Cynthia Faires Griffith, MPAS

All the Fam came in this weekend for my graduation. It was a great weekend to see everyone and get graduated!

 Me and Mom before my Grad Party at P F Changs. 

 The sis and bro-n-law joining me and Mr. 

 Of course most of the grad picts of me in my regalia are grainy... donno. But here is the dipolma to prove it! 

Modeling the hood. 

Now I am off to hibernate (study) for the week so that Friday I can add the PA-C. 

So much to be thankful for...

As the year wraps up, I must write and say that this year more than most are so many tangible reminders of how much I have to be thankful for.

This time next week I will have graduated with my Masters! I can't believe that almost three years have gone by since I started. To anyone thinking of undertaking grad school know this time flies so that is a big pro for doing it. Also, I can't believe that I got married during grad school. (More evidence to me that you can't predict how your life is going to go...)

Anyway I will be getting graduated with my lovely wonderful family around me. The first of January we are heading to Indonesia for the first time with the Hubbies which will be an adventure. And then when we get back I should be starting my new wonderful job! (more on that to come in a later post but lets just say dream job...)

My lessons for 2011:
-Go with the flow but do your best
-Let the little things go
-Celebrate
-To want less

Volunteering

Today I spent the day volunteering at the Aids Interfaith Network (someone made me, I am not that good of a person, though I wish I could say I was!). It was a great and humbling experience. I must confess that I was the world's worst volunteer. I did way more socializing than "volunteering."

During the morning I played Farkle with some of the patrons of the facility. This facility has an adult day care program. Basically a place where people can come throughout the week and spend time socializing, playing games, and also getting a couple home-cooked meals.  This provides respite care to family members who are the full-time caregivers of these people and socialization for homeless individuals who would otherwise be on the street.

After two rounds of getting trounced in Farkle, it was time for bingo. I have never played this competitively so I had some learning to do. One of the patrons S. taught me that you never clear your card until someone yells "Clear your card." Just because someone yells Bingo does not mean that they have won, they may have the wrong numbers covered by mistake and then if you have cleared your card you can't continue when the game resumes! The last bingo prize was a bag of white cotton socks. A man at our table St. remarked, "man, I want those socks. You always need some good socks." That broke my heart. Socks?!

I came home and decided I was going to bag up some of mine and Mr's warm clothes and donate them when I go back on Thursday. In about 10 minutes of shuffling around in the garage and closets I had 6 wal-mart bags full of clothes for the shelter.

Mr. and I are not fashonistas by any stretch of the imagination. But even so we have 4 closets in our house and all of them are filled to the brim with clothes. I counted in Mr.'s side of the closet he has 42 dress shirts! 42! (excessive I know and he doesn't wear all of them).

It is so easy for me to think about what I want that I don't have. Uggs, hardwood floors, a new car... But I was so thankful for today. Because it made me look outside myself and my problems and my wants and needs.

Volunteer your time, give an old coat to a shelter, bring a bag of food to a food bank. You will get more than you give. 'Tis the season!

ER: PA school reflections

Mostly in the ER you see people on the worst day of their life. 
I put staples in a guy's head who woke up drunk in the ER and had no idea how he got there. 


I saw a guy who lost both his legs after being run over by a fork lift.


I had to tell a lady that for the fourth time she was having a miscarriage. 


Mostly in the ER you see people on the worst day of their life. 


I stitched up a 45 year old African American lady who had been in a car wreck. Her daughter had been driving and hit the brakes. The daughter was fine but my patient went into the windshield and we thought initially that her face was fractured. Luckily it was all just swelling and lacerations. I sewed up her lip and her hand. To pass the time, we talked about where I was from and where she grew up. A week later I heard "Dr. Longview" being called across the ER. There sat this beautiful lady in a white sundress. She had come back to have her stitches taken out. The swelling had gone down and I was able to see her pretty face. She told me thank you for talking to her and stitching her up so nicely. I couldn’t help it, tears started to well up. No one ever came back must less told me thanks before. It was so fulfilling to see someone look so much better, so much more whole and normal.  It was a wonderful experience and really helped my work in the ER come full circle. 

PA Reflections: Surgical Oncology Rotation Mrs. M.

