Category Archives: Health and Wellness

Vaccinating Our Children

So, my husband and I decided to vaccinate our seven-year-old boy.  We are both vaccinated ourselves and had no problems with the vaccine, other than some mild side effects like arm pain, a little bit of weakness, and fatigue. All which Covid caused as well, minus the arm pain. Even though I am a medical provider, I’m still a mom and had some hesitancy ‘s and concerns about vaccinating my son. Although I will say all my non-medical friends had their children vaccinated before I did. One day I was walking and having a phone conversation with my best friend of almost 30 years. She had placed her 7-year-old son in the Pfizer Covid vaccine trials. He did very well with both vaccinations. I said to her “Well I feel like our son is still growing and yeah I know vaccines are pretty safe nowadays and there have been studies on mRNA vaccines for over 10 years. Again, I just feel like he’s still growing, and it makes me a little nervous to give him a vaccine while he’s still growing.”  Do you know what she said to me? She said “Uh yeah, but they get like five vaccines at a time when they’re born. And they’ve had at least 20 vaccines before they’re the age of two.” You know, she was completely right, and this blew my mind even though I knew it already. Sometimes we all just need a little reminder of the things we already know. 

Our son got covid in August just after school began for the school year. It took both him and me down for about a week. Though we were on the 10 days of quarantine then. I can tell you that in Hindsight I am glad I had the 10 days. Going back to work, in the emergency room on 12-hospital shifts was rough. I had a hard time walking around for periods of time without being winded. The more energy I used, the harder I went down later.

Since we both had some natural immunity now, my husband and I agreed to wait on our boosters and on our sons first vaccination. We waited a total of 4 months, mostly because we didn’t want to feel crummy during the holidays. I got my Moderna booster, and my son received his first Pfizer vaccination in late December after Christmas. He had a little extra boost of energy and no negative side effects. Not even arm pain. Yesterday he received his 2nd Pfizer vaccination. He had an extra boost of energy again for a few hours, but this time he did experience some arm pain with mild swelling later in the evening. Today is the day after his vaccine. He is acting completely appropriate. He is tired but his energy seems to rise with Ibuprofen for his shoulder. . . and he is extra cuddly.

assorted cooking spices

What nature has given us . . . and the benefits

Photo by Vicky Tran on

Elizabeth Massey  PA-C

Honey – Oh let me count the ways that Honey is amazing and tasty! Honey seems to have it all. Honey is an anti-inflammatory, antimicrobial and moisturizing for the skin. Honey has been known to help treat acne, soothe a sunburn, and even lighten scars. Clinical research has actual shown Honey to be effective in healing wounds from burns. Honey has shown anti-carcinogenic effects In vitro in a model of melanoma – however more research is needed to its complete value in the dermatologic treat of melanoma.

 (not for ingestion in children under 1 yr of age)

assorted cooking spices
Photo by Shantanu Pal on

Turmeric (Curcuma longa)– This simple spice from the cabinet contains antioxidant, antimicrobial, and  anti-inflammatory components. Some use Turmeric orally to help with their anti-inflammatory diet. Please speak with your health care provider before ingesting Turmeric as it can have a blood thinning effect. Topically Turmeric has been known to keep its anti-inflammatory components. It has been shown to calm redness and reduction the appearance of scarring, fight acne and brighten the skin. There is even some research that show curcumin might help decrease UV damage and may even boost collagen production. There are some lab and clinical studies that are investigating how Turmeric may help with Psoriasis due to the down regulation of Interleukins and TNF-a (Tumor Necrosis Factor) Turmeric is commonly found in Indian dishes such as curry.

Hemp (Cannabis Sativa)has been all the rage lately.Hemp contains Omega Fatty Acids. These fatty acids can help reduce redness and inflammation. Those with eczema or Rosacea may find a benefit from this non-comedogenic oil.

“Evidence suggests that phyto-, endo-, and synthetic cannabinoids contain properties that aid in the treatment of the brain, prostate, breast, skin, pancreas, and colon cancer.” 

Vitamin E oil is a fat-soluble antioxidant. It is commonly used on scars and other skin imperfections. It has been used in dermatology and cosmetic products for years by acting as a free-radial scavenger. Some studies have suggested Vitamin E has antitumorigenic and photoprotective properties. Vitamin E is made by plants and dietary sources, such as, nuts, spinach, olive oil, sunflower oil, and whole grains.

colloidal oats
Photo by NastyaSensei on

Colloidal Oats is an old topical treatment for various skin conditions. The oil acts as a skin barrier, anti-inflammatory and antioxidant. Antibacterial is still up for debate. Avenanthramide are phenolic compounds in the oats that inhibit NF-kB activation and inhibits cytokines.

