felt the same way.)

Ultimately, I decided to talk to the staff, just letting them know I was concerned for this girl's health and wondering if they had any kind of protocol for such a situation. They were aware of the situation and it was not the first time someone had expressed concern. They were working toward revoking her membership (although I’m not sure if they were working on the medical aspects of her disorder). I felt like the action I took was the appropriate one, but for the first time, I realized this wouldn’t be the last time I faced a dilemma like this one.

We all have choices to make. May I continue to always struggle through difficult ones and not just take the easy path by doing nothing.

Ready, Set, Go.

May I ask you a question? What hard thing are you doing? 

Stop and think about your answer before continuing. 

Did you stop and think about it? Nope, I didn’t think so. So, seriously, pause and consider this question before moving on.

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Now, did you stop and think about your answer? Ok, good. I’m assuming you did.

This question keeps surfacing in my mind. It’s part of our human nature and our culture's expectation to avoid doing hard things. Do what’s easy. Live for the moment. Why work hard when you don’t need to?

When I was a teenager, I read an amazingly challenging book by Alex and Brett Harris titled “Do Hard Things.” Ever since then, I’ve tried to avoid dwelling in my comfort zone. To grow and stretch myself. To do hard things. One of the things they emphasized was to do what’s hard for you. Getting straight A’s in college. Easy – for me. It may have looked like I was doing hard things to others, but often I wasn’t. And that’s where Alex and Brett challenge their readers – find somethings that’s hard for YOU and then do it; don’t just give the appearance of doing hard things to be recognized by others.

I’m in the midst of reading two books right now – Counter Culture by David Platt and The Curious Incident of the Dog in the Nighttime by Mark Haddon. Both books address doing hard things. Counter Culture focuses on doing hard things for Jesus with regards to our views and actions relating to abortion, sexuality, human trafficking, ethnicity, public display of religion, marriage, immigration, orphans and widows, and poverty. The Curious Incident of the Dog in the Nighttime focuses on an autistic child and life from his perspective. One parent gives up on him and takes the easy way out – an affair and disappearance from the boy’s life. The other parent sticks it out, even though he doesn’t always understand or relate to his son.

This year has held many hard things – uprooting every month, living in multiple locations, watching friends go through difficult life situations, being depressed, family living far away, transitioning from being somebody’s to being single, hours of commuting, totaling my vehicle, and trying to build new friendships. These are hard things, but they aren't "doing hard things." Doing hard things is more about responding in ways you'd naturally not, setting goals for yourself, and challenging the status quo. So, in the above examples, doing hard things is more about having a good attitude, initiating friendships, finding joy in the circumstances, negotiating a new vehicle with the car dealership in the middle of my surgery rotation, driving 9 hours in one weekend to see my family for 1.5 days, following up with friends, and not letting myself become bitter or passive. 

So, what does doing hard things look like to me currently? Moving beyond my introverted self and investing in other people’s lives, initiating conversations, not avoiding difficult situations, getting up every day with a positive attitude, being diligent in my devotional time and Bible reading, staying physically active (training for a half marathon although I really don’t enjoy running), having hard conversations, saying NO to the good and YES to the best, thinking about the future and starting the job search even though I’d rather be passive and let things just happen, and letting others truly know me.

Each person’s hard thing looks different. It could be giving an honest answer, not giving up on your kids, picking up the phone and talking to someone rather than texting them, asking that co-worker how she is doing, picking up extra groceries for the food pantry even though it might dip into your “fun money,” making that job switch, asking someone to dinner, getting up off the couch and walking 10 minutes, taking the stairs instead of the elevator, refusing to complain when it would be so easy, or letting yourself be vulnerable for your own good. The main thing is that it is something HARD for YOU.

So, that’s my challenge. 

Choose something HARD to do. 

Commit to it. Keep at it. And if you fail, try again. 

I know I am.

