Peacock Surgery


Peafowl are common birds of the phasianidae family, related to the pheasant. They are found in warm, tropical regions of the world. The male of the species, the peacock, is known for its resplendent display of tail feathers, the peacock train. They are some of the most beautiful birds on Earth.

My friend, who told this story to me, has a friend who owns a no-kill farm out in the country. The place is fantastic; friendly goats, peafowl, war-like geese, chickens, and even the last remnant of the dinosaur, the emu.

Though they may be vastly different than human beings, the peafowl can succumb to very similar ailments and conditions. This story, related to me and not done by me, is the story of a peacock with a very bad cyst.

My friend’s farmer friend had purchased a peacock. At first, he paid no mind to the cyst on the side of the animal’s face. But the cyst grew quite large, and was causing the poor bird problems with its vision and breathing. As you can see, its left eye was nearly useless, as the pressure of the cyst was pushing it out of its socket. It also had a rasp to its breathing, as the cyst was putting pressure on throat. This animal needed help.

My friend, who told this story to me, is quite familiar with cysts. However, he is not a veterinarian. Be that as it may, this appeared to be a sebaceous cyst, a very common growth. They are non-cancerous, and generally filled with semi-liquid or dead tissue. They are formed when the sebaceous gland, which produces sebum to coat skin and hair (or feathers) becomes damaged or blocked. They are typically not a problem, unless they are in a troublesome part of the body, such as this poor bird. Cysts grow slowly, and this beautiful animal would have continued to suffer.

Well, my friend, who is not me, has removed cysts before. It’s really quite simple. A shot of lidocaine, an incision, and then you scoop the gunk out. A course of antibiotics is then in order.

But, my friend had no lidocaine. This would have to be done Viet Nam style. He did, however, have two brilliant surgical assistants who were invaluable in this surgical procedure.

So, in my friend went. My friend did not know this, but a scalpel designed to cut human flesh barely works on a peacock. It took a little slicing. My friend was concerned that the animal would recoil in terror and pain, but it was quite cooperative throughout the entire procedure. More so than any human, actually, and without any lidocaine. Cysts are full of material that has no nerve endings; once you cut through the skin, you’re working with dead tissue. Also, my friend’s farmer friend told me that an animal will frequently settle down in a mixture of calmness and fear once it realizes it has no choice.

After just a few cuts, there it was: a disgusting mass of dead, crumbling, moist material. I will spare that picture. My friend scooped a lot of it out. It was… rather repulsive.

Withing minutes, the peacock’s left eye began to descend into its proper place, and the milky material in the lens all but disappeared. It’s breathing became less labored. Amazing what can happen when you release a little pressure.

Unfortunately, my friend got a little too ambitious when digging out the core of the cyst, and severed an artery. Again, my friend is no veterinarian, but he was confident that there was no major artery in that part of the animal. With some constant pressure applied with sterile gauze, the bleeding stopped.

My friend cleaned out the wound with saline, and applied some animal antibiotics. Every farmer has a bottle lying around: Tylan 200.

The bird looked much better after the surgery, but a little rough. It’s eye had returned to a normal state, and its breathing became better. My friend’s farmer friend kept up with the antibiotics, and I’m happy to say that the bird is doing just fine.

The cyst had been with the animal for quite some time, so it was unused to using its left eye. However, the little peacock brain has returned to normal use of its vision as its vision neurology has healed as well.

So, a happy ending. Again, I had nothing to do with this. It was related to me by a friend. The peacock has returned to his ostentation, and is living a happy life. This is what healthcare is all about. All life is precious.

Update: He’s looking pretty good!

Licensed To Heal

Well: How about this?

Hoo-doggy, but that was a long ride! For the first time since I started down the path to become a Medical Assistant, on January 7th, 2020, I am now completely certified, licensed, and ready to go.

It has been a mind-blowing adventure. Along the way; I left a job of 15 years, I gained new friends, and I lost my father. But now, at the end, I am finally ready to go. I am ready and willing to work.

Yeah, bullcrap!

Thank you, Washington State Department of Health. They are the unsung heroes on the front-lines of America’s War on Competency.

So, there’s certification, and then there’s licensing. In Washington State, any healthcare practitioner, at any level, needs to apply and obtain a license from the Department of Health. Sounds reasonable. I think you need a license for just about everything. Which reminds me, I need to renew my license to flush the toilet. But anyway, my healthcare practitioner’s license. I had heard along the way that it can take 2 or 3 weeks. Hey, no problem. Time for a little break!

Yeah, bullcrap!

I sent in my application to Olympia on January 2nd, certified mail. My instructor had advised me to send it certified, as I would have proof of its arrival. One can also apply online, but my wise instructor said certified mail was the way to go. I filled out the enormous packet of literature, and made my way to the local post office. The USPS informed me that my application would arrive at the Department of Health on Monday the 4th.

Yeah, bullcrap!

My application did not actually arrive in Olympia until January 6th. Well, I know the USPS has been under fire, what with them being a punching bag during the Presidential election, but I suppose I can understand the delay. The thing is, Olympia is about an hour and change drive south of Seattle; I could have driven it there faster! Kind of a scenic drive, too, once you get past Tacoma. The Nisqually Delta is a beautiful sprawl of wetlands.

It would have been a useless drive. The Department of Health, due to Covid, had closed their in-person office. Everybody works at home these days. Except Medical Assistants. So be it. At least now they had my application, and could get started on it.

Yeah, bullcrap!

I called the Washington State Department of Health on January 21st, 2021. I figured this should have been enough time, and that they should almost be done. I spoke with a nice representative. She was very helpful. She told me that they had not received my application.

A-what, now?

The representative informed me that they will start the application process once they have transacted on my application fee, a paltry $145. She told me that she saw no payment under my name.


So I took a stroll up to Chase Bank, where I had worked for 15 years before starting my medical adventures. The nice banker at one of the desks looked up the status of my money order, and saw that it’s status was: ‘pending.’ That means that it is currently being processed, and would post the next business day. ‘Pending’ is a word I would come to be very familiar with.

