ED - Finishing Week 1

5p-1a
The first week started a little slow but ended with some cool stuff. I got to help insert a Central line (IV in the neck) by holding the US and flushing the lines. I also got to remove an intraosseous IV (IV in the bone). We talked about intraosseous IV lines in school but I had never actually seen one. There was a little blood splatter on my white coat - I felt like I had been "anointed" into the ER! Thankfully it wasn't a big deal and I was able to roll my sleeves to cover it up.

I had another patient that complained of numbness and tingling in his fingers. We ended up doing a full stroke and heart check on him. Thankfully it all came up clean, but we didn't get any answers for the numbness and weakness in the hand.

Lots of chest pain. A patient with odd symptoms that ended up being a UTI. A young person who pulled some muscles in their back while moving furniture. AA lady who OD'd on narcotics. A woman in her 30's with chest pain that we had to do a full work up for MI.

End of Week 1 - I got to go home to be with my family for the weekend. Tomorrow we will finally celebrate my birthday - so nice to be with everyone to share the cake! One of my nephews is making me a special cake. I can't wait to see what they planned!

July - ED - Week 1

So I thought I would document some of the cool things I saw/did in the ED this month.

My first day, I only worked a few hours.

Chest Pain with a complete Heart Block

Kidney Stone - recurrent

Headache - new onset, sounded like a cluster headache, checked for acute narrow angle Glaucoma

Generalized Weakness, increasing confusion - unknown cause

Day 2 - 12p-10p

Headache - possible migraine, CT normal

Chest Pain - admit

Gallstone - non-unobstructed

Nothing else of note

Day 3

Attempted Suicide - cut neck with a buck knife extended from side to side. I got to go to the OR to see it repaired. Saw a laryngoscope as a trach tube was inserted.

Rollover Car Accident - Head Laceration that peeled the forehead back. Later found out she had a skull fracture

Threatened Abortion - 5 week pregnant woman with bleeding.

Dementia - Elderly lady that no longer swallows and doesn't eat or drink.

Seizures - elderly lady with seizures and DNR

Cellulitis - bilateral lower extremities with cellulitis, tense red skin and peeling skin. Bacterial infection with satellite lesions - called Infectious Disease

This may not be as interesting to you, but I know this will be a good resource when I graduate :-)

3rd Year has Begun

June was a busy month. I started my first rotation June 1st with Pediatric ortho at Children's Hospital. I worked 12-13 hours a day, 5 days a week. I learned a lot about Cerebral Palsy and other congenital disorders that cause limb and muscle deformity. I also learned a lot of surgical skills.

In my 3rd week, I was able to do a small surgical procedure by myself - from cut to close. It was a hardware removal of the distal tibia. I actually got to do almost 100% of the other leg too. It was so cool! Someday I will look back on this and wonder what I was so excited about but when you are just beginning, every little task is "cool".

I have also gotten to read a lot of x-rays, a hip US, and a hip MRI. I am getting better at finding fractures and classifying them. There is still so much to learn, it is almost daunting.

I spent many late nights in surgery and writing progress notes. All part of being a real PA, except I don't get paid. One morning I went in at 6am to do rounds on our patients. It was a really good experience to talk to families alone. I know I can't answer every question but it is fun trying.

My final eval was very encouraging. My preceptor commented that he felt I would be a great Orthopedic PA, which means a lot to me coming from him. It is what I really want to be and I pray God will provide a job in that specialty when I graduate!

High Stress

Somehow I missed the whole month of February. Wow! Since then I have started, and finished, a parenting class. It has been an interesting class because it comes from a secular point of view. Without God there is no compass for behavior. I don't understand how you are supposed to tell your kids not to do something without a reason - especially when the common trend is no spanking or any other adverse consequence, besides a "time-out". Several people in my class mentioned having their mouths washed out with soap to deter bad words - evidently this is not supported either. I really don't think I would have been very obedient if the only consequence was sitting in a corner. The class was a great way to learn what parents are learning these days, even if I don't agree.

I am also in a "Psychosocial" class that talks about the "Softer" side of medicine - family background and personal impacts, especially on kids. I am even more confident that pure pediatrics is not my gifting. Did you know that a lot of pediatrics is dealing with school, home and friend issues. I had no idea that parents turn to their Pediatrician first! I feel I have so many other people in my life I would ask first.