A Glimpse in Ultrasound, OB/GYN

A tiny being, growing inside her mother’s womb.
Only five months old, but already with fingers, toes, a heart beat, and brain development.
Today’s the day Mom and Dad find out if they have a daughter or son.
The sonographer glides the probe over Mom’s expanding belly, checking many parameters of growth.
Dad waits impatiently for the anatomy to reveal a boy.
The sonographer concludes her exam and announces, “It’s a girl!”
And Dad’s heart sinks as his dreams die.

As I’ve rotated throughout ob/gyn, I’ve seen parents slightly disappointed about the gender of their new baby –in both cases, a girl or a boy. It’s understandable to want the other gender when you already have multiples of the same. But it’s inexcusable to not be happy if you don’t get what you want.

In the above (true) case, maybe Dad needs to realize his attitude will go a long way towards developing his new daughter’s sense of worth and self-esteem. Or that his 3-year-old daughter could misinterpret that she is not wanted since she’s not a boy. Or maybe he needs to understand that he’s the one who donated the X chromosome in the first place. Whether he’s having a daughter or son is completely determined by his sperm.

I’ve seen the damaging consequences of people having to live with their parents’ expectations that they would be a girl or boy when they were the other. It’s not a pretty sight. So, do everyone a favor and celebrate new life no matter what he or she is.

Of Life and Other Things.

Recently, there has been a trend to analyze social media’s impact on our lives. And the danger that comes from only seeing “one” side of a person. You know how it is…log on to Facebook and see only the things which that person cares to share. It often leads to an unbalanced portrayal, leaving us discontent with our own lives or wishing things were different. The truth is a screen does not do justice to capturing a multi-dimensional life. However, with that disclaimer, continuing reading for an update on my life and thoughts lately.

I haven’t shared any thoughts about my trip to Africa online mostly because it takes time to process and summarize. I’m not quite ready to comment yet on that aspect of life. But there are so many other thoughts swirling through my head. To write a coherent post connecting all those thoughts is pretty much impossible. However, even with some disjointedness, read on, Dear Reader, read on.

Satisfaction & Moving On.

I long to be satisfied fully by Jesus. Yet many days, when I step away from the rush of work and my schedule, I have this vague underlying sense of discontent. The thing that concerns me the most is that I’m usually such a content person. Perhaps, it’s to prepare me to make changes. Or maybe it’s to stretch me to be more reliant on God and his plan for my life – an incredible, intimidating plan that I don’t dare to imagine for fear of failing. I suppose only time will tell.

Goals. What Really Matters?

Throughout life, some goals change while others remain. It’s been hard to stay motivated about some goals lately. Maybe it’s the cold, wintery days. Or the fact that I was exhausted coming back from Africa and being thrown right into my next rotation. Maybe it’s due to the changes that come with time. Or the fact that time is rapidly approaching and June 20^th loams right around the corner. As I was reflecting on where I see my life headed, it’s a vast unknown in many ways. And like they say in Alice in Wonderland, if you don’t know where you’re headed, it doesn’t much matter which way you go. But God promises to be a lamp to guide our steps and a light to illuminate our path. And if I can only see one step at a time, I’ll take each one by faith.

Such true words.

Moral tension. Ethical indignation. The right to life, but mostly “for the mother.”

Working in ob/gyn at the University of Iowa, I knew I would encounter many ethical situations in which I was not comfortable. Since we are such a “progressive” state and city, abortion is routinely offered and performed. It’s been challenging to be surrounded by a majority that does not see life the way I do, and who indirectly make you feel like you’re unintelligent for holding such views. Fortunately, I have not been required to view termination procedures. But even in grand rounds this morning, we talked about the state of “reproductive freedom” in the U.S. and how “women should not die because of an unintended pregnancy” due to back-alley abortions. True, but neither should babies.

Opposition. Pray & Act.