Well, the next day, I called the Department of Health again. It was a different representative, but he also was very pleasant. He said that they had received my money order and cashed it. Government priorities! I was informed that now that they had the payment, they could begin the application process, but it could take several weeks.

Yeah, bullcrap!

So, I figured I had some time off. I relaxed a bit, cleaned the apartment thoroughly, and defended the Earth against the invading alien horde in XCOM. But I would spend each day practicing my clinicals, going over material, studying. I had to stay sharp. I knew I would be headed to work soon.

I applied for a several jobs; I kind of cast a net. It’s tough for a brand-new Medical Assistant, even though there is a demand. Each facility I interviewed with understood that I was still in the licensing application status of: pending.

A couple of days go by. I call the Department of Health (I’ve memorized the number by this point, if anybody needs it) to where things are. The kindly representative informed that my status was still: pending. He directed me to a website where I could look up the status myself. I navigated through the digital maze of a government website, found my name, and saw my status. There it was: pending.

There is something I need to mention. Way back in 2002, or maybe 2003, I really can’t remember, yours truly committed a heinous, vile crime against the people. Brace yourselves. I was arrested for possession of marijuana. Please feel free to shame me. I deserve it. Funny thing is, several years later, long after I had stopped smoking it, you can now buy it in the store here. Nevertheless, I went through the judicial process of a pre-trial diversion agreement. As this was my first arrest ever, for a misdemeanor, I simply had to stay out of trouble for a year and they would not file any charges. I had briefly consulted an attorney before I sent in my application for my healthcare practitioner’s license, and he informed me, after I read the verbiage from the application, that my situation did not apply. He advised me not to mention it on the application’s list of ‘ have you ever been evil.’ Okay.

Yeah, bullcrap!

The despicable crime I had committed kept nagging at me in the back of my head. I again called the Department of Health, and told them of my sins, breaking down, sobbing. I was admonished, severely, by the almighty representative I spoke with. I groveled, begged. She told me that I should have included the crimes against humanity I had committed, and she was perplexed as to why the attorney had told me to disregard it. She informed me that there was nothing they could do, until they got to the background check phase. I was told that this would delay my application even further.

Yeah, bullcrap!

So I did my due diligence, and contacted the court where I was brought before The Law. They literally could not find my records. Seriously. They told me that a specialist would contact me the next day. The next morning, I saw the email in my inbox. I nervously opened it. It basically said, not using legalese here: “Uh… Dude? That was like, 18 years ago for possession of pot. We don’t really keep those kind of records lying around. Sorry man. Peace out.” However, they did email me an official court letter saying that my records no longer existed. I kept it handy, for when the Department of Health called me out for my misdeeds.

I emailed the records to the Department of Health. I gave them a day and called them, ready for my seething reprimand. A representative (I got a different one each time I called), was rather indifferent to my violations of the sacred laws of Washington State. He had reviewed the court materials I had sent over. He told me that a misdemeanor possession of a substance that was now legal, 18 years ago, was not even a blip on their radar. I though: great! They must have started the background check phase!

Yeah, bullcrap!

The representative told me that they had not yet started the background check phase. I asked what ‘phase’ they might be in. He told me they actually hadn’t started on my application yet.

A-what, now?

I really never found out exactly what they were checking. A background check, sure, but that process, which we’ve all had to go through when we get a job, is a day or two at most. They already had my official transcripts and my proof of passing the exam. You got me as to what else they might have been checking. Driving record? Credit record? Calling my Mom?

I understand, though; to a degree. The Department of Health is overworked, understaffed, and extremely backlogged. But you’d think that they might out a little more urgency into those that wanted to enter healthcare. Especially now. You may have heard of this whole Covid thing. In case you ain’t been keeping up on current events, pal, we’re getting our butts kicked!

Time counts, and keeps on counting. They days go by. My savings dwindle. I really could not have gotten a job in this interim; they’d look at my resume and wonder what a guy with a medical certification is doing applying at Kroger, unless he’s waiting for his license to clear and will bail as soon as he gets it. I keep checking my application status online. It was always: pending. Pending, pending, pending.

I called the Department of Health on March 9th. They informed me that my application was in process. I asked the (again, friendly) representative what stage of the process they were in. He replied: well, we actually haven’t started yet.

Yeah, bullcrap!

This couldn’t go on. I had to do something. Why, I am inclined to write a letter to the authorities! Which is what I did. I wrote an obsequious, begging, pleading email to the Washington State Secretary of Health, Dr. Umair Shah.

Well, sometimes, the squeaky wheel gets the grease. And sometimes, our public officials hear the voice of their constituents. Perhaps. I received this email response on March 17th:

Hello Andrick Schall,

Thank you for contacting Dr. Shah regarding your medical assistant certification application. I have been asked to research your application and respond.

The Department of Health is committed to working with others to protect and improve the health of all people in Washington state. We understand that there is an increased need for all types of medical assistants, and we are sincerely sorry for application delays being experienced.

We received your application on January 20, 2021. Our review and the required background checks were completed, and the certification was approved yesterday. The active status can be verified through, Provider Credential Search.

Thank you for your patience and cooperation with the credentialing process during this difficult time.

With regards,

T. Diane Young

Credentialing Manager

Health Systems Quality Assurance

Washington State Department of Health

PS~ Here’s your license, pothead. (I made that up.)

So, there you go. Sometimes you have to be patient, and sometimes you have to squawk a little. I have two solid job offers lined up, and am mulling them over now. My decision of which job to take is, of course: pending.

Caffeine and Anxiety – Not Always the Best of Friends


Caffeine and Anxiety Disorders – Not always the best of friends

Well, who doesn’t like a good cup of coffee. I sure as heck do! What a great way to start the day! You have that first cup, you feel that pick-me-up, and you’re ready to go. You shake off the morning grogginess, and you feel great! At least that’s what your brain is telling you.