Next week I start "Long-term Care". The next 2 weeks will be the busiest of the semester. I will learn a lot through hands-on experience and high stress. Hopefully I can rise to the occasion :-)

Then it is Spring Break - that is the light at the end of this stressful "tunnel". I am really looking forward to it!

Kindergarteners

This month I am volunteering in a Kindergarten class not too far from my apartment. If you are ever feeling bad about yourself and want a little boost, go into a Kindergarten classroom to help out! The second I walked in, small children got out of their seats to say hello, give me hugs and ask me to sit with them. Throughout the morning, I repeatedly received random hugs and requests to participate in their activity. For example, going to music class with the children was optional because the teachers often need help prepping in the classroom but I was "dragged" into music class to sing songs and dance around the room - the dancing/skipping/jumping was a little awkward...

Next week I have a final in one of my classes. This is not a typo and it is not a midterm. My last day in Neuro is next Thursday. Kind of excited about checking one more class off the list.

One more week of volunteering with small children....I think I will miss it.

Spring Semester 2010

So I have started another semester...actually we started January 4th with only one class: Neuroscience. It sounds pretty dry but we have a great professor that makes the information very practical and fun. She allows us to ask all sorts of questions: i.e. why are some sounds soothing? We have looked at nerves throughout the body, including motor and sensory and the nerves to special senses (i.e. hearing). We have also looked at reflexes and then some of the pathology that goes along with all of these areas. It is very interesting. Neuroscience will end February 4th, which will be nice. One less thing on my plate! Considering this semester has 22 credit hours – anything off the plate helps!This semester we are doing something called "Lifespan" which means we will do rotations with newborns and the elderly. Each month is something different. This month, I start with volunteering. My program allows us to pick an area of interest and spend 20 hours helping out, but we have to work with people! We can't just sit in a corner stuffing envelopes :-) I have chosen to volunteer in my church nursery and help a friend in her Kindergarten classroom. I will also be helping at a soccer clinic for a local elementary school and possibly helping with a science day at a school in Colorado Springs. A lot of opportunities and I am looking forward to them!

My next rotation will be in parenting classes. It might sound odd but my program focuses on pediatrics. Many parents ask their health care provider for advice with child behavioral problems. I am not sure how these classes will go because I don’t agree with modern discipline techniques but I need to know what I am allowed to tell parents. It doesn’t mean I would have to treat my own kids, one day, like this.

After that I spend 2 weeks in Long-term care, 2 weeks in the nursery, and then 4 weeks in Palliative/hospice care. It will be nice to have something different each month, but my schedule will always be changing. That is life in the medical field though! I am most looking forward to the nursery. I love newborns and I look forward to doing assessments on them.

The end of 2nd semester

This week was the end of 2nd semester. I had 4 finals - one each day this week. What a week! Having been out of the undergrad schedule of finals, this was a lot for me! 1 was completely accumulative - Microbiology. This required knowing the organism, what it looks like, all the diseases or problems it can cause, and how you would test for it in the lab.

2 of them were semi-accumulative: Neonatology and the Physiology/Biochem class.

Neonatology consisted of 2 exams for the entire semester. I had a TON of slides to memorize but it was more than that. The exams were more application, which is good but hard to study for. For example, a 36 week gestation baby is born with X vital signs (Blood pressure, pulse, respirations, etc.). The mom has a history of X and had X complications in pregnancy. The baby is now having trouble breathing - what do you think the problem is or what kinds of tests would you order?

Physiology and Biochem was the class I was most concerned about but it went really well. The exam is all write in/short answer. Sometimes it is hard to know what the prof wants because the questions are a little too vague.

The last exam was in Women's Health and that one went well too. It was just a regular exam but after a week of studying for other exams, my brain was just shot! :-) I needed sleep and my brain needed a break! It is hard to keep cramming information into an overflowing brain. I have never been so ready for a break than right now.

Wednesday night (the night before my Women's Health exam), I took part of the night off to go to my campus Bible Study where we read the Christmas story. We each had a part to read. I hadn't done that in a long time and it was a lot of fun! It is easy to lose the Christmas spirit when there is so much going on in the season. I am thankful for all this time off before Christmas to "get in the mood" and prepare (mentally) to celebrate the birth of Christ.

Now I have a little over 3 weeks until I have to be back so I am visiting my grandparents. It is nice to be away from school, relax, sleep in, and hang out with my grandparents. Being so busy throughout the school year, I have very limited chances to see them.