Activated Charcoal is activated Carbon that is highly absorbent. It is still used orally for medical overdoses due to its ability to absorb. It is not as commonly practiced as it once was due to the duration of certain toxins in the stomach.  Activated Charcoal has natural antibacterial properties and when used topically may help lift bacteria and remove impurities from pores. Thus, may help reduce acne and improve overall skin health. Anecdotally some has said it helps with itching. While there is anecdotal evidence of the topical benefits there are limited studies. My personal experience has been – activated charcoal soap works best on hard to clean areas. Especially the hands of mechanics and painters. This works great on oils and permanent paints.

***Resources from the National Library of Medicine National Institutes of Health and Pubmed.***

Honey: Honey: A Therapeutic Agent for Disorders of the Skin


Vitamin E:

Hemp : ,

Activated Charcoal.

Colloidal Oats:

Lavender: relieves anxiety, producing calming effects


Why soap?

I like my pretty things to be functional.

Hmm, I’m not sure.  But It seems to incorporate everything I like. Creativity, happiness, cleanliness, and it helps people. Soap can help everyone and washing with soap has been one of the greatest discoveries in medicine. Why not fight illness with something functional and creative?!

I also like to learn new things and I have always enjoyed chemistry, but never to its fullest. Now I understand things so much more. Detergents vs no detergents. How can I get oil and water to mix?! Scented vs non scented. Essential oils vs Fragrance oils. What can I use as a binding agent?

Growing up I almost never used soap to clean my body. I always seemed to experience more acne and never knew why. I’m 41 years old now and I finally know why. I have a sensitivity to Sodium Lauryl Sulfate, a commonly used detergent in soap, shampoos, cleaners, and laundry detergents. Is there anything wrong with Sodium Lauryl Sulfate (SLS). . . No. Unless it causes you are problem.

Did you know there is more than one type of soap?! There is water soluble and non-water soluble. Non water soluble is commonly made by Cold or Hot process and can take days to weeks before it can be used for cleaning the body. While Cold process CAN be purely vegan, it most commonly involves using animal fat (Tallow). So yes, you may be rubbing your body with animal lard every time you bath. There is NOTHING wrong with cleaning yourself with animal fat. I personally am of the mind that if an animal is to be killed (food), then the ENTIRE animal should be used. No, Im not a part of PETA but I do have a tender heart for animals.

Most of the soaps I work with are water soluble and do not involve tallow. Though, sometimes I dabble. I will say for the most part, I do not want to wait more than a week to use a bar of soap.

Lavender. . . everyone loves lavender. I have always had such a headache with this smell. Why? How can that be? Isn’t it supposed to be calming? Well- essential oils come from the oil of the actual flower or herb, while fragrances are artificial. However, essential oils can actually cause more nasal and skin allergies, simply because it comes from the oils of nature. There are some flowers that we can not extract the oil from and we are forced to use an artificial Fragrance in order to replicate the scent we enjoy.

At some point I will be posting a little cheat sheet of what nature has given us to help us in this world- None of which will be medical advice. I can make no claims that any of the ingredients in soaps can treat an ailment. As nothing has been fully evaluated by the FDA.

Moderna Vaccination Daily experience post 2nd Vaccination (updated 1.27)

I did it! I received 2nd Moderna vaccination yesterday evening 1/24/2021.

Getting the vaccination has been the easiest vaccination I have ever had. Almost completely painless. Both vaccines seemed to provide a few moments of elated energy. There were some brief experiences when I thought my side effects were going to get bad. I felt a globulus feeling in my throat for about 15 minutes. No oral itching or swelling and no shortness of breath. I also experienced occasional itching to the injection site and discomfort to the opposite arm, where I received the first vaccination. My vaccine could have been received in either arm. My choice was simply due to what side would be the easiest for the nurse giving me the vaccine (David).

This morning, 17 hours post vaccination, I woke with a slight headache. It resolved with food and coffee. My appetite is lessened and my right arm Hurts like hell. The arm discomfort is worse than the first vaccine and this time my injection site has developed some redness and hardening. No Tylenol or Ibuprofen has been taken yet. No fever or body aches, but there is some fatigue, weakness and brain fog.