Caffeine is the most widely used psychoactive substance in the world. I’m from Seattle, the coffee capital of the world, (even though you can’t grow coffee beans here) and the birthplace of Starbucks. They’ve pumped the brakes a little as the world changes with the pandemic, but basically you can find a Starbucks anywhere in the world. Just turn around. But shoot, I tell you. I remember when it was just a cup of coffee. To each their own, but I do get a little annoyed when I get in line behind someone who wants a double-pump, almond, half-steamed, skim-milk, peppermint Karenchino. It’s just mud! We drink it for the caffeine!

I don’t keep it a secret, and I’m not ashamed of it, but I have an anxiety disorder. How society judges the mentally ill is for another post. My disorder has been largely held in check for a long time now, and I’m functioning very well, despite the recent loss of my father. But let’s take a look at how caffeine and anxiety work together, or, more properly put, don’t work together.

Most folks get their caffeine from coffee, a brewed drink prepared from roasted coffee beans, the seeds of berries from certain Coffea species. This makes caffeine an alkaloid, a naturally occurring organic compound, usually derived from plants. When coffee berries turn from green to bright red in color – indicating ripeness – they are picked, processed, and dried. Dried coffee seeds (referred to as “beans”) are roasted to varying degrees, depending on the desired flavor. Roasted beans are ground and then brewed with near-boiling water to produce the beverage that we all love.

I’m speaking generally of caffeine, but there are plenty of other ways to get the substance in your body: tea, soft drinks, chocolate, and, if you’re feeling like trashing yourself, No-Doz.

How caffeine works, and why it makes you feel good

Your brain does a lot of neat tricks, and it accomplishes them in clever ways. When your neurons, or brain cells, are firing, they are doing exactly that; sending jolts of electricity to one part of the body or the other, telling it what to go do with itself. To aid in this, your brain uses what are called neurotransmitters, nifty little chemicals. There are quite a few different types, and each of them plays either a few roles or many, depending on the need. There is one neurotransmitter in particular called adenosine, a natural central nervous system depressant, which keeps you mellow and composed. Caffeine blocks the actions of adenosine. So you wake up! At the same time, this blockage of adenosine results in the brain releasing other neurotransmitters, namely dopamine, which makes you feel great, and glutamate, which helps ramp up the body. But of course, the caffeine wears off after a while, your neurotransmitters try to return to normal, and you get tired. So time for more mud!

But wait, there’s more! Caffeine also inhibits the release of a neurotransmitter called GABA. GABA’s role is to calm the mind and decrease feelings of fear, stress and anxiety. So when you have a lot of caffeine in your system, GABA cannot do it’s job.

Anxiety Disorders

Anxiety disorder is an umbrella term for several conditions characterized by worry and fear. It is the most common mental illness in the United States; over 40 million people have some form of it. In these challenging times, the disorder has become more prevalent.

At the risk of WAY oversimplifying things, the physiology behind an anxiety disorder is as follows. (Yes, these is a physiologic mechanism behind it; so the next time someone tells you to just calm down and deal with life, tell them to take a good look in the mirror, worry about themselves, and don’t offer unsolicited advice. Or feel free to use stronger language, if you like.) There is a part of your brain called the amygdala. Like most parts of the brain, it plays several different roles. One of the hats that it wears is playing a primary role in fear and anxiety. Studies have shown that people with increased activity in their amygdala are at a much higher rate for depression and anxiety. In the case of an anxiety disorder, the amygdala will overreact to the illusion of fear, if you will, and signal another part of your brain called the hypothalamus. This then will activate your sympathetic nervous system, responsible for the phenomenon known as fight or flight. In doing so, this floods your body with chemicals called cortisol and adrenaline. This action increases blood pressure and pulse, increases muscle tension, and the acceleration of the breathing process. These are well-known symptoms of anxiety. In the meantime, the same mechanism floods your brain with a neurotransmitter call noreprinephine, which mobilizes the brain for action and alertness, at the cost of rational thinking. This is also a well-known symptom of anxiety.

One of the main neurotransmitters that calms the amygdala is GABA. Many psychiatric medications are used to treat anxiety, but some of the most common are a class of drugs called benzodiazepines (Klonopin, Xanax, etc.).

There are, undoubtedly, psychological factors that contribute to an anxiety disorder, but that’s for another time.

When caffeine and anxiety collide

Well then, it is clear that the physiological mechanism of action of caffeine and the physiological mechanism of action of an anxiety disorder can be disharmonious. Excessive caffeine can greatly exacerbate an anxiety disorder. Tremors, difficulty breathing, cognition problems; these can all result when an anxious mind has too much caffeine.

As an aside, I was on benzodiazepines for a time, and I thought I could drink all the coffee I wanted to. I could, for a while. But the chemical storm was raging in my head, and, as strong as benzodiazepines are, caffeine can be much stronger.

My anxiety disorder is well-managed these days, so I keep my coffee to 1 or 2 cups per day. Some individuals with an anxiety disorder find that tea or matcha works well for them, while others may use supplements. Some people with an anxiety disorder are better off avoiding caffeine in their lives altogether. I cannot diagnose, and I cannot give medical advice, but for those of us with an anxiety disorder, the role that caffeine plays in our lives must be considered.

Thanks for reading! Wear the mask, social distance, wash your hands, stay safe!



Sometimes It’s Good to Wait

“Patience is not the ability to wait, but the ability to keep a good attitude while waiting.”- Anonymous

Well, I THOUGHT I was in the final stretch of my preparation for employment as a Medical Assistant, but there is one more hurdle to jump through, one that I did not adequately see coming.

I have completed all of my academic requirements, with pretty darned good grades. I successfully completed my externship. I passed the National Healthcareer Association’s federal exam. I have been granted the certification of Certified Clinical Medical Assistant.

However, the merciless machine of political bureaucracy, that impacts us all on some level, is the last flaming hoop I have to jump through. And it’s being mighty obstinate.