Right before finals

2 Corinthians 12: 7-10 - 7To keep me from becoming conceited because of these surpassingly great revelations, there was given me a thorn in my flesh, a messenger of Satan, to torment me. 8Three times I pleaded with the Lord to take it away from me. 9But he said to me, "My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me. 10That is why, for Christ's sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong.

This is a great passage to reflect this semester. God has definitely been refining me over and over this semester - and sometimes it hurts. I have felt very weak and incapable this semester but God is my strength. School is quite challenging and when you are used to having your hard work pay off with really good grades and accolades, it is quite humbling (and feels a little painful) to not have that anymore.

I will say that I am encouraged by how much I am learning. This last week I had to do a physical exam on a practice patient in 45 minutes, including 187 steps! I got really good feedback that my technique is really good which is what really counts. I can learn all the textbook stuff and still not be a good PA. Skill is what matters - and bedside manner :-)

We got our schedule for Spring and it looks like a lot of time with patients which I am looking forward to. I have realized I am not a career student - I am ready to be out in the real world, working with patients and not just filling my mind with knowledge. I desire to learn so I can be a better PA, not just to know random facts.

By Thursday, I will have 2 semesters down....one step at a time.

Dental Care by a PA???

So my program has decided to pilot a program that teaches PA students how to do basic dental care for kids. Evidently there aren't enough dentists to do basic mouth checks for kids so family practice is taking up the slack by providing fluoride treatments for kids. I definitely did not go to PA school with the idea that I would be doing mouth care but I am very thankful to have this opportunity, especially if my profession will be expected to have this skill in the future. It is also another way to differentiate myself while applying for jobs in the future.

Tomorrow, I will be working alongside dental students to learn how to do a full head and neck exam on a patient (aka my fellow student). It will be a step out of my comfort zone but it should be a great learning experience. I also enjoy meeting the other professional students on campus. Sometimes we get so wrapped up in our specific class, it is easy to forget about the MANY other professional students on campus. Someday I may need these professionals to help diagnose and treat my patient. It is always good to have a better handle on what they do!

I have already learned so much about Pharmacists and how they are educated! Did you know that, in most states, you could ask your Pharmacist for medical advice - more than just for cough syrup? They know their stuff! They are taught all the medications - and not just what dose is appropriate. They are taught WHY patients take them, what drug interactions might occur, and way more than I even know right now. I am constantly impressed by my friends in the Pharmacy program. They know much more than we give them credit, so the next time you have a question about your medication or wonder if it is really the right drug for you, ask your Pharmacist!

Male and Female Exams...

Ever wonder how medical professionals learn how to do male and female annual exams? Well, this week and last week, I spent time at school learning how to do them. My school has volunteer patients that are educated in how to teach medical students how to do these exams on their own body. It is really helpful because these people know their bodies so well, they can tell you if you are feeling the right gland or organ and how to adjust your technique to make sure you are doing it right (and so you don't hurt your patient).

It was really helpful! Not all schools do this, and I can't imagine walking into a clinic being expected to do these exams without this educational experience! I can't say I will be looking forward to my clinical experiences doing these exams, but I feel so much more prepared than I ever thought possible.

Funny thing is, I thought these exams would be gross and I wouldn't be able to do them - so not true! It really is amazing what you can do when other people believe you can do it and provide the circumstances that don't give you a choice :-)

Kayaking and Canoeing

This weekend I was able to get away from school and take a break. After taking 6 exams, turning in several assignments, and feeling a little overwhelmed by all the work I had to do in so little time, I was so thankful for the guy in my Bible Study that invited us all out to his family home near a lake. I hadn't been near water for so long and it was so relaxing to hang out with fun people, go kayaking, canoeing, worship, food, and fellowship. The whole weekend was great!

I really needed to laugh and enjoy God's creation. I loved being out on the water and just looking at all God has made. It was a gorgeous day too! The sun was shining and the water was freezing...but we still enjoyed splashing each other, talking, and relaxing.

Evenings were spent singing and reading God's Word together. I always walk away feeling like I should be spending more time reading the Bible and praying - such a great group!

We also played Cranium and I discovered sculpting is not my fortee, but it was fun to see non-medical skills come out of the group - like acting or drawing.

After worshiping with the group, I now want to learn to play the guitar...maybe I can squeeze that in with everything else - who knows?

Tonight I met my parents for a small dinner and dessert for my mom's birthday. Driving in the snow wasn't fun but it was great to see them and enjoy a good dessert.

Now I am back at home and need to study. Taking a break does have its' draw backs - catch up time...