Day 2-3 post 2nd Vaccination 1/27/2021

After I posted about the first 17hrs, I began to feel a bit worse. Weakness, fatigue, mild body aches, arm pain and apparently lability were big things for me. I did end up taking Ibuprofen for my arm and the body aches. The ibuprofen helped immensely. My husband and I observed that my injection site developed a hard, red, warm, protruding golf ball sized projection from my arm. I attempted to take a picture on my own but the indention below the swelling was difficult to appreciate. The ibuprofen did help with both the pain and the swelling.

I experienced some events of mild depression and crying around the 25- 28 hour mark and the next morning. Most likely this was from the fatigue and lousy feeling my body was experiencing. This also happened a few hours after I had my epidural when I was delivering my son. While I did not feel the contractions, I had experienced some depression with crying and thoughts that something just wasn’t right. It turned out to be I was under dosed on my pain medication. I didn’t physically feel the pain due to the epidural, but some portion of my brain was still experiencing it enough to make me depressed and cry. He wasn’t delivered until many hours later.

The next day (Yesterday 48hrs after) I felt much better. I did not appreciate just how weak I was the day prior until I had more strength in my legs next morning. I still took it easy and was mostly tired. I got outside and took a short walk in the neighborhood.

Now, my arm pain has virtually resolved. . . unless I actively press on it. The swelling has also improved. I feel pretty much back to normal and am making lists of what I need to do this week.

Here is an image of how the vaccines compare as of now.

QUICK Recap: Shot Sunday evening – felt weird but ok, Monday – Felt the worst- very weak, tired, mild body aches, Horrible injection site pain with swelling, and labile. NO FEVER. Took Ibuprofen for discomfort. Tuesday- Felt much better. Weakness almost resolved, went for a walk but still easily fatigued, improved arm pain. Wednesday (Today). Almost back to normal and doing daily activities.

***If you not ready to get the vaccine just yet, then Help fight CoVid one soap at a time! *** Visit my shop. There are some fun soaps for sale. This is a great way to help 1. Stay healthy by washing more frequently 2. Helping a stressed medical provider keep everyone a little safer with a stress reliever 3. Know your purchase is not mass produced. 4. Practicing a little self care. Some are great purchases for Children who hate to wash their hands. LIKE MINE! All products are made to order.

As changes occur I will update.

Moderna Vaccination Daily experience post First Vaccination

This blog is to update those who are interested in the EU of the Covid 19 Vaccine Moderna.

A quick review of the 2 Emergency approved Vaccines: Pfizer and Moderna.

 Quick review of Pfizer and Moderna Vaccine differences

2 shots  – 21 days a part2 shots – 28 days a part (+/- 2 days in each direction of 2nd Vac)
Ultra freezer storage32 General freezer
36,000 participates30,000 participants – I know some personally
16 years old +18 years old +
There are currently studies with enrolled children 16yrs old. Some are my colleagues children.

No- it does not inject genetic material into your body. It inserts instructions (a playbook, for the sports fans) to respond to a foreign invader (COVID-19 19).  So, this kind of vaccine could actually be safer than other vaccines because it just teaches our cells HOW to fight rather than introducing an empty shell of an invader without instructions of how to fight them.

Why did I decide to get an Emergency Usage vaccine instead of waiting for one to be officially approved?  Although not approved, they are deemed safe enough to be administered in an emergency. Initially, I wanted to wait about a year. While I believe in science, I am a natural skeptic.  Then I began to think about the people I care about and who I know that CAN get the vaccine. Child- NO, Husband – No, Mom and Dad- Not for a long while (might not even given the option anyway), In laws (not for a while), closest friends – No, my friends children – No. Hmm, so really I was/ am the only one who can actually DO SOMETHING to help those I care about. My last ER shift was last week. Every headache, sore throat, sniffle, or food that seemed off made me concerned that I might have COVID-19. Because I chose a career that put me at risk also put my loved ones at risk. What if I gave my son MIS-C from COVID-19?! I could never live with myself if I gave anyone I care about COVID-19 and they died.

Day 0 Moderna Vaccination DAY!!