I don’t often write about encounters gone badly. But, honestly I don’t really have a lot of insight into when encounters go badly.

Mrs. M is a 47 year old with metastatic breast cancer who was sent to our office for a consultation for palliative mastectomy. Those two words seem diabolically opposed to me. Basically her disease was likely going to overtake her in the not quite forseable future. She was undergoing chemotherapy and her disease was stable, not advancing. However, it was so diffuse initially that this was not entirely hopeful news.  The medical oncologists thought I guess was that in select cases of metastatic disease removing the primary site can prolong survival. (not cure the patient was increase their lifespan).  However, in my attending’s quick and appropriate judgment the decision was no or at least not yet until further medical treatment could be employed to shrink the primary tumor further.  

Let me back up to my role in the encounter. I rushed in. Spanish speaker ok, Lo siento Me espanol es muy mal. I checked off the breast CA risk factors she had, asked about new complaints, and did my physical. I didn’t explain why I was there or ask her why she was at our clinic.

When my attending shared her assessment with Mrs. M, she burst into tears. Thinking back over the encounter I realized Mrs. M I never asked Mrs. M why she wanted the surgery or what she thought the surgery could do. What if Mrs. M. thought this surgery was going to cure her. . . We decided to wait on the surgery because it was not in her best interest, it could make her last months more painful, the surgery would be extensive due to the size of her tumor and this may be a bigger risk to her health than if the breast stayed. We decided to wait until the last rounds of chemo and further medical treatment that was planned. If the tumor shrank at that time the surgery would be a better option. However, I didn’t even understand all of this until the Doctors explained this to me. So what if she thought we were saying no we were not going to do this not because we didn’t want to… We never asked. We didn’t explain our rationale.

I just finished a book about communication in healthcare. But it didn’t sink in. I failed Mrs. M. I didn’t realize it, the sleep deprivation and stress of being uncomfortable on my new rotation let me get in the way of my strengths compassion and communication.

PA reflections: Surgical Oncology Rotation

Monday I start my 3.5 wk Surgery Oncology rotation. From all reports it is doubtlessly going to be long hours, six/seven days a week, with people who are less that Mr. or Mrs. congeniality. I am not super excited, actually I am probably closer on the spectrum toward dreading it (the most of all the rotations this year).

But bright points are:
--It is only 3.5 wks long
--I will be ale to come home everynight, even if it is just for a couple hours of sleep.
--It will be something new and different.

Wish my luck but after monday just know I probably will not be blogging much for this next month!

Book Review/reflection: The Spirit Catches you and You fall Down.

This morning I finished this book. It is a less popular/main stream book than I normally am drawn to. However, the book was very interesting/applicable to me.

The book is a nonfiction investigation into the life for a family of Hmong refugees living in Southern california who have a daughter with Epilepsy and the doctors that are trying to cure this little girl of her disease. The book is about cultural miscommunication/ Eastern medicine vs. Western medicine.

Being in the medical field sometimes I feel pressure to be God. I don't think I am alone in this feeling, as evidence by Lia's Doctors in the book. We feel it is our job to cure, to heal, to know all the answers. But medicine like anything else is often times not black and white. Solutions to problems can be problems themselves. Lives are precious, but sometimes in an effort to save medical intervention can make things worse.

The book is a beautiful complete look into the lives of the doctors, nurses, social workers, and family involved. As a healthcare provider it was wonderful to read. Medical Education in this country teaches us to treat diseases, teaching us pathopysiology to explain to our patients how diseases affect our bodies and how the medicines we will use will restore new order. However, how does this translate to a culture where Epilepsy, a condition that called in Hmong is "The spirit catches you and you fall down,"  is caused by lossing your soul to an evil spirit.

Medicine focuses on life, preservation of life, sometimes at the expense of dignity. Not once was I ever taught about any treatments that heal a soul. Western medicine preserves life, there are many cases where without it people: life, soul and all would expire. However, I think most of us would agree there is more to life than just an EEG or EKG reading. This book is a beautiful, mind bending, heart wrenching look into these struggles. For health care professionals who deal with this everyday. It is an invitation to look over these tough things again. For people like Mr., next in line to read the book, hopefully it is a glimpse into what I struggle with during my 9-5 life.. or more like 5:30-6 life. Things that sometimes you shut out as you come home because the burden is too great.

