This was an unusual day. It started bad and actually got better. First thing, I arrived at the clinic at 9 am to work with another PA, one I haven’t been with before. And discovered her and the other student setting up to do a skin biopsy. Quite illogically, I was upset, because I very much want to be involved in procedures, and I felt like the other student didn’t belong to be there. Fortunately, I kept quiet; because the patient turned out to belong to the doctor the other student was supposed to be with, and the biopsy had been arranged on the spur of the moment.

Then, Dr. C pulled me into a corner; I thought she was going to talk about the extremely short note I had written about the transgender patient of yesterday, and I was all set to give her my last-ditch statement, that bigoted or not I absolutely couldn’t do anything more with that patient. Instead, she demanded to know why I was late. Yes, there seems to be a rule which I didn’t hear about until the end of the fifth week, that one must arrive at 8:30 regardless of any other scheduling. She looked completely skeptical at this explanation. Ok, great start to the morning.

Then, the PA’s first patient is a guy with a known and documented history of cervical radiculopathy, with an acute episode of neck pain. So I check range of motion, and reflexes, and muscle strength in the arms, and go tell the PA about it. I would need two hands to count the number of things I’d forgotten, like had he ever had surgery for it, and had I checked (rather than taking his word for it) that sensation was intact in his fingers; those two I agree I should have thought of. But her differential diagnosis included a stroke. And I’m sorry, I just don’t agree that brainstem stroke ought to be included on the differential for neck pain with absolutely no other neurological symptoms! And it just went downhill from there. I couldn’t seem to hit what she wanted, and when I did get something right, no joy. I could not wait for the morning to end. It’s probably a problem with me. I don’t get along well with most female authority figures. Something about the look and tone of a middle-aged woman who is absolutely right, and knows it, and knows that I’m absolutely wrong, just gets me. Probably because when I grow up I’m going to look and act exactly like that. I need to get used to being completely wrong and being told so; I know it’s only going to get worse when I get into higher pressure rotations. Hopefully a thick skin is acquired, not inborn.

But the afternoon was great. The male doctor and I get along fine. We probably have some father-daughter transference going on, and I think I have an easier time not contradicting men. His statements about how Bush is responsible for every detail of his practice that goes wrong don’t bother me so much, maybe because they’re so impossible. Also, he actually smiles when I get the answers right. There was a diabetic patient, new to his practice. She’s had type 2 diabetes for nearly a dozen years, and her sugars are absolutely out of control. So I got to do a complete history; the fact that she had a diffusely positive review of systems was nice, because we could actually do something to help her. And I actually understood the reasoning for rearranging her insulin regimen. Then there was the obese female patient who hadn’t had a pap smear in years, and cheerfully agreed to let me do it. She was easy to do; everything went smoothly; my confidence level for the pelvic exam is back up again. Of course the doctor had to rib me about wanting to do that all day for the rest of my life, and I told him no, I want to deliver babies all day. Newborn babies are an unbeatable argument. Everyone is so happy, and (after you wash them) they smell gorgeous.

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