Bear Fighting in Cyberspace

Billings 2009 082Some have wondered if I will one day practice medicine in China.  During an interview at Rocky Mountain College, home of the Battlin’ Bears, the director had even suggested that I could do a clinical rotation here.  The thought had occurred to me many times.  Many friends and fellow Bull Dogs from Yale University’s PA program completed international rotations in Latin America, South East Asia, and the Middle East.  Yale even has a tropical medicine rotation in Kampala, Uganda.  This feature was one of the major draws that lured me into their program back in 2007.  In any case, I believe my international experience – of which my time in China is the backbone — will be an asset as the PA profession continues to globalize, and more international students attend American PA schools to bring the Rod of Asclepius back to their own countries.

After a year at Yale’s PA program I took some time off from graduate school to serve my community as a medical assistant in a rural health center in the wilds of Pennsylvania.  Medical assistants should not be confused with physician assistants.  MAs are similar to nurse assistants.  They receive training on the job or in certificate programs, and their duties depend on the particular clinic or institution in which they work.  For instance, one clinic I interviewed with in Virginia had their MAs perform pap smears.  They wanted to know if that was okay with me.  No problem, I had told them.  Yale had even educated me in the fine art of pap smears, digital rectal exams and obtaining specimens.   But I wanted to know if it was okay with their patients:  How did their patients feel about somebody other than a provider performing such an intimate exam?  And how did the clinic’s providers justify ceding such a vital component of the physical exam to position requiring only a high diploma and a certificate?

In the end, I joined a rural health center in my hometown where I spent most of my time measuring vital signs, drawing blood, and honing my vampire comedy routine.

One day last April, a patient came in for a physical exam required by her college.  She had been accepted into a master’s level PA program and was very excited.

I was glad for her.  And we would be colleagues someday.  That my small town was home to another future healer was great news indeed.  Feeling professorial, I then thought to help her in her aspirations, and narrated the process.  “So right now, I’m taking your pulse, that’s your heart rate,” I had said, explaining that anything less than 60 beats per minute is considered bradycardia, and anything more than 100 is tachycardia.   Now she would be one baby step ahead on her career path.

She told me that feeling a person’s heart beat made her squeemish.  She had worked as candystriper at a local nursing home.  She sang songs and read them newspapers.

I had reassured her.  Yes, it was a full contact sport, but you get used to it quickly, especially when you see a patient in pain or tears.  Once you don that white coat and stethoscope society empowers you with the privilege to cross the boundaries of personal space and break the touch taboo.

She will be an excellent physician assistant someday.  But for me April was the cruelest month.

Now it was almost Thanksgiving.  I recently skyped the director from Rocky Mountain College PA program for a followup to the October interview.  I was investigating the reasoning behind the admission committee’s decision to “not select me.”

Dr. W told me that I had high marks all around for my interview.  I was above and beyond the cut off.  But the admissions committee was skeptical about my lack of academic science background.

I refuted this claim by asking him take to glance at my transcripts and resume.  Did he see that I had served as a research assistant with Dr. Rathmell when he was head of the University of Vermont Department of Anesthesiology?  That I had helped one of that department’s pain fellows write a history of medicine paper on the use of intrathecal opioids?   That I had graduated with honors from that university’s post-baccalaureate premedical program?  Or that Yale’s PA program director had heartily endorsed me in her letter of recommendation?

Then Dr. W said that I wrote like an English major.

(Ah, hell no!  Snap, son!  No he did’ent  He did not just go there!).

Of course, I had been an English major once upon a time at Thomas Jefferson’s alma mater, The College of William and Mary.  And by the the fucking way, since we were now bullshiiting, I might as well say that I had even minored in Hip Hop English.

He then tried quoting some of my prose to illustrate his point.

Chagrined by the scientist, I disregarded the fact that he just butchered a quote from my CASPA narrative.  Instead, I told him I wrote this way to illustrate that I am in the vanguard of a movement to humanize medicine.

Then he said that I was a very personable guy.  But it came across as being “too familiar.”  He let this last statement hang like an ominous implication as if perhaps he had just announced with prophetic doom that it had been my risky lifestyle that led to such a dire diagnosis.

Now upon further reflection I should have replied to Dr. W that this was my way of showing I would not have an autistic bedside manner.  Moreover, I would not gaze at patients like the way one interviewer had gazed at me.  She had looked at me the way you look at a bug smeared upon a microscope slide.  And I should have told him I was looking for answers not excuses.  To be fair, he sounded very kind.  But he was giving me the shaft, and his words were coated in a thick layer of Vaseline.

The follow-up with Rocky Mountain College was not unconstructive.  Dr. W suggested that I can improve my chances of getting into PA school by continuing my education.  Perhaps I can go to paramedic or nursing school?   In essence, he was suggesting that I should go back to college for another two years just to get into college.  Then the doctor conjured up the specter of fear, warning me that staying in China and teaching English would be frowned upon by admissions committees.  At the very least, I should come back to America and get an entry level position in health care.

Oh, to come back to heaven and breathe again the clean air and ride my bike upon safe clean roads.  Maybe by the time I got back the service sector would be hiring again?

There was no evidence to support this, but it flashed in my mind that I was speaking to a man little versed in adversity.  His kind suggestions were disconnected from the reality experienced by those less fortunate or even those of us just trying to eke out a life during the global economic downturn.  I had been in college for ten years already.  I had served in the Marines.  And still had to beg, plead, and volunteer just to get noticed, and be interviewed for such highly sought positions as Emergency Department Technician or Nursing Assistant.  These were jobs that paidy $9.00/hour, lacked benefits, and carried the risk of back injuries.  And human resource departments kept files upon files of applicants desperately seeking these highly coveted jobs.

Even if I did – by some miracle – come back to America to work in entry level healthcare, there was obviously no guarantee it would pay off in winning this crapshoot lottery:  I already had 2,400 hours of patient contact experience (over twice the prerequisite amount for most porgrams), I had been accepted into Yale’s program with just 800 hours, and programs were also accepting students with negligent amounts.

Dr. W also suggested I contact CASPA – the centralized application service for prospective physician assistant students – which acts a middle man between prospective students and PA programs.  RMC PAP originally thought I lacked academic science background because CASPA categorized UVM post-bacc work as “professional” and left it unverified.  “It says here you have 3.5 G.P.A at UVM,” Dr. W had said.  “You graduated with honors, did well in immunology, microbiology, genetics, organic chemistry.  These are all heavy duty sciences courses.   But CASPA didn’t verify them so it appears you don’t have the right stuff.”

I finally got what I needed from Dr. W.  I put his words in a battered old cup, and fired off the first opening salvo of emails to CASPA.  The saga will continue in a future post.

In the meantime, I was just thankful to have a meaningful job where I could teach, write and travel.  A meaningful job in a hellhole sure beat groveling for a pittance in paradise, where I was invisible to the scowling, time crunched angels and cherubs flitting about in their daily grind.  But here were mortals happy and kind.  The Middle Kingdom may be hell, but it was a heavenly remedy for an American’s anomie.  And I would have more time to perfect my vampire comedy routine for my once and future patients.  There was no chip on my shoulder.  Not a single crumb.  There was only fear in a handful of dust.