I received my Moderna vaccine in my left arm on 12/27 at 4:15pm. I received the vaccine at the hospital where I work.  The vaccination was far less painful than any vaccine I have ever received before. No, it was not cold. The vaccine must thaw or warm before it can be given. While working in the ER the previous week I had a discussion with a patient, and they expressed how painful and difficult it must be to receive the vaccine because of the temperature. I’m not going to lie; this briefly crossed my mind as well in the prior months to approval. However, I am educated about vaccines and injections, so it was a fleeting thought. Sometimes it can be difficult to remember that what is common knowledge to me is not common knowledge to everyone else.  And yes, I did get a photo for my “Gram” at Pa_moments.

Not everyone in my life has voiced support about getting the vaccine. Rather they have chosen silence, which is probably the most respectful. Though I have difficulty understanding how someone can be so overtly supportive of a soldier getting shot in service to our country and not support me in receiving a shot in service to the entire world.

I have not seen the amount or severity of COVID-19 that other providers have seen. Though I have and presently see the entire Emergency Room Full of admitted COVID-19 patients. Patients are lined up on the walls of the ER and down the Hallways that connect to the ER because the ER and ICU are full.

After the injection I had to wait for 15 minutes in the same room so I could be monitored for immediate reactions. None! So off I went to inform my friends and family and social media platforms, of course.

I had no arm soreness that evening. I did have a wave of fatigue around 7:30pm and I thought I would not have the energy to shower. BUT I took my shower and felt better. I slept very well last night. Maybe it was due to the vaccine or maybe it was due to the new 12lb weighted blanket I received for Christmas.

Day 1 PV (Post Vaccination) 12/28

I woke up with a sore Left arm. Worse with movement. There was no bruising noted.  Otherwise, I went about my day without side effects that I could relate to the vaccine. Don’t forget to vote, Georgia! NOW at 2:00pm, 22 hours post injection my left arm still hurts but only when I touched. It is brutal when my son encounters my shoulder when we play. The arm no longer hurts when I move it.

Day 2 12/29

So far today has involved an intermittent sore throat. And as the day continues, I am a more and more fatigued and a bit weak.  Not a normal daily tired, though. In fact I am currently in bed with my laptop typing this. My left arm is still sore but slowly improving. Some of the things that run through me mind are: Do I have COVID and just have mild symptoms? And If I do, did I get it during my last shift? How am I going to feel tomorrow? I am on shift in the ER tomorrow. Only time will tell.

Right now, I don’t even know what shifts I can pick up next week because there has been no announcement about school next week. Will it be Face 2 Face or virtual? Time for either a nap or coffee, while my child continues to watch TV.

Day 6 1/2/2021


Yes, Last year was hard. 2021 will also be hard. For some it will be much harder than 2020. The difference is 2021 seems to have light at the end of the tunnel.

At 6 days post Vaccination I have had some occasional headaches with nausea and dizziness. This seems to resolve pretty quickly AND it may be from the lack of food. The first event happened while I was in the ER on day 3 post vaccination, yesterday on day 5 also while working in the ED and then on my day off. My arm pain has completely resolved.

I am still waiting to see if I get full-blown COVID symptoms. In the last 2 days I have been in close contact with at least 100 COVID + patients. Yes, I was always wearing my itchy N-95 mask, plus a surgical mask, goggles, gloves and a gown. The Emergency rooms really are at capacity and then some. There are tents outside of the ER. COVID patients that require admission usually stay a few days and right now their stay is in an ER room and not a different room in the hospital because those beds are full too. It really is a sight to be seen in order to be understood. Please, only go the the Emergency Room if it is a true Emergency. My personal wait time to be expected at the Emergency room is 3 hours. The wait on Wednesday was 5-6 hours. Most were COVID patients.

Day 17 (1/13/21) post 1st Vaccination

I had my annual physical yesterday and besides the typical COVID weight gain that seems to have effected everyone, I am healthy. In hindsight I realize, the nausea and fatigue was definitely from the vaccination. They are completely normal post vaccination symptoms that can happen with ANY vaccination, including the yearly flu vaccination and the vaccines that are given to multiple children daily. What have I learned after personally speaking with those who are tracking these post COVID reactions? IF you have had COVID previously, then the post vaccination might be a little harder on you than someone who has not previously had COVID. Why? Now your body knows the correct response to this foreign invader. While you reaction may be a little worse post vaccine it will not last as long as your prior encounter with the REAL invader.