PA reflection: The Veteran's Hospital

This week I started a new rotation at the Veteran's Hospital in Dallas working in the Infectious Disease department as part of their consult service. Also on Wednesday and Friday afternoons I see patients in the Immunosuppresion clinic.

Rotations are a funny part of life/PA school because you are constantly in a state of flux/change. (BTW if you didn't know, I hate change). You spend 3.5-8 weeks at one place and then you are on to the next thing. The progression goes about like this-- deer in the headlights, to competent clinician, to saying your goodbyes and repeat. I just spent the last ten weeks of my life in family medicine. . . The work wasn't really hard or mental invigorating, the hours weren't long. So I don't mean to tell you that I work hard currently but working 8:30-4:30-5ish, eating lunch at my desk, always thinking about what I haven't thought of yet and what I am missing has made for long days this past week. However, I truly love it at the VA. I liken it to a circus. Every day before I am in the building I pass the crossing guard who waves and says things like, "Hey doc, looking good." "Hey doc, think of me it is going to rain on my today." "Hey doc, you have that seat in your car pulled so far forward!" I got a pat on the back this Friday. Needless to say I can't help but smile walking into the VA (veteran's administration). I walk past a popcorn stand, boombox blasting music, a player piano, a canteen (anywhere else it would be called a cafe).  If you wear a white coat at the VA you can't walk with your head down like I normally do in the hospital, consumed in my notes, thinking about the next person I am going to see... nope you have to walk ever aware of your surroundings because everyone you pass says, "Hey Doc" "How you doing, Doc" "How's your day, Doc" When I weakly tried to correct the first gentleman "saying I was a Physician Assistant student" he just smiled at me with a couple teeth missing and said "good luck, Doc"

This isn't why I love the VA though. I love the people and I love the work. Infectious Disease sounds exotic and some of it is Histoplasmosis, or Rocky Mountain spotted fever, or the Bubonic plague (yup still exists). But mostly it is HIV and Hepatitis. The Immunosuppression clinic on Wednesdays and Fridays is almost entirely HIV patients.

I had never met anyone with HIV until my first day on my ID rotation.

He came in so sick with Disseminated histoplasmosis, an AID's defining illness.
(just as an aside to keep this story interesting to people not in a medical profession: That just means ... there are certain diseases that are more common in people whose immune systems are compromised. When you see them in patients without HIV, as a good clinician you need to test that person for the illness.) This man did not know that he was HIV positive. His first night in the hospital, his wife calls and says she is sorry, for years she has been treated for HIV and though they have been having unprotected sex she never told him.   

I love the work. In college, I studied psychology. Alot of psychology is about combating stigma... stigma about the profession, the patients you treat, the illnesses. So I am used to stigma.
Stigma is the most interesting thing about my work at the VA. As a health care professional, I can say with first hand expertise (although probably not the same expertise as nurses, whom I would consider the experts in this field) there are many gross diseases. (So unprofessional I know) But there is a long list of things the little girl inside me thinks are super gross that I see and treat every day. Sometimes I smile thinking about how my mom wanted me to go into medicine like it was so academic or scholarly. As an engineer she had no idea...

But I really can't get my head around all the stigma associated with HIV. One of my goals for this rotation is to learn how to communicate with HIV patients professionally, being aware of privacy issues and in a way that dispels stigma and judgement. Because truthfully, I feel neither of those things when I am with my patients. They are all patients with illnesses that need treatment and luckily treatment has advanced to a stage that we are able to help patients live long productive happy lives.

In one week, I have already learned so much from my patients about medicine, HIV, and humility. I love the work. Working with people how have given so much for our country and now I get to take care of them. I see my Papa Carl in each one of my patients. Growing up, he would drive 3 hours to go to the VA in Oklahoma. He had the same quiet respect, joking manner and history of service that these men do.  I love the work I do.

More reflections from the other side of the white coat...