Psych-Social aspect of medicine

This semester we have focused on the medical care of children. I am taking a class that talks about the psychological and social aspects of medicine that practitioners need to consider when caring for a patient. Last summer we talked about different cultures and that can affect the type of questions and care that an individual might need. For example, other cultures often use alternative medicine or herbal remedies that can interfere with prescriptions. It is important for doctors to know EVERYTHING you are taking, even if it is herbal. Some of them can negate the effects of prescriptions OR interact poorly.

Last Friday we had someone speak to us about neglected children. One aspect of the talk that struck me is that if a parent doesn't find a "suitable substitute" to take care of their children, it could be considered neglect. For example - a babysitter. So I asked if there was an age that was too young for babysitting: 13! If you leave your child with someone under the age of 13 and something happens (even if it is a basic accident), you, as the parent, can be convicted of neglect. I started babysitting at 11 and I know many parents hire young people to watch their children. Just be careful - it could backfire!

There are many aspects of neglect - including environmental. Living in an unsafe environment or a filthy home (filled with refuse) is considered neglectful. I always considered neglect as lack of attention or failing to provide food but there is so much more!

What I find interesting is that there is such a broad definition of neglect yet so many children live in these situations daily and nothing is ever done to fix it! So sad. Even without a lot of money, parents can keep their home clean or send them to school to get fed or help them study their homework. Lack of money does not indicate an inability to care for and love their children, but they often go together. Tragic!

Last Day of Clinic and midterms

Last week was my last day at the Endocrine clinic. On the one side, I will really miss it because I have enjoyed seeing patients. I have learned a lot about Endocrine, including thyroid disease and growth hormone deficiencies. One of the classes I am taking now is all about hormones of the body so I am sure all that I have learned will come in handy soon.

My last day in clinic, my preceptor let me see my own patients. I was able to get the patient history, do the physical exam and then report to my preceptor for her to do the final wrap up. It was a great time to test what I had learned over the previous weeks. I knew the proper questions and what we were looking for with different diagnoses. I wasn't even nervous. I enjoyed talking to the patients and their families, and I look forward to the future when I can do this completely by myself.

Since then, life and school have been tough: 5 exams since last Friday and today was the dreaded exam. It took 3 hours...and it wasn't even a midterm, just an exam. We have one of these every month or so. It's a bear but I am learning a lot. Today's exam was all about how our bodies metabolize sugar and blood glucose regulation during fasting. I now understand insulin deficiency (Diabetes).

The other exams were: Women's Health, Neonatology, Physical Diagnosis and a group exam that requires talking through potential diagnoses for a particular set of symptoms. This time we talked about developmental delay in a child. There are so many possible causes including maternal illness during pregnancy. Did you know that a fetus can have a stroke? Many problems can be diagnosed before birth, including many kinds of heart defects which allows doctors to prepare for delivery.

I have really enjoyed Neonatology. We have been learning about fetal development and why the first trimester is the most critical for protecting the fetus against drugs or other harmful affects. One thing that I found interesting was that the nervous system isn’t completely developed until 4-5 years of age. This is why infantile illnesses can still dramatically affect a child’s overall health. Brain damage can occur after birth. For example, recent studies show the cerebral palsy is not usually from perinatal hypoxia (lack of oxygen during birth). Evidence shows that there is much more to it and CP can actually develop after birth as well.

One topic that has been hammered this semester is STDs – in almost every class. It is a topic I never really cared to learn about but I have learned so much about the reasons why STDs can be so detrimental to personal health, as well as future children. To protect a fetus from an STD, they will do a C-section because maternal illnesses can be transferred during birth.

Anyway, this is a very small taste of all I have been covering over the last few weeks. Hopefully I will retain a good portion of it for future use.

One more exam next week – Microbiology. I will be thankful for next weekend – a weekend without major studying to do! My on-campus Bible Study is having a retreat next weekend – a great weekend to meet new people, relax and have fun!

Clinic - 1st real patient

Today I saw my first real patient - by myself! I thought it was a run of the mill "follow-up" and it turned out pretty interesting! I tried to be very thorough, and I got to do the physical exam too! At the end, the doc came in and wrapped it all up. She said I can see more patients by myself next week! I am really excited about clinic next week...and a little sad too because it is my last day in clinic for the semester.

Days like today give me reinforcement that I am where God wants me to be. I really enjoy talking with patients, hearing their stories and trying to help. I love working with kids - even though he was so shy, he wouldn't talk to me :-) Medical providers ask some awkward questions like "Are you having any diarrhea or constipation?" What kid wants to tell a stranger about their bowel habits???? BUT it is our job and the information helps us diagnose!