In other news, there is a possibility I will be transferring to the ICU to help the staff take care of the overflowing COVID Floor. YES. . . COVID FLOOR. There is no longer just an ICU – there is an entire floor of Intubated patients with COVID and there are more and more that are intubated and staying in the ER because their is no room on the COVID ICU floor. What you see on the TV and hear on the radio about the healthcare system being overburdened is true. There is NO room for Non-COVID emergencies. There are less providers available to take care of them and there is no where to put them. Please stay safe and be responsible. I am hopeful to receive my second COVID Vaccine (1/22- 1/26) before I begin my time in the ICU.

Day 26 (1/22/2021) post 1st vaccination

This past week we had a little scare with our son having a low grade fever 100.5 to a max of 102 once. He Vomited as well with minimal appetite. The only exception was ice-cream, of course. It last for one day. No nasal congestion or cough. If the pandemic was not going on he would not have seen a provider. None the less we had him test via a Rapid nasal swab for CoVid. Both strep and Covid swab were negative and he is back to his rambunctious stir crazy self.

Now I am 2 days away from my second CoVid vaccine and I am nervous because a lot of my colleagues are having reactions (similar to having the flu). We are planning our work and our sons school schedule around the potential reaction I may have.

***Check out my next Moderna Vaccination Daily experience post 2nd Vaccination!

**If there is anything specific you would like to inquire about or have me address please contact me via the contact page.

** Also, if interested – There will be some fun soaps for sale in my shop shortly. This is a great way to help 1. Stay healthy by washing more frequently 2. Helping a stressed medical provider keep everyone a little safer with a stress reliever 3. Know your purchase is not mass produced. 4. Practicing a little self care. Some are great purchases for Children who hate to wash their hands. LIKE MINE!

COVID-19 and New Approaches to PA and ARNP Education.

Author: Elizabeth Massey, MHS-PAS, PA-C, EMTP

Former Associate Director of Clinical Education of Physician Assistant Studies

Corona virus 19 (COVID-19) first entered the US via social and mainstream media by demonstrating its initial effects on Wuhan, China. Most educators or providers first thoughts were surprise and intrigue, but not necessarily fear. Then Covid-19 completely shut down China. There were news reports on how their citizens were coping with isolation and a decreased food supply. Not to mention the fear Citizens had when leaving their homes. This was startling and surreal to many medical providers even though they were not yet affected. The virus progressed to Italy with devastating effects. Now it is in the United states. Months have come and gone with COVID 19 in our daily lives. COVID 19 was not something educators, practitioners or students had anticipated. Clinical rotations came to a screeching halt, along with outpatient clinics and elective procedures. As re-opening cautiously takes shape, we now look at how to adapt to our new world. Below are 7 Strategies PA and ARNP programs can employ to help ready their students in preparation for Clinical rotations and beyond. These strategies can not only benefit PA and ARNP program educators but can also guide APP applicants when choosing a program. Current Physician Assistant and Nurse Practitioners students should query their programs on these strategies to help relieve some anxiety about COVID-19 and their future as providers.

During the Clinical Year

  1. Ensure all clinical students have been appropriately fitted for an N-95 mask and make sure each student is supplied with at least one mask before going out on rotations. Some Facilities require the students to have appropriate PPE before they can rotate. Applying students and current students should ask their program who will be incurring this cost. Will the appropriate fitting be scheduled and payed for by the school or will this be the student’s responsibility? Correct N-95 fit is an OSHA requirement for those taking care of COVID patients.
  2. Have a discussion with the students about potential COVID testing and Quarantining prior to certain rotations. Some Facilities require Negative COVID Testing or have a Quarantining protocol. There are currently rapid tests and PCR tests available. Who will pay for these required tests? The student, the program or the facility? See appropriate facility for individual requirements.
  3. Focus on more rural areas for finding clinical rotations. Individually run clinics are more likely to accept students because there is less red tape. These providers also tend to enjoy the helping hand of a student.
  4. Discuss the possibility of Telemedicine rotations with potential Preceptors. These discussions could decrease the clinical students housing costs. They can be done as a 3-way virtual call, which works best for Behavioral Health rotations. However, there are many strategies to assess patients across many different specialties and complaints.