Ms. H was not an unusual patient. She had an exacerbation of her systemic sclerosis. She needed a feeding tube placed on our service in preparation for a J tube. Her esophagus and stomach were so inflamed that Ms. H was unable to eat or even drink much without becoming nauseous and vomiting. She was on our service a short time but her case is similar to others I have had. These cases force me to struggle with a difficult part of medicine: treating symptoms to palliate the progression of a disease that we as practitioners cannot cure. I struggle with this because I want to study and learn and practice to heal people, not just help them cope with a disease. On my medicine rotation several times I came across cases like Ms. H’s where there was nothing we could do to cure her or reverse the trajectory of the disease. She asked me what to do one morning, what I would do if I were her and would not be able to eat again. I advised her to have the feeding tube placed and then the J tube when the surgeons thought she was ready. This, I told her would prolong her life. I said I didn’t know about being able to eat regularly again, but certainly not in the immediate future. I felt in that moment, we both wanted something more. I wanted to give her a better option. One that would let her go home and eat what she wanted again. Maybe she wanted the same.

It wasn’t the end of Ms. H’s life but you could call it the beginning of the end. I knew that, I think she did too without me telling her. In medicine today, we have so many cures for things. I am more and more thankful for those instances in the hospital because increasingly what my team seemed to be battling was chronic conditions like COPD or CHF or in Ms. H’s case Systemic Sclerosis. Medical management can in these cases elongate life, but not change the trajectory. It is in these instances that my education took a different path. Instead of learning about TIMI scores and maintenance fluids formulas or antibiotic spectrums and specificities, I was learning how to experience sorrow with someone at the loss of being able to eat.

In true form: Internal Medicine in Review

Of all rotations, I was most apprehensive about Internal medicine at Scott and White. I was scared of moving to a new place, away from my husband and my dogs and the comforts of home, as well as the magnitude of knowledge required just to get by. Before the rotation, I was certain I would work in a clinic setting post graduation. I liked the 8-5 life and the comfort of always working with the same people and getting to know patients and families as they grow. After spending two months at Scott and White, I realized my preconceptions about this rotation were all wrong.

Instead of being something I just had to get through, Internal Medicine became my favorite rotation and the time flew by. I did not mind the long hours and would often be the last student on my team to go home because I wanted to take on more patients. Internal medicine is a unique rotation because you get to see everything in medicine. I was never bored and always curious. Above all, I learned to think on this rotation. I was a valued part of the team and became more and more able to put my plans into action.

This is also the first rotation I had experiences with death. I made an objective to hear and experience end of life issues during this rotation. I made an effort to go with my upper levels to hear the discussions with families. However, these experiences were nothing like the first experience with my own patient. I remember when Mrs. M. came in to the hospital for decreased energy. My differential was small, she was eighty-nine and had eaten like a bird for the past week. My plan was hydration, Ensure and a medicine to increase appetite, PT/OT and home. We found she had a UTI and treated it and she was getting more of an appetite and improving. She was going to go to a skilled nursing facility but could not go over the weekend so we kept her until Monday. On Monday she was constipated, we kept her a couple days to try and resolve the constipation but then it turned into a small bowel obstruction. KUB led to CT and we found a mass in her pancreas and addition metastases to her liver. All I could think about when that report came back was the first time I met her in the ER. Mrs. M died within the week. I did not realize this was going to be the last time she came into the hospital. I did not think we were going to be her last doctors. Waking someone up every morning for more than a week makes you feel a connection to them. I enjoyed being part of a hospital team. I got to experience so much with my patients and their families over a very limited time.

I have learned so much on this rotation about treating people and practicing medicine. It was bittersweet to leave. I enjoyed my time at Scott and White.

Family Pictures

I have been in Temple, Texas at Scott and White doing my internal med rotation. It is alot of long hours and I have no internet at my hotel. I wanted to post some pictures from our Family photo shoot Thanksgiving. Abby with Sweet Fix is an amazing photographer.

Sick Day

I never know when I should (rightfully) succumb to my illnesses and call in sick. The people pleaser in me just makes it two (read too) hard. But when you wake up and can hardly talk and just think well I guess I can spend the whole day studying instead of going to the office that is sick! and pathetic.