On a positive note, I will get Tuesdays off for the second half of the semester so I can study, sleep, catch up on life...you know, the essentials!

Craziness is around the corner 5 exams in 8 days - I know I will survive and the program won't let me fail out...all very comforting :-)

Vaccinations

So my nephew told my sister that he just got immunized for "munkungacoyta". Well, there may have been some confusion on the name of the vaccine, but I think it reflects an overall confusion about vaccinations. By the way, he meant meningococcal vaccine.

Immunization recommendations are always changing. Recently changes have been made to the tetanus vaccination. Did you know that when you get a tetanus vaccine, it includes diphtheria? When you look at your records, you should see "Td" as the name of your tetanus vaccine every 10 years. In the last few years, they have added a new component to this vaccine - Pertussis (Whooping Cough). It used to be that your last Pertussis vaccination was ~ 10 years old, but there has been a concern about waning immunity so now when you get your tetanus shot, you should be getting a TDaP (Tetanus, Diphtheria, and acellular Pertussis). If you haven't had a tetanus shot in the last 2 years, you might want to ask your doctor about this TDaP vaccine.

Even if you don't fully break out with Pertussis, you could be a carrier to those important children in your life. Infants are particularly susceptible because they haven't been fully vaccinated yet. They don't even get their first shot until they are 2 months old, and it is a 3 series vaccine. Full immunity isn't expected until after the 3rd shot.

For those of you concerned that vaccinations may cause Autism or other developmental problems, there is no evidence that this is true. I have read many studies comparing children who got all the vaccines at once and those who didn't. There is no link. Also, without the vaccines, your children are at extreme risk for major illnesses. Whooping Cough in an infant can turn into serious pneumonia, requiring hospitalization. Meningitis can be deadly. It is important to protect your child from some of these critical illnesses.

If you have older children in school, they can be carriers for diseases, even if they have been vaccinated. I didn't realize that you could bring home illnesses, even if your immune system fought it off. Scary, huh?

No need to be paranoid though. Just get the recommended vaccines.

Difference between NP and PA

I have been asked more than once, "What is the difference between a Nurse Practitioner and a Physician Assistant?" I attended a lecture today on the history of the PA profession and the speaker gave a great chart comparing the 2 professions. I thought it would be helpful to share. This picture can be clicked to make it larger and easier to read:

Cool Clinic Tidbits

This week in clinic held a bunch of "firsts" for me. I heard my first heart murmur, first wheeze (lung auscultation), first visual of ambiguous genitalia, first spina bifida patient... If you aren't medically minded you might not realize how cool this is for me.

Someday I will need to identify the abnormal noises and if all you hear is normal, it might be hard to know what the abnormal noise is, when you hear it. Also, I want to work with kids and ambiguous genitalia occurs more frequently than you might think. Spina bifida also occurs frequently enough that I will treat patients with the medical complications from spina bifida.

Spina bifida is a congenital abnormality where the formation of the spine is not complete. It starts flat and then folds closed from the middle out. For these patients, it might connect in the middle but then not close on each end. Repair is not simple, even though it sounds like it might be. Paralysis is common due to damage to the nerves running the length of the spine.

I also learned in clinic this week that hives can signal a VARIETY of problems - including thyroid disease. So, if you ever have unexplained hives and your doctor wants to do a full blood panel on you, it's because it may not be an allergy or anything obvious. Hives CAN be simple but aren't always. The patient we had this week was referred from an Asthma and Allergy clinic.

This is just another example of why medicine is truly a PRACTICE - rarely are symptoms straightforward - but it also makes it fun, as long as you aren't the patient. For the medical provider, it is a puzzle that needs a new angle or some tweaking to figure out. It is also another reason why medical doctors are always learning and they may tell you they haven't heard of that "new study" you just read about. I heard today that medical science is new every 3-5 years. Scary, huh? By the time I graduate, almost everything will be obsolete, but you know what won't change? Patient care. No matter how the sciences change, human interaction and fact gathering is still the same. Treatment options may change but respect and compassion will always be the foundation.

Enough about that.
Sad to say only 2 more weeks in clinic for this semester - it also means the semester is almost half over. Wow!