During the Didactic year

  1. Train and make sure the students are comfortable with Telemedicine. Teach the students how to evaluate patients via video. A good example would be to instruct the student on telling their patient to pull down the lower eye lid to help evaluate for anemia. This not only comes in handy for clinical rotations, but this will expand the student knowledge of Telemedicine, which will be a growing industry moving forward.
  2. Put more emphasis on ICD 10 coding during the didactic year. Why? Clinical students must be exposed to a minimum amount of a different type of patients to meet graduation requirements. Benchmarks can vary per program. These are monitored by ARC-PA. If the students are more familiar with coding – they can input more appropriate patient contacts during each rotation, regardless of the tracking system the programs use. For example, a student could code for pregnancy AND anxiety. This will help a student and the program with meeting the minimum requirements for both Women and Behavioral health rotations. In September, ARC- PA updated their standards to include ICD 10 coding.
  3. Appropriate staffing for all portions of the program. Didactic and Clinical. Anyone can get COVID regardless of appropriate protection. One sick person adds a lot of work to other colleagues’ plates, even if equally divided. More Clinicians than ever are feeling burn out from all the changes COVID has brought to both personal and professional lives. The burn out is not isolated to those practicing clinically, but academically as well. Heavy redundancy with regards to clinical preceptors as well as academic staff and faculty can help share the burden and reduce the mental fatigue from the pandemic.


Occupational Safety and Health Administration (2020, April), United States Department of Labor, Temporary Enforcement Guidance – Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak, Retrieved from

Accreditation and Review Commission on Education for Physician Assistant, Inc., (2020, November) Accreditation Standards for Physician Assistant Education© Fifth Edition, Retrieved from

For the Published Version of this Article please visit the link below at MELNIC!

7 Strategies for APRN and PA Student Clinicals World of COVID

7 Strategies for APRN and PA Student Clinicals World of COVID


Gout on one foot with Tophi on the other. Make sure you know if you patient is an over or under secretor before you begin on maintenance medication. #pa_moments #gout

Gout. Most common to the first metatarsal but can occur in any joint. Note the erythema and edema. It is also exquisitely tender to even light touch.
Tophi noted (large bump appearance) to the first metatarsal joint. Tophi occurs from multiple previous gout attacks.

FOOSH injury

FOOSH Fracture

These 2 images are from the same patient who had a FOOSH event. This patient Fell On Out Stretched Hands. A FOOSH event commonly results a Distal radius fracture. This is also known as a Colle’s Fracture. The image also shows angulation and a small ulnar styloid fracture. Obvious Deformity was observed. When evaluating these patients always ensure Cap refill and pulses are present as well as Range of Motion. This particular patient had cool fingertips with a delayed cap refill. Then I compared the temperature and cap refill to the other hand. It was the same. Always make sure to compare both extremities when evaluating a patient. The patient did have a strong pulse, but was just cold. Range of motion was obviously decreased but the patient did very well regardless of pain.


Reduce the deformity and splint via a sugar tong and sent to ortho the next day. Ortho might appreciate a heads up though. If you suspect a vascular injury or compromise – immediate ortho consult is required.

You can either perform a Hematoma block for pain with oral/ IV medication or you can chose Conscious sedation. I prefer a Hematoma block as it is relatively less invasive than sedation and an easy procedure to perform. Once the patients pain is under control you can manipulate (usually with your finger on the dorsal surface of the hand where you feel the step off) the injury back in place.

Prior to reduction make sure you have a tech or someone with you who has appropriately measured the length of the patients arm and all the splint supplies ready to be applied after you have reduced the injury. You will have to hold the reduction in place until the splint has been applied appropriately.

Some providers prefer to use finger traps to help with placement of the bones post hematoma block. This is a providers preference. I personally find it helps with the reduction and sometimes the break will reduce on its own without manipulation.

Covid 19 and its effect on Physician Assistant Education and future.

Elizabeth Massey, PA-C

Corona virus 19 first entered the US via social media and its effects on Wuhan, China. As an emergency Medical Provider and PA school educator I first thought, “Uh, Wow! That sucks.” Never did I think the virus would spread to the states. Then Covid-19 completely shut down China. There were news reports on how their citizens were coping with isolation and decrease in food supply and the fear of leaving their homes. This was startling and surreal to me even though I was not yet affected. The virus progressed to Italy with devastating effects. Now it is in the United states. Surely, we the smart people of the United states would learn from the other countries in the fight against this virus.

As a full time, Physician Assistant Educator and a part-time PA in the ER, I had colleagues at the CDC who related how BIG this was and knew the shutdown was coming soon in the US.

But did the US really shut down? No. It was left to local government with different opinions on the severity of the issue. I digress.

