A modest manifesto

We had a little bit of weather out New England way last night, ayuh. A Nor'Easter, they call it. About two to three inches of snow fell, out at the homestead. The sticky, snowball-fight type stuff. Interestingly to this flatlander, the slightly higher elevation we have on our ridge was enough to keep the town itself from seeing much more than on campus, where they only got a dusting.

We'll see about how my Midwestern sensibilities handle the wool-wetting squalls of a proper Upstate NY/ SW Vermont weather system. I can tell you that about two solid weeks of dribbling grayness has left me unimpressed and with a fine head start on my latest bout of Seasonal Affective Screw this, I'm Going to Take a Nap disorder. I did find a fine woolen topcoat at the local Goodwill for $12.99, so the "wool-wetting" thing above is not just an artful phrase.

Speaking of artful phrases, I said I'd divulge the reason I'm so happy-go-lucky lately, and as a matter of fact I did make time to squeeze in the watching of a four-hour Shakespeare documentary over the long weekend (as well as The Big Lebowski and Ninja Scroll). Meanwhile, my classmates slaved like beaten dogs to prepare a stack of work for their courses. And say, come to think of it, I haven't adequately explained why I'm not in those same courses, nor how it is I'm nonetheless their classmate if that's the case.

So, dear reader, sit back for another lengthy story. Not that it's a complex or difficult thing to explain. I'm just so much more laid-back about my pre-med stuff now... or, to be more precise... (needless pause)... my pre-PA stuff.

Yes, these days I've been tooling around the winding mountain roads, the back seat loaded with books on not Organic Chem but Human Anatomy & Physiology. Not Calculus, but Statistics. The weather guy has been predicting rain, the Kaiser Chiefs have been predicting a riot, and I've been feeling like finally instead of "potential," I have a future I am excited about, and a way to get there.

A side note... true, technically I might be able to say I'm a pre-med or I'm headed to "med school" and be correct, because I do plan to apply to a mess of schools, and many at of the top of the list will be schools where the PA program is part of a med school that also trains young MD's (and if I can have a Scrubs moment, going someplace where Young MC is on faculty would be a bonus. Bust a move!). But let's be clear: in this day and age, in the good ol' US of A, the bare fact of it is, you don't gotta be a doctor to practice medicine. And I'm not talking about some 'alternative' thing either. Good old paternalistic, ego-driven, Western know-it-all medicine can be done, and done very well indeed, by Physician Assistants. For dudes like me, that's a concept that is just brimming with intrigue and attraction.

I would have been remiss not to seriously think over my options, once I got on the road and discovered how well "the system" used for training future doctors and I get along... or don't. I might have been too proud or too stubborn to consider the advantages of finding another way... but I wasn't. What sealed it was my thinking long and hard about what I want to do, how and where I want to practice, and then combining that with what I don't want to do, and the things about the job I frankly don't want to have to deal with. It all adds up very nicely to exactly what the PA profession is (according to one way of looking at it). It's practicing medicine without a lot of the intervening stuff that makes docs crazy.

Now, sure, absolutely, you want your doctor to be someone who could conceivably pick up the nuances of Orgo (or Physics or Calculus), sufficiently well to get a decent grade in a course. But having worked in pretty much exactly the place we're all trying to get to, I know how far down the list of important characteristics that really is. You want smart, yes. You want quick-thinking. You want knowledgeable, even encyclopaedic. You want 'able to talk like a person.' You want a lot of things, and so few of them have anything to do with academic achievement, after a while it starts to become scary to think that such a large proportion of doctors started out as kids who got great grades in science courses.

This is not to say that poor achievers have any better shot at becoming good doctors, or that they should. Getting good grades usually means working your ass off, and you need people who can work their asses off, both to be decent students and to be decent actual working physicians. But the thing is, the PA way of doing things isn't all that different, in terms of the things that matter to people (meaning practitioners and patients, a group often overlooked in this whole training thing). Before I get into the guts of it (literally!) in PA school, I'll have to prepare with some of the things pre-meds don't see until med school year one: a buttload of anatomy, physiology, statistics... hey, waitaminnit, those are my courses now. Hmmmm.

I anticipate an objection here: No, it wasn't because I had an academically bumpy Summer. It wasn't even because more terms like that one would assuredly have helped me get lost in the pile, kept me from getting interviews, and made it unlikely I'd get the shot to get into med school in a year, or two, or maybe more. Nor was it any doubt about my ability to get through med school (and do it damn well, as a matter of fact). It's more that I already know what it's like to slog through something that's almost what you want to do.

If the going is tough, that's fine. If it's circuitous and time-consuming and expensive and stressful, that's fine. But only if where you're headed to is where you really want to be. So if you're smart about it, you think a lot about where you want to be. And you don't stop thinking about it, now and then, just because you're on the way to someplace people respect and think is cool. So, I thought about it.

I don't want to own and run a small business. I don't want to head up a department. I don't care (that much) about huge piles of money, or my name being synonymous with a maneuver or a weird-shaped surgical tool. I don't want to pay malpractice premiums higher than my income was when I worked in the corporate sector. I don't want to set policies. I don't want to call all the shots, just those that constitute care for my patients. I don't want to be the only guy within 50 miles who can do something. I don't want it to ever be considered a weakness if I feel I want to consult somebody.

I want to teach a little, write a little, do a little research into things that interest me, and mostly just practice medicine. I want to work on a team, as one of its leaders. And oh yeah, I want to have a life. As a PA, I will be "limited" to practicing, and I'll have to do it as part of a team. I honestly don't see the down-side here.

So around Labor Day, I made the decision. My pre-reqs are for PA school, and the classes are much more directly applicable, which is nice for an impatient and energized student like me. Hey, I like understanding things for their own sake, I really do. But I have a tough time being graded on things when I can't see the connection, and because of limitations of the system I can't be given time and space to find my own. I have a tough time believing that academic performance is an indicator of smarts or ability.

Oddly enough, I'm currently on track for A's in everything. Hmmm.