This past Sunday we studied Nehemiah 4-6. It was certainly helpful to note the opposition Nehemiah faced and summarize his response, which was consistently two things: pray and act. Of course, it’s not super worthwhile just to determine these things; the real value comes with applying them in our own lives. We examined our individual response to opposition to close out the study. And it was then that I realized I often pray, but sometimes my action is to just wait. Don’t get me wrong. I think waiting can be the appropriate God-directed thing to do in many situations. But there comes a time to act. And I’m learning that lesson in my own life recently.

Recent Happenings

It’s been wonderful to be “home” these last few weeks. And while here, I’ve been able to expand my mind, comfort zone, and friendships. I’ve joined a ladies’ bible study and have been able to connect more with these women through studying Isaiah’s life and challenges. Sometimes one just needs girl time, which I often miss when I’m away on rotations. Another group I’m involved with met last week to discuss Counterfeit Gods by Tim Keller as part of our book club. Such a challenging read. If you haven’t read it, do. Then on Saturday, I attended a Valentine’s Day evening hosted by the guys from church. It was lovely as expected, and the entertainment was fantastic. I’m so blessed to be part of a community that cares. Also, studying for my rotation, game days, getting my computer repaired (*sigh* again), drinking entirely too much coffee, finishing Sherlock season 3, phone chats, ethnic dinners, and friend dates have been part of life these past two weeks.

A first for me: eating fish from the bone. Or in this case, half a fish :)

Having fun at the Valentine's Dinner with the gals.

Idols

Speaking of Counterfeit Gods by Tim Keller, I’ve been thinking about the idols in my own life. I’ve always been one to somewhat deny, at times, I value anything more than God – who he is, for himself, and not for what he does. It’s a sobering, terrifying thought to conclude there are things in life that I've put more practical emphasis on as important, even if transiently. And that realization is humbling and appropriately inspires sorrow and repentance. It will most likely be a struggle for the rest of my earthly life to keep things in their proper perspective and priority, but it’s a struggle worth fighting.

So, that’s life in a nut shell. Just a reminder before I head out…let’s try to not limit people to who they let us see. Every morning as I ride the bus and walk through the hospital I try to picture what someone may be facing that day and say a brief prayer as they pass. It can feel overwhelming to me to know there are so many people most likely dealing with many huge challenges, but our God is not overwhelmed. And even if it’s a brief, 5-second thought to me, he holds their lives in his hands and is constantly pursuing their souls. Just like he is pursuing mine.

Hello, Iowa. And all the beautiful snow.
Even if it barely makes double digits some days, it's home for now.


And a final video:

Afrique

It's that time of the year where I usually do a recap of the last twelve months. But since I've already done that in pieces throughout this year and I have limited time right now, I figured I'd skip it this year and share something else instead.

This Christmas break has been a wonderful refreshing time at the midway point in my clinical year. I've been able to visit with dear friends and soak in the the love from my family while visiting home this week. I'm always struck with how I couldn't have imagined a year ago that my life would look like it does now, and in another year I'll feel the exact same way about this coming year.

As I reflect on the past, I also look forward to the future. More specifically: the next month when I'll head out to Tanzania, Africa for a month-long elective rotation in international medicine.

I got to thinking about my expectations, and this is where it led:

"So, it’s two days until I step into a month-long whirlwind of cultural experiences: Paris, Kenya, Tanzania. What to expect? I always think it’s amazing how much you can change after living life for a month, so I thought it would be great to do a before and after. Here’s the before.

I’m expecting to be stretched out of my comfort zone. Mishaps will happen, which will make the story that much more interesting. The patients mostly (or only) speak Swahili. Time is stretchable. Resources are limited. The hospitals will be open-air. I’m expecting to encounter poverty, diseases easily treatable if they only had the resources, death, starvation, HIV/AIDS. But I’m also expecting to find resiliency, resourcefulness, compassion, and strength of the human spirit.

My evenings will probably be filled with less electronic-based and more creative entertainment. I’m expecting to learn some Swahili, to come back with sun-darkened skin, pictures of exotic animals, having tried new foods, mosquito bites, stories. Possibly having taken bucket showers. I’m sure I’ll be craving veggies and meat, and maybe a coffee. I’m hopeful to remain well – bringing antibiotics, hand sanitizer, soap; drinking bottled water – but know it's a distinct possibility that I may get sick.