The PA school where I was busting my hump went virtual about a week and a half before finals. My world changed in more than one way – as I’m sure it did for many others. I was now a virtual educator full time.  I chose to furlough my part time position in the ER. My ER colleagues needed all the hours they could get to help support their families. The full time ED employee hours were shortened to 10 hours a month. Other facilities and companies were reducing the hourly or salary pay and cutting hours. I commend the ER staffing company I was and am working for with how well they treated all their employees during this hardship.

Meanwhile, I was learning new online platforms like zoom, and trying to figure out HOW we could test students while still maintaining test integrity. Special testing was required and still is – and this costs schools money that was not previously used on testing.

In a medical program it is important to learn physical skills. Skills like how to properly examine a patient, or how to perform certain procedures. This became exceedingly difficult and time consuming. As if working 50-60hrs a week in a medical program was not enough.  Now there was the extra time factor of staggering 8 students at a time in a lab (masked and gloved). Once the students left all the equipment and the room was disinfected.  Do not forget to add the wait time so the disinfectant could dry. Repeat for the next set of students. This was done for every class that required a lab. Labs that usually took 2 hours for a group of 40 students now took almost 2 days to complete.  This took one instructor out of the mix for 2 days’ worth of normal teaching and preparing. One might say it was a big change for schools and students. But this was only the didactic troubles medical programs were having.

The Clinical aspect of learning medicine was impacted the most by Covid 19. At first, only ER rotations were affected. Before long Clinical sites all around the country were cancelling their rotations, and some schools were pulling students out of their rotations. There were national meetings on how to keep the students in their sites or how the student could still get their required patient care hours, so graduation time was not altered. Rotations were shortened, flipped, changed, and postponed. The hardest hit rotations were the rotations that occurred in hospitals: Emergency Medicine, Surgery, OBGYN, or any Inpatient rotation. Then there were facilities that were just concerned for lawsuits should the student become Ill. There were very few rotations that allowed PA students to rotate and many of those required a N-95 mask. As the country is aware, there was a PPE shortage. Honestly, there is still – As I have ONE N-95 in a brown paper bag that I use when I am on shift. There were preceptors who simply didn’t feel comfortable with a student now. Some of the prior preceptors were furloughed or relieved of their duties entirely. Now there were fewer preceptors employed in general, and Many willing preceptors found themselves at facilities that were not.

There was a point when our program only had around 10 students on rotation while the other students were to study or do CME until a rotation became available. How would we decide which student would be allowed to graduate on time and which would not?

A few months later some facilities gradually began letting medical students back into certain rotations only. Hospital rotations were still a problem, but then Physician Assistant students began to have another problem. Select facilities would only allow Medical students or Medical students and Nurse Practitioner students, but not Physician Assistant students. Physician Assistant students are trained via the same model as Medical students and not the nursing model.  Thankfully, schools have learned ways around these difficulties, but many providers are burned out from Covid 19.  As Physician Assistants graduate, they will have a difficult time finding jobs as the market is saturated due to the layoffs of Physician Assistants and Nurse Practitioners. Now many of the positions available are Covid related–precisely what many facilities were preventing these very students from learning.  Some employers chose to only interview Nurse practitioners because of the autonomy level they have in some states – they do not need a physician to independently practice.  Now, 7 months later, some facilities are keeping Physician Assistants students out and will until spring of 2021.

What does this mean for the future of Physician Assistants? New graduates will have a difficult time finding employment and may not be as ready as they could have been due to reduced patient contact. Previously employed PA’s will have a difficult time finding employment with the pay they previously had. Nurse practitioners will continue to have a better lobby for themselves then PA’s will – which will make employment easier for them -thus driving PA pay down with it. Again, I digress. Physician Assistants around the country need to join together and help the students and schools still struggling to find meaningful rotations and Physician Assistants need to join together with their local Chapters to help fight for a better PA lobby for our profession. Don’t forget we can PIVOT in any direction- good or bad. Let’s pivot up!

A cancerous lesion

Squamous Cell Carcinoma

The pictured wound is post biopsy. 
67 year old Female previously had an injury that healed. About a month later, this growth occurred. It itched with mild discomfort. Present for about 4-6 month prior to biopsy. 
Biopsy results: Squamous Cell Carcinoma.
Patient treated with the Mohs surgery and doing well. 
Squamous Cell Carcinoma (SCC) is an overgrowth of abnormal Squamous cells. Usually progresses quickly but curable with appropriate treatment. SCC can metastasize to other organs.

Good company in a journey makes the way seem shorter. — Izaak Walton