Every healthcare practitioner in Washington State, from CNA up to MD, needs to be granted a license to practice medicine from the Department of Health, after they have completed their training. Fair enough. I suppose it’s a good thing that the government checks you out before you start treating people. However, Olympia does like to license things. I think we need a license to flush our toilets now. But I digress…

I finished all of my academic requirements, and was granted my credential, in the last week of December, 2020. I filled out the application and sent it off, with a money order for a paltry $145, on December 2nd. I paid for the application to arrive in Olympia on January 4th. My instructor had advised me to send it certified mail. Now, I hate to knock an agency that’s trying it’s best, and has been under political attack for some time now, but I’m not entirely certain that the USPS has their heart in it. I don’t know, maybe book a Tony Robbins seminar with the New York Jets or something.

My application arrived on January 6th. Good golly, Miss Molly. Olympia is about an hour drive from Seattle. If I had known that this was going to be the case, I would have just driven the application down myself. Scenic drive, too, once you get to the Nisqually Delta.

I called the Department of Health later that week, to see if they had gotten the application. They couldn’t find it. Well, alright! Things are going great!

Well, the wheels spun for a little bit, and I called Olympia on January 22nd. Bear in mind, I knew that the licensing was going to be a requirement, but I had figured about a week, at most. Wha-wha! Anyway, the courteous representative I spoke with said that they indeed had received my application, but had only started work on it 2 days earlier.

The representative told me that they were running very far behind, and that it will take some time. I asked him if it would take longer than 2 or 3 weeks. He did not hesitate when he said: Definitely.

I call the DOH every now and then, just to make sure everything is still going okay. The assure me that it is, but it will still be awhile. Every representative I’ve talked to has been extremely courteous and friendly. I guess you can afford to be when hold the power. The big smile says: “You have to wait, jackass! Anything else I can help you with? My pleasure!”

I know the Department of Health is busy. I know they are behind. Covid, you know. That virus, I tell you… Handy excuse for delays. Can’t put a man on Mars yet? Covid.

I suppose, also, that because of the need for healthcare workers (Covid), that there may be quite a few former healthcare veterans who are reentering the field. But really, you would think that the DOH might expedite things a bit for people getting healthcare licenses. Because, you know, Covid.

The DOH, of course, needs to do a criminal background check. That makes sense. But I can’t possibly imagine what else they are investigating about me. My grooming habits? My shoe size? Whether or not I remember cursive and how to hook up a dial-up modem? (Yes on both.) Whether or not I remember to put my pants on everyday? (Most, days, yes.) Are they going to call my Mom or something?

So I sit and wait. The school did warn us that this would happen, but I wish there had been some way to engineer things a little more expeditiously. I had assumed I would be working by about mid-January. That hope collapsed like a Seahaws offensive line, and Russell Wilson is lying dead on the ground.

Even though there is a high demand right now, it’s tough for a new Medical Assistant to find work. Naturally, clinics and facilities prefer experienced people. I’ve had a few interviews, and things went well, but they always ask when I think I’ll get my license. It’s not like they can put a position on hold while they wait for the DOH to press the right buttons. Healthcare needs help now.

But, everything happens for a reason. So they say. I’m not sure I believe that, but, as it turns out, this might not be entirely bad timing.

As it turns out, I could use the time off right now.

It’s no secret, and I’m not ashamed to say it: I have an anxiety disorder. Anatomy and physiology fascinated me in school, and I’ll write a post soon on what goes on in an anxious person’s head.

Over the last month or so, I’ve had several stressors develop. One is being unemployed, and living on my dwindling savings. Another is the licensing process itself. An anxious mind tends to do what’s called catastrophising, playing out, repeatedly, the worst case scenario. I got anxious with the DOH and their delay. What if they find something? What if I filled something out wrong? What if they tell me that I belong in healthcare as much as that loony lady from Georgia belongs in Congress? What if I can’t perform as an MA once I do get a job? My externship was fascinating, but not without its problems. That’s for another post, as well.

The main stressor is my father. He is 92, and has had several strokes recently. My family found out recently that he has weeks, 2 months at most, left to live.

I tell you, there’s a lot of work that needs to be put in when someone is checking out. Calling extended family members, contacting various agencies, that sort of thing. In the meantime, you still have to find a way to experience grief.

I could feel the spiral happening again, and for the first time in a long time, I experienced a panic attack. It’s a horrible sensation. I wouldn’t wish it on anyone. The brain is like any other organ in the human body; sometimes things can go wrong with it.

But, I have a very skilled psychiatrist, Dr. Dispensapill. With a small tweak of my medications, the anxiety has largely abated. It will still be present, along with periods of depression. These are normal as you watch your father die. But there is a difference between situational anxiety and depression and clinical anxiety and depression. With some good therapy, the anxiety has lowered dramatically, and I have had no further panic attacks.

And so, life goes on. It’s really not such a bad thing that I have this time off.

I’ve been going over the healthcare basics again. It’s surprising what I’ve committed to memory, what now comes naturally without having to think about it.

I bought one of those dummy arms so that I could practice my phlebotomy. My brother Pedro says he’s willing to be my human test arm. Er……

I’ve done a ton of writing and research, and will have plenty more posts coming.

And I’ve done that usual trick people do when facing the loss of a loved one: I have cleaned the HELL out of this apartment!

My head is getting screwed back on, and I’m feeling better. But I have grief to come. It’s good then, to have a little time off.

Make every moment count. Don’t be afraid to tell someone you love them. Wash your hands!

The Long Journey Is Nearly Complete

Well, how about that! I have passed the National Healthcareer Association’s certification exam, my next to last step on becoming a medical assistant. It’s been an incredible ride, to have success in an academic program in a year such as this. I’m not quite out of the woods just yet; in just over a week, I will start my practicum at a clinic in Woodinville, Washington. I am required to put in 165 hours of clinical time, the last bit of my training. This last step will be a massive challenge, but also a fantastic academic opportunity. I imagine I will learn more actually working with patients, in a clinical environment, than I have in any classroom. I am extremely eager to start! If all goes well with my practicum, the state of Washington’s Department of Health will grant me a license (well, after I pay for it) to practice healthcare. One more mile to go….

