Cartoon of the Week:
If you are a PA and you were ever in an emergency situation out in public, it can get interesting. This was especially true before 2000, when no one knew what you did. My approach (and it only happened a few times) would be to watch from the sidelines during the chaos (usually ten “know-it-alls” rush to be the center of attention). I watch to make sure they are doing harm. If they are, I would move in and announce that I am a Physician (Assistant) and say assistant so low that they wouldn’t catch on. Otherwise, it would be the same as me saying, “I’m here to help and I’m the guy who cleans the doctor’s office” (again I’m talking prior to 2000).
From 1994 to 2009 one of the most-watched drams on TV was the show ER. In 1995 through 1990 and again in 2008, the actor, Gloria Reuben as Jeanie Boulet, PA-C. Not only was this show seen by millions in America every week, but exported to over 3/4 of the world through live time and syndicated re-runs. What a great opportunity to explain the role of the PA to the world! WRONG!. It could have been but became a huge opportunity missed. The PA role was very miss-represented as a little more than a medical assistant, who rarely made any medical decisions on their own. Many of us, especially ER PAs, were extremely frustrated that this was allowed to continue this way. I wrote and called the TV show many times to allow me to get involved with developing the character and giving ideas about PA-specific (real world) plots. What about one battle-axe nurse who refused to work with the PA? That was happening in the 90s. But it was to no avail.
So often I’ve had patients who wanted me to make major changes over the phone, sometimes several calls between visit, wanting changes each time. I know it is often not convenient for them to come it, but I always tell them that it is unsafe to “practice medicine via phone calls.” That concept was the inspiration of this cartoon.
More than once in my career (especially in the early days) when I was in a social setting and tried to explain what I did for a living and the other person thinks I’m lying. The worse case when I ran into one of my wife’s old boyfriends at a party and he kept confusing what I did with a “medical assistant” (intentionally I think).
Here is my PA Cartoon for the week of November 18. This times it is an animation, one I created in 2010.
This is based on a real experience. During our didactic year, we were given assignments to go to the University of Kentucky Medical Center and do COMPLETE H&P on real patients. I remember taking three hours to do my first, including looking into every orifice, looking at their entire body for skin issues and asking them about every detail of their miserable little lives.
This story comes from a real-life experience. I was working in the Village of Garbage outside of Cairo, Egypt for a couple of years. I met another American PA who was living in Egypt. He had seen an article that I had written in the Physician Assistant Journal and looked me up.
Bill (the other PA) worked for an American company that employed both American and Egyptian workers. He was responsible for taking care of the American employees and an Egyptian physician was responsible for the Egyptians.
One day his Egyptian counterpart came into his office and said, “Hey Bill, I want to show you something.”
Bill walked with the Egyptian physician into his exam room. An Egyptian man was sitting on the exam table with his shirt off. Bill could see a large surgical scar going down the man’s belly and a small, red, granulated hole at the top of the scar that seemed to be oozing some fluid. The Egyptian doctor asked the man to arch his back and he did. When he did, the tips of a pair of curved hemostats came protruding out of the hole. To make a long story short, about six months earlier the man had a cholecystectomy. During his follow up with the surgeon, he showed him the new hole that had formed and the metal thing sticking out. The surgeon said something like, “Just ignore it. It will go away in time.”
There is not one specific story behind “Shrinking.” However, if you worked as a PA in most parts of the country during the 1980s and 90s, you would understand the point. You often felt invisible. In the early days, truly you were in the shadow of your SP and had no self-identity. We have come a long way as our hospital list providers by the alphabet, not by MD first.
The story behind Resusci-date takes me back to my Air Force days ( ca. 1994) my SP was spending his last shift in the ER before discharge. We were always doing practical jokes on each other. I had the ER shift just before him. The ER call room had a bathroom with two doors, one led into the call room and the other out to the hospital hallway (where anyone could enter). I took our full-size Anne resuscitation dummy and sat her on the call room commode. I then pulled her jogging pants down around her ankles and then took the end of the roll of toilet paper and wrapped it around her hand. The last thing I did was remove the overhead light bulb.
The next morning the nighttime staff (Dr. B had already left for the day) told me that he came up to the front desk about 3 in the morning, looking hung-over from sleep (it was a slow ER at night) and asked, “Who in the hell has been in my bathroom all night? I’ve walked in on her twice.” He had no clue in the dark bathroom, illuminated only by the light from the call room when you opened the door, that it was our dear Anne.
The above cartoon came to me when I was asked to represent the PA profession for a career day at a middle school outside Marquette, Michigan. The thing I remember (and this was 1993-4?) that the kids were so excited about the person before me, a veterinarian, but when the teacher (clumsily) introduced me, the kids’ faces were perplexed. I had questions such as, “Are you then like a nurse? a doctor?”
The inspiration for this cartoon came after I had a hard day in the ER (Air Force hospital ER) and the follow-up physician came in and congratulated me on a complex diagnosis. I think it was the time when a “migraine” patient was brought back and roomed. Her vitals were normal, including an oral temp of 98.8 F. She was sure it was a migraine as she had them before and she just needed Demerol. However, when I placed my hand on her forehead to do her ophthalmologic exam, she felt very warm to me. I went out and took the thermometer from the MAs and took her temperature myself and it was 103.5 F. She also had nuchal rigidity. To make a long story short, her spinal tap came back indicating viral meningitis. The MD who came on after me had the job of reviewing my chart notes before I left. He came in and said, “Man, what a pick-up. I would have just given her, her Demerol and booted her to the street thinking she was afebrile.”
I had admitted the patient. But then the next day, when I came to work, (and her husband was in the hospital by her bedside as she was quite ill) was furious when he found out that his very sick wife had only seen a PA in the ER. He put in a complaint against me for being a PA. My commanding officer (a gynecologist and hospital medical director) came down to my office and told me about the complaint. Then he asked me to write a letter of apology to the family. I had the look of this guy, in the cartoon, on my face and I said (which was disobeying an order in the Air Force), “Hell no! I may have saved the lady’s life and there is no way in hell I’m apologizing for ‘just being a PA'”.