As with previous travels, when I come back, I probably will be jet lagged. I’ll think twice before drinking the water. I’ll be overwhelmed by the abundance and materialism of America. I’ll get back and have the shock of cold weather. It will be strange to drive again and I’ll question if I still remember how to. It may take a bit of time and effort for me to re-adjust to the good ol’ US of A.

But I’m sure at the end of a month, I’ll be even more thankful for the experience. I’ll not regret my decision. I’ll be glad I dared to do something so challenging and rewarding. My soul will sing praise to the God who places this desire of the nations into my life."

Guess we'll find out if I'm right ;) And with that thought, best wishes for the Happiest of New Years to you and yours.

The Happenings of Life. Des Moines. November. December. 2014.

The time here in Des Moines seems to have gone more quickly than any other rotation I’ve had so far. I’ve enjoyed my time in this city. I’ve had great roommates, wonderful preceptors, and some time to do some fun things.

Broadlawn's has been an interesting and enlightening place to work. It's been a good experience and I can't believe I only have one more week left.

Broadlawns

Home Sweet Home, for now.

Besides visiting the capitol building, I’ve also been able to indulge in some other local things recently.

A friend from Iowa City recommended a country- line-dance place, and I’ve been attending the advanced and beginner nights for the past 4 weeks. It’s been fun to get out and see how other places teach, learn new dances, and meet new people. Definitely gives me something to look forward to outside of work besides studying.

The bar where lessons are held.

Lessons at Miss Kitty's.

Of course, it wouldn’t be my life if I didn’t find the local public libraries and check them out. Des Moines has a partnership with Iowa City, I guess, so I was able to get a library card for their system while here. And now I officially have 5 active library cards: Jefferson City, Iowa City, Coralville, Cherokee, and Des Moines. I know. I need an intervention. I suppose there are worst things in life.

Books. Just 'cuz.

Recent reads this past month have included: Skipping Christmas (John Grisham), The Plain Truth (Jodi Picoult), and The Fault in Our Stars (John Green), Jesus > Religion (Jefferson Bethke). Currently reading:  LiveDead: The Story, Til We Have Faces (C.S. Lewis), Forgotten God (Francis Chan), and Alcatraz Versus the Evil Librarians (Brandon Sanderson).

One of the realities of being a grad student is coffee. It’s always great to find a coffee shop where one can study. Since I’ve been here, two of my haunts include Smokey Row coffee shop (which is super cute and quaint) and Caribou Coffee (mostly because it’s right down the street and we don’t have wi-fi in our apartment). One of these days I won’t drink so much caffeine. But that day, folks, is not today.

Yep, you guessed it. Smokey Row Coffee shop.

The inside of Smokey Row.

Also, I was told I needed to eat at Tasty Tacos while in Des Moines. Apparently, the general consensus is that they are super good. I’ve found one person I work with who disagrees and everyone tells him he’s crazy. So, today for lunch I decided to give it a try. They were right! The tacos were awesome.

Tasty Tacos. Yum!

In other news, we experienced our first snow in Iowa within the last couple weeks. My roomie and I went out for African food. We bought our tickets for Tanzania with 2 days in Paris for New Year's Eve/Day. I saw Mockingjay: Part 1 in theaters. I was able to go home for Thanksgiving. Got my visa application completed. Christmas music is in full swing. 

 

Snow, snow, snow.

Safari restaurant. African food from Somalia. 

Hello, Paris. And Tanzania. And Amsterdam. And Chicago.

Thanksgiving with the parents.

And my roommate and I got locked in our apartment the other night. Yep, that's right. Locked IN. You have no idea how ridiculous that sounded when I called maintenance. But apparently the spring in the dead bolt broke, and the lock therefore couldn't unlock. It took about 2 hours for them to "break in" and fix it.

And that’s it for now. Consider yourself updated.