At that point, then, I will have obtained the credential of CCMA, or certified clinical medical assistant. There are four different guilds that have been granted legal authority to certify low and mid level practitioners; the NHA, the AAMA, the RMA, and the NCCT. All of them may certify medical assistants, with slightly different titles, but for all intents and purposes, all four are greatly similar. My certification focuses more on the clinical aspects of healthcare, whereas the others may focus more on administrative, or both.

The NHA exam was an absolute bruiser. It was 150 questions, multiple choice, and we were given 3 hours to complete it. That may sound favorable, but those details mask a brutal, demanding trial. I needed 2 and a half hours to complete it… There were very few black and white answers on the exam; most of them were abstract, so to speak. The exam would present you with a scenario, and you would need to pick the most relevant answer pertaining to the legal scope of practice, ethics, and training of a medical assistant. Only about 65% of students pass it on their first try. Not everyone in my class made it.

That was last Tuesday, the 10th of November. To be honest, today’s the first day in a while where I’ve felt I can actually relax. I was in a daze after that exam. I had a sense of accomplishment, sure, but I was also exhausted and burned out. I have been hitting it hard since my academic training started, January 7th of this year. When I was younger, college didn’t work out so well for me. This time, as an adult, I pushed myself incredibly hard. For the first time in my life, I have succeeded academically. At age 48. An old dog, a new trick.

So today, I’m allowing myself to relax a little. For about an hour, anyway. I played my beloved video games, something I haven’t had time to do in a very long time. I was holding off the advancing alien horde, defending Earth, before my work ethic/guilt started nagging at me again. After this post, I’m going to practice some more with the sphygmomanometer and read more about the endocrine system. There is no off position on the hardcore switch!

Be that as it may, this is all still very surreal. I still have the practicum, the last, largest hurdle to jump through, but I have come farther that I thought I might. I am thrilled beyond belief to be entering this field. I have come to enjoy the subject matter greatly; healthcare is like a job and a hobby to me. In this regard, I realize I’m very fortunate to have found something, later in life, that I enjoy, and, if my grades are any indication, something I show some aptitude for.

I have a cumulative 4.0 gpa for the entire program. I am on both the Dean and President’s list. I am a member of the American Association of Medical Assistants, and I have been invited to join Phi Theta Kappa. I find it odd that I am being recognized for my intelligence and dedication in a field that, until I started this program, was completely foreign to me. Yet, here I am.

I fully realize that I will be entering a field that is already dealing with a substantial burden. I’ll hit the ground running with the flames at my feet, but I feel more than up to the challenge. If I can contribute, in my own way, to helping improve peoples’ lives, the sense of accomplishment and pride may be more of an intrinsic reward than the paycheck.

It is also surreal, and humbling, to consider how far I have come, and how much I have turned my life around. It was not easy to get here. 2019 was an incredibly difficult year for me. I had already been on a long, extended medical leave from my former employer, for a rough, intractable anxiety and panic disorder. It just would not abate. Things collapsed for me in the summer of that year. I ended a 13 year relationship, as neither of us were happy. I had become addicted to opioids. Needless to say, this phase of my life was incredibly painful and difficult. It took me a few months to recover. It was hard to leave that relationship, and it was profoundly difficult to kick the painkiller habit. I didn’t sleep for about a month. But I came through. The anxiety disorder was still debilitating, however. Eventually, my skilled psychiatrist, Dr. Dispensapill, reached deep into his back of tricks, and tried a medication that is very rarely used anymore. Damned if it didn’t work, and continues to work. Since August of 2019, I have had no panic attacks, and no anxiety (well, plenty of test anxiety, but that’s situational, not clinical), and I am the happiest I have ever been. I returned to work, I enrolled in school, and I have excelled. There is no way I could have done that had my anxiety disorder still been present. Say what you want about psychiatry, and many reactionary people do, but I can say that it has definitely helped me.

My training started in January of this year. I had a only a vague, naive idea of what a medical assistant did. They just take vitals and answer the phone, right? Hoo-doggy! I could not have been more wrong. It turns out, they don’t let just anybody walk in off the street and start practicing medicine. You need a little training, first. I was not prepared, at all, for the amount of material they threw at me. My textbook is over 1300 pages long! It was a serious mental shock, at first, being in an academic environment for the first time in a very long time, and absorbing information that was completely new to me. I quickly settled in, though.

All of it was fascinating, all of it. I was expected to learn an enormous amount of information in a rather short time. I called it med-school light. But, as it I found it so interesting, I dedicated myself completely to this new endeavor. Every class was something new and fascinating.

So, in less than a year, I learned, and became quite proficient in, skills and knowledge that, had you told me I would have had just a year ago, I would have chuckled in disbelief.

The technical skills, though challenging, were a blast to learn. Palpating a pulse. Drawing blood. Using a sphygmomanometer. Calculating medication dosages. Giving an injection, wherever you need it. Audiometry. Assessing vision. Not only running an ECG, but knowing what the process meant. Lavage. Pediatric measurements. Microbiology. Laboratory procedures. Autoclaving. Sterile fields. Using the AED. A jolt of adrenaline (it doesn’t go in the sternum, Pulp Fiction style).

Administrative components, as well: scheduling, ICD coding, CPT coding, patient screening. And, just for fun, I can now tell you everything about health insurance you need to know. And yes, in America, it’s a bit of a mess.

Soft skills, also: the long history of medicine, the names that made a difference. I’ve now achieved a rudimentary law degree; healthcare is replete with legal and ethical obligations, and I’ve come to understand them fairly well. Basic psychology was part of the ciriculum. I’m more Jungian than Freudian. Learning terminology was brilliant, as well. Most of what you hear in healthcare has its roots in Greek and Latin (that’s another story), and I can practically speak the ancient tongues now. Terms that I’ve heard all my life; now I know what the heck that actually means.