Week of 1st Exams

So this week existed of 2 first exams - Microbiology and Physiology. Microbiology wasn't too bad. I have been sick this week and wondered if I would hold up long enough to finish studying for both exams. The Micro exam was mostly about Strep and Staph infections. Did you know that the same Strep bug that causes Strep throat can also cause Rheumatic Fever and Scarlet Fever? In clinic on Tuesday, I also learned that both of those illnesses still occur in the US. I never hear about them so I thought they were like the measles or rubella - guess not. :-)

Physiology is very complex. If you ever wanted to know how you can be dehydrated and still have to go to the bathroom, this is the class to take. It is very interesting and, at first, I was having a hard time pulling all the pieces together, but yesterday a lot of the pieces started falling together. The exam was all short answer with a few multiple choice. A note on the multiple choice though - these questions had more than one answer so the questions was really - "circle any of the following options". You can't even narrow down your options with that! :-) The exam was hard but I felt I understood the material. I learned from this test that I need to prepare a little differently for the next exam. Live and learn, right?

Tonight I start playing on an indoor soccer team. I haven't played in YEARS - 4 or so - tonight will be interesting. Thankfully there are enough players to have a couple subs so I won't have to play the whole time. I fully expect to be sore tomorrow and maybe regret the decision to play :-)

Thankful for the weekend - ahhhh.

Interesting Clinic Thoughts

Today was another day of Endocrine clinic and there were a lot of interesting cases today. Yeah, we had a lot of the typical growth hormone cases but today was also the day my preceptor had hospital rounds. We saw 2 patients in the hospital this morning. The first patient is part of a research study. Neonates are screened for a lot of illnesses and genetic markers that predispose them for other illnesses. If an infant tests positive for some of these markers, the parents can choose to enter their child into a research study that monitors those particular levels throughout their lives. This child is currently healthy but because the patient tested positive for some of the indicators for serious illnesses, blood tests are done on a regular basis to catch any problems early on.

The second hospital case of the day was a complex case that started out with a large blood clot and ended up with pneumothorax (air between the lung and the chest wall that inhibits full lung expansion), surgery and a month+ hospital stay. The current tests indicate hormone deficiencies that lead to the blood clot and because it wasn't caught right away, there was a ripple effect causing the other health problems.

During the office clinic, a patient reported that their 2 children regularly get Scarlet Fever and Rheumatic Fever which I thought was interesting. I have a microbiology exam tomorrow and I was just learning about Streptococcus and how the pyogenes species can cause both of those things. I thought they were eliminated a long time ago -like the measles - because I never hear about them, but I now know that isn't true.

I love seeing how my classes parallel with my clinic experiences. It makes the textbook information more interesting and relevant.

A Realization from the weekend

This weekend I realized that I really need to get away more often and do things non-school related. I studied so hard this summer but didn't give myself enough time to enjoy myself. If I had continued at the same pace from summer, I would well be on my way to burn-out right now. I need to be ok with not getting all A’s and learning the information because I NEED it and not for an exam. It really is a whole new mindset.

God did not make us to consume ourselves with facts and figures. Yes, it is all important for our future patients, but I am confident that I will learn the information in time. It is why we are sent on so many rotations! The 2nd year students have said again and again how much they have forgotten from their first year. You might think, “Then what is the point!?!” I will say I have experienced how much easier it is to learn and remember something after it has been covered once. The 2nd years can now teach themselves (or remind themselves) of what they had been taught in their classes as they use the information in their rotations. I am encouraged to know that I will not be expected to remember 100% of what I am learning the moment I step into rotations :-) The more you use something, the easier it is to hold on to the information for future practice.

This week will be a busy week but I am so thankful for the time I spent with family. I studied too, don't get me wrong! The weekend was all about balance. Friday night was the party. Saturday I saw my 11 year old nephew play flag football (he won, by the way)! I studied for a while, went out to eat with my dad and sister. Then my sister and I got pedicures to celebrate her birthday (which was over a week ago). The rest of the day was dedicated to studying and hanging out with my sister. Today, I went to church, studied in the car and went out for lunch. After lunch, I was at the airport and headed home.

I have been told that airports are good places to study....I will caution you on a couple things. If you are a people-watcher, it is NOT a good place to study, and if you have too many materials, there could be a space problem in being able to handle all the necessary study materials. Thankfully, I was able to secure an isle seat on the plane but there isn't even a lot of room to get a laptop out on a plane (and be able to type on it).

Overall the weekend was awesome! I am so glad I went, but now I need to shift gears to the upcoming week. I really need to be efficient this week!