Above all else, my most favorite subject, the one I found to be profoundly captivating, was anatomy and physiology. Brilliant, fascinating stuff. The human body is an amazing machine. We can talk about the different body systems (cardiovascular, pulmonary, endocrine, nervous, integumentary), but these are all just simply arbitrary designations of convenience. It’s all one system, working together, dependent on each other, all the time, constantly striving towards homeostasis. It’s an absolute miracle when you look under the hood. The more I learned of the internal workings of the human body, the more it both reinforced the concept of intelligent design, while at the same time rendering it completely absurd. That’s for another time, as well.

There were 3 things I learned in the program that are not only crucial to healthcare, but, I found, greatly applicable to my everyday life. The first was the concept of adaptability and flexibility. Plans, schedules… those are adorable, but when you are dealing with the sick and injured, or with life in general, things do not often go according to plan. Or ever, really. It is a skill to change and adapt to the environment around you while maintaining composure and dedication. Think of your feet, move to the next issue. The second thing I learned was the concept of empathy. Empathy was drilled into our heads since the first week of class. You never judge how a patient came to be how they are, you are there to help them get better. However, the concept took on a deeper meaning to me, the more I studied. As I mentioned, I greatly enjoyed anatomy and physiology. At the end of each chapter, of each particular body system, were several pages of what could go wrong with that particular system. Some of it was absolutely heartbreaking. Each of us in our own way is broken. My empathy developed into a deep sense of compassion. A lot of work goes into a human being. All life is precious. The third thing I learned, and kept to heart, was simply this: you never stop learning. I have found that the more I know, the more I realize I don’t know. There is no ‘done’ in healthcare, or any emerging field. There is always more to learn. I have developed an insatiable desire to learn more. Being a healthcare practitioner requires continuing education, but there is no need for the industry to mandate it to me. Though at this point my academic commitments may be complete, I intend to keep learning and studying. We have come a long way since bloodletting and leeches, but there’s still so much we just don’t know.

Near the end of my third quarter, on the last day of class, my instructor told us a story that finally hammered home the importance of what I was learning, what I had dedicated my life to. He was always a supportive and jovial man, but not at that moment. We were finishing our training in advanced life support. He told us that he wished someone who knew this material had been there for his son, who would have been 25 the following week.

Well, as you can tell, I’m quite excited to continue this journey. Thank you for reading, and thank you for letting me sound my triumphant, barbaric yawp. I’m excited, thrilled, and profoundly optimistic about where my life has now taken me.

Wash your hands! Wear the mask!


Straight A Student!

BAM!  That’s 3 quarters down, 7 classes, all 4.0s. Not bad, for a 47 year old college drop out. I’m well on my way, but I still have some serious work to do. I don’t start the 4th quarter until September 29th (my birthday!), but my foot is still on the gas. A classmate and I are meeting regularly; we’ve already gotten the exam prep books, are making flashcards, and she and I are committing as much to memory as we can. The 4th quarter will be 6 more weeks of classroom instruction, followed by my practicum. I’m not sure where that will be yet, but one day at a time. If all goes well with that, I’ll be eligible to sit for the federal exam.

It’s been an amazing 8 months. I never really thought I would have such an affinity for healthcare, let alone be somewhat good at it, if my grades are any indication. I still have a lot to prove to myself, as I have yet obtain a license and actually treat a patient, but I’m more confident than ever. It turns out, I really love this stuff! Healthcare is really cool! It annoys me when people malign seeking professional medical care. You have a problem, you get it fixed! Although, how we as a society pay for it is a whole different matter…

I’ve got a long way to go, but I’ve learned a lot. I can take your vitals, any of them, however you like. I can clean and dress a wound. I can set a cast. I can stitch you up. I can run an ECG. I can draw blood and prepare the specimen for lab work. I can give you an injection just about anywhere, and I even know how to prepare the dose! I can explain how the law relates to healthcare, and I can talk all day about my new favorite subject, physiology. The human body is an amazing machine. I really can’t help you much when it comes to how the brain works, that’s a little tricky; but if you need to know about the endocrine system or how the circulatory, respiratory, and lymphatic systems work together, just let me know!

Well, back to the books. Wash your hands!

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Medical Terminology (and the ancient Romans were kind of jerks)

Well, the third quarter is underway, and so far it’s going great! I’m taking 2 courses; one is Pharmacology and Medication Administration (this is what the chemical is, this is how I will inject you with it) and Administrative/Clinical review (this class is a lot of fun –  the instructor basically sets up exam rooms, and we practice on-boarding patients; the instructor, playing the MD, then gives us a procedure to carry out with the patient), which ties together everything I’ve learned so far. We are also studying medical terminology, and where it comes from. Not sure why that wasn’t covered in the first quarter; perhaps they just wanted us to get familiar with the jargon before we closely studied the etymology.

Everything in healthcare seems to have a needlessly fancy name, but there’s a good reason for that. Just about every bit of terminology a practitioner uses is either Greek or Latin in origin. There is also the occasional eponymous term, a word named after the person who discovered/invented it (Pap test, Alzheimer’s, Tommy John surgery). I’m oversimplifying the history a bit, but a long time ago, when Hippocrates and his colleagues figured out that illnesses and diseases were actually environmental and not divine punishment (although that unfortunate concept still exists today), and began to actually study the human body, the ‘English’ of the day was either Greek or Roman. Many people in the known world (which was much smaller then, than our own) spoke one of these two languages; much like a good portion of the known world speaks English today. This way, a physician in Rome could correspond with a physician in Roman occupied England, who perhaps spoke a local dialect, and they would know what they were talking about. The practice continues today.

The word ‘doctor’ comes from the Latin ‘docere,’ which means: to teach. It also shares its roots with the word ‘docile.’ The thinking here is that one cannot properly learn and absorb information if one’s mind is not calm and focused on the matter at hand.

But, as it turns out, the ancient Romans could be a little flippant. The word ‘hyster’ comes from the Latin ‘hystera,’ the word they used for uterus (think: hysterectomy). The Romans believed that women got moody and emotional because of their menstrual cycle; therefore, the word ”hystera’ shares a root with the word ‘hysteria.’ Well, that’s charming. Sure, some women do occasionally get a bit out of sorts on their menstrual cycle, but that is not a character flaw or an indication of a psychological or psychiatric disorder. A woman’s endocrine system is simply in overdrive, if you will, forcing an ovum into the uterus. So there you have it. The etymology of medical terminology is fascinating, but glib, dismissive opinions are nothing new.

Wash your hands!

3rd qtr so far

Cute Animal Stories and Physiology

cat nursing puppies

The link above is a very cutesy video, but it had me reaching for my textbook.

According to this video, the mother cat had recently lost her kindle (I love collective nouns) and was, quite naturally, profoundly depressed. This animal foster family took the cat in, and found the cat to be needy, sad and distressed. It was only after the introduction of a litter of puppies that had lost their mother (what is this, a Disney movie?) that the cat came around.

There is an endocrine gland (that means it makes hormones) in the middle of your brain called the pituitary gland, answering to your CNS by way of the hypothalamus, a bridge between the CNS and the endocrine system. The pituitary gland is often called the master gland, because it does a lot of stuff, probably gets paid more. One of the hormones it secretes is called oxytocin. In mammalian females, oxytocin plays a major role in commanding the body for pregnancy, birth, and nursing. However, in both genders, oxytocin, by the very nature of its primary function, also engenders feelings of attachment, belonging, and intimacy. This cat was flooded with oxytocin, was depressed, and needed attention. When the puppies were introduced, the oxytocin returned to its primary role, and the cat became a surrogate mother. At this time, the cat’s pituitary gland produced another hormone called prolactin, and enabled the animal to nurse the puppies.

I’m not trying to reduce the powerful emotions this cat felt, emotions that would also easily occur in a human being, by explaining it away in technical terms. I’m not trying to take the ‘awww’ out of it. Just two things:

1: It is profoundly interesting that external, emotional events have a direct, physiological impact on how your body functions. Your emotions are very real, can be very strong, and, if you need proof, take a look inside and see the physiological process. If someone tells you to suck it up, if someone shames you for mental illness, if someone tells you to stop feeling a certain way, then they are A) ignorant of how the body works, and B) an asshole. “It’s all in your head!” Well, of course. Everything is. But that’s ontology, for another time.

2: It’s also profoundly interesting that we’re looking at two completely different species here. That’s incredible. That speaks to the strength of the survival instinct, but that’s for another time.

Well, I’m procrastinating again. Gotta hit the books. Wash your hands!

Fight or Flight in America as a Sociological Phenomenon

Crisis Fatigue

The link above is an interesting article. The physiological phenomenon known as ‘fight or flight’ exists in most living creatures, and is deeply ingrained into every human being. It’s a crucial component of the survival instinct, and has been for hundreds of thousands of years, existing as well as in our progenitor ancestors.

As simply as I can put it: Your 5 senses and your intuition will perceive a threat. This gets crunched in your consciousness, a poorly understood concept. This threat then gets sent to your amygdala, a part of your brain, for verification. This triggers a response in another part of your brain, the hypothalamus. The hypothalamus wears many hats (and we really don’t know how), but it kind of serves as a command center for a lot of things. In this sense, it triggers the fight or flight mechanism. Admiral Hypothalamus will activate your sympathetic nervous system, a part of your electrical wiring, which fires up your adrenal glands, which generally have about 8 cups of coffee in them already. Your adrenal glands will freak out and push the panic button, and secrete a number of hormones, mainly adrenaline, cortisol and norepinephrine. The adrenaline will ramp up your blood pressure and your pulse, and accelerate the actions of your lungs and muscles. The cortisol will adjust your glucose (stuff you get from food) to provide a burst of energy. The norepinephrine will flood your brain, increasing alertness and response times. Every other system takes a back seat, including rational thought. At this point, you’re ready to kick some ass. This goes back to the time when our ancestors had to face off grizzly bears. We don’t have to do that anymore (except for those idiots in Yellowstone who want a better picture), but fight or flight is very much with us today, in response to both physical (a mugger, a mean dog, road rage) or emotional (fight with your spouse, boss wants to see you, the principal called) experiences. Eventually, the response will abate, and you are left exhausted and weak.

Problems happen when people are under constant fight or flight, and the response does not get a chance to wear off. This will result in anxiety, depression, PTSD, heart problems, or all of the above.

I know nothing of sociology. However, this article posits the idea that American society has been living under a steady, constant fight or flight response ever since 2020 started. We are now suffering from the effects of 3 social phenomenons that are causing Americans a huge amount of stress. It started with the emergence of a virus we thought we may be able to control, but we were very wrong. Then, racism reared its ugly head once again, when George Floyd (and, let’s face it, he’s not the only one) was murdered by a police officer. This has triggered a massive social disruption of anger and violence. Perhaps worst of all, the federal leadership (dammit, GOP, I hate to say I told you so… I take no glee in his failures) has been fully exposed as incompetent, dysfunctional, and unwilling or unable to rise to these challenges. In fact, our President’s behavior has gotten worse, and it is clear that he is in way over his head. In the meantime, the violence continues, and the pandemic has now killed 111k Americans. At this point, things do not show any signs of significant improvement or healing. As with an individual, problems will arise when the fight or flight response does not get a chance to settle down. We are seeing that now, in the hatred, anger, depression, isolation, anxiety and general “I’m pissed off today” attitude in nearly every American. If things do not settle down, the damage to society, as with an individual, will be massive, and will take longer to heal than we can imagine.

Well, I’m just babbling instead of doing my homework. Sorry for the long post. I better hit the books. Wash your hands!

The Seattle Freeze

I thought I would muse on the cultural phenomenon known as The Seattle Freeze, and the internet community’s hatred of my hometown. You see it pop up now and then. I am a native of the Emerald City (that are not very many of us left), and I have spent most of my life here. Just thought I’d weigh in.

Evidently, my beloved Seattle is not well received by the rest of the nation. Just do a google for ‘I hate Seattle’ and you will come up with tons of results. Most of the time, the criticism focuses on the weather, the traffic, the homeless and drug problems, and, more to the point, the people of Seattle themselves. You read about the Seattle Freeze, and how people are so unfriendly here. People also bitch about the Seahawks. Well, as a native, bleeding rain, let me address the concerns of the world:

First, the weather. Yeah, I get this. I completely understand. The weather here kind of sucks. We get many, many days of little to no sunshine, and, in the winter, the sun goes down around 2PM. The lack of light really can really mess with your head. However, it’s worth noting that most places in America get far more rain than Seattle, annually; they just get it all at once. Our annual precipitation is spread out over half of the year, in that perpetual, gray mist, obscuring the sunlight. I call it living in the cave. Don’t like it? Well, hang in there until March! Another way to look at it is that the atmosphere is simply an extension of the Pacific Ocean’s sprawl. As in, the tide is really in today. Maybe it’s because I’m a native, but the weather here has never really bothered me. We rarely have any kind of winter, and we rarely have inhospitably hot summers. It’s 40-70 degrees here, year round.  The weather is rarely a problem. No heatwaves, no droughts, no massive snowstorms. We do, however, have to deal with an occasional earthquake or volcano, but those are few and far between, thankfully. Our weather, though perhaps not always sunshiny, is generally cool and comfortable. Air-conditioned outdoors. I kind of like it. Ultimately, however, I have to ask: Does anybody wonder why it’s called the Emerald City? Everything is freaking green here! This is a great place to be a plant! You look at the rest of the country; in fact, just drive over Snoqualmie Pass, and you will notice that the rest of the world is kind of dirt-brown. I love the green and gray of Seattle.

Okay, the traffic. I have absolutely no rebuttal here. I am in complete agreement. The traffic in Seattle F*CKING SUCKS. This is an axiomatic truth. Again, I say this as a native, people in this town do NOT know how to freaking drive. This is the only one that really gets to me. This city is not big enough to have New York or Los Angeles level traffic problems. And, traffic or not, people here drive like they are on the Fury Road, on a bunch of crack. Seriously, people. My hometown has GOT to learn how to drive. We are, finally, developing a great light-rail system, but it’s about thirty years too late, and will eventually be finished right about the same time my 16-year-old niece is collecting social security. I took the Link light-rail the other day; it’s great, it makes you feel like you’re in a big city. But yeah, the traffic here is awful, and people drive poorly. I own this; Seattle is a terrible place to drive a car.

Okay, the homeless and drug problems. I can not make any snide or humorous comments here. These are serious, societal problems. It is more than obvious, when you peruse Seattle, any neighborhood, that we have a major homeless problem. There is a lot to unpack here. Drug addiction, mental illness and the lack of affordable housing are plaguing Seattle. However, this does not stop at Seattle’s borders. This is becoming a nationwide problem and should be addressed at the national, federal level. Sadly, with our current federal government, I don’t see that happening anytime soon. All we can do is put a few bandaids on the problem, but until we change how American society addresses mental illness and affordable housing, it’s probably not going to get better in the near future. I wish that the Congressional delegates we hire to send to D.C. would at least attempt to get some federal dollars to come our way to address these issues, as the problem is acute, and people are dying on the sidewalks. Again, we have a homeless problem that is only getting worse, but this is not a Seattle problem, it is an American problem. I don’t have any quick answers, but, last I checked, I am not an expert at anything and I don’t make decisions on how we spend our tax dollars. It is pathetic that the richest and most powerful nation on Earth can’t take care of its most vulnerable citizens. But hey, it’s nothing that some massive corporate tax cuts and a needless war with Iran won’t solve, right?

Alright, the Seattle Freeze. It’s real, I’ve seen it. But on this issue, I can only speak for myself. I am very shy and introverted. I get bad social phobia. I don’t like to go out; I would rather spend time at home, writing, reading, or watching bad movies while I cuddle with my girlfriend. Or I like to get out of the city altogether, which is a great perk of living in Seattle; mother nature is always a quick drive away. Anyway, I don’t drink and I don’t dance. That’s just me; I have absolutely no problem with people who enjoy recreation in a different manner than I do. I am told that I am very pleasant and easy to get along with, which I suppose is true. I like people, I’d just rather spend my free time in a quiet, peaceful atmosphere. I’m no misanthrope, I’m simply just not the outgoing type. Sadly, however, Seattle has a reputation of being full of people like myself, only they take it a few ugly degrees further, and are publically rude, intentionally isolated, and don’t return your phone calls. Well, that does suck. It can be extremely hard for someone new to Seattle to make friends. Seattlites come across as aloof, distrusting, and better than everybody else. Well, I may be aloof, but I usually trust people, and I sure as sugar know that I’m no better than anybody else. I can’t really speak for the city, but we need to fix this. I suppose a good place to start would be by just being nicer to strangers in public. This is easy enough, and I enjoy doing it. You never know what troubles another person may be having that particular day, so it’s a good thing to go out of your way to be pleasant to someone you don’t know. I will at least start there. I would encourage my fellow Seattleites to smile a bit more, and actually say hello to people. You still won’t catch me at the dance club, but we could all stand to be nicer to the people around us.

Lastly, the Seahawks. Richard Sherman is gone! He’s gone! Marshawn Lynch is gone! Sure, Russell Wilson can be a bit too boy-scouty, but he’s not talking trash. Get over it, people! But hey, if the Seahawks are considered one of the NFL’s most hated teams, I’m kind of okay with that. But, whatever, New England. You go right ahead and keep thinking the Patriots are great, even though they cheat their asses off. Whatever.

So, that’s just my two cents. I love Seattle, and it’s too bad that the rest of the country has such a poor opinion of my hometown. Which brings me to my final question: If you know the weather is bad (which it is), if you know the traffic is bad (it definitely is), if you know that the homeless problem is not being properly addressed (we have a lot of work to do), if you hate the Seahawks (12!), then why do people keep coming here?!? Don’t get me wrong; I love that I have watched my small hometown grow into an international city, and the influx of new people, from all over the world, has really created a great cultural scene, but is the rest of the country really that bad? Well, feel free to set me straight, and I’ll post again soon. Take it easy, everybody!