I hate staying home. The walls start to close in ... so inevitably I will leave the house which I feel is a strict violation of the sick day privileges. Also, I try to be productive, clean, do errands I need to do on a business day and then my "day of rest" turns into a more busy day than if I had just gone to work.

Also, what is the sick day supposed to accomplish. I try to think well thoughts but inevitably the virus/or bacterial in this case illness will probably just run isn't 7-10 day course (I am on day 7 today so here's to hoping 7 day course!).

What I loved was sick days when you are little and that means all day with mom being pampered and watching TV and eating liquid things... As an adult it means you are woken up by your alarm clock which you put on snooze every 10 minutes because you are in too much of a haze to turn it to dismiss, then your husband calls to see how you are and you can barely form words (this is common every day before I have had my coffee but with this sore throat I am even more indistinguishable.) Then you get up put on dress clothes and psych yourself up for another day until... All the head congestion hits and you look at the clock and realize you have snoozed one two (read too.. I'm sick give me a couple typos!) many times and you should be there now. O well change into PJ's and succumb to the beginning of a marvelous sick day. Which must begin with a blog post!

Teen and Pre Teen Self Esteem Help

I have become accustomed to a certain type of patient and visit. The 9-13 year old girl who is overweight. It breaks my heart because I see alot of myself in this population. I weighted more in the fifth grade then I do now. I was chubby due to the fact that my family valued school and academics more than exercise or playing sports.

It is so hard for me to watch these encounters because the girls are so self conscious and shy about their weight. I need advise: how do you broach the topic of increased exercise and being overweight with a preteen or teenager without making them feel worse about themselves.

Not a regular post

Yesterday at the Gyn clinic I experienced the saddest thing I have yet on rotations. A friend of mine always said to not run away from sadness but just to walk into it and embrace it because it is a feeling to. Since it is a part of healthcare and life I thought I would write about it even though I do not think of myself as someone who likes to say things that are sad. My instinct is to jet.

The visit started out good. Measuring the fundal height (the height of the uterus, a hint at gestational age). I listened to the heart and lungs. We did the pap smear and went to sono. I am standing over my Dr.'s shoulder looking at the screen and the mom is situated looking at a huge plasma screen projection (the facilities are so nice). We located the uterus, the gestational sac. By located I mean I saw this on the screen. There is never any narration till the end of the sono (at least in my experience with this Dr. (i have seen others that do narrate)). We locate the less than 10 week fetus/gummybear. I knew something was wrong when the Dr. turned on the Doppler (an instrument used measure the flow of blood flow through vessels.) The Dr. was confirming what he already knew.

I must break away here and say that the number of miscarriages is in the highest sites in the literature about fifty percent with alot of them happening within the first 4 wks before someone even knows they are pregnant. It is a way more common thing than I think lay people realize.

The Dr. solemnly proceeded to tell the new mom that there was no heart beat and that the pregnancy would not progress any further. He now narrated slowly and quietly what he saw on the Doppler and the sono screen. As the tears rolled down the silent mom's face, I thought of my mom and several friends of mine who have had some Dr. give them this same news probably in the exact same way. I thought of myself someday full of hope and excitement sitting in the sono chair and I, with all my might, held the tears back from falling down my cheeks.

New life is such a miracle. All the things that have to be perfectly orchestrated that sometimes we take for granted for a baby to be born healthy.
I hesitantly post this my intention is not to make your day sad.

Labor and Delivery

So my first week in OB is over. I get one day off a week so I am trying to enjoy it. Mr. thought it was tomorrow so he was going to get all this stuff done today so we could spend the day tomorrow together. The end result I am solo today :) but I kinda like it.

I am working at Parkland hospital where the most babies are born in the world. 1 in 24 texans and 1 in 250 new americans. We have mom's pushing in the hallways, when beds run out... (crazy).

so summary of the first week's thoughts:

the rotation is awesome. I feel so lucky to be able to watch, help with baby's being born everyday. But it is LONNNG hours. I don't know if I like the hospital dynamic as much as I thought I would.

Addison Montgomery is a superhero doctor because no one works emergently on Mothers and Babies. That is why you have OBGYN and Pediatrics (never thought about this). OBGYN's catch the baby and punt to Pediatrics. One of the scary intervals for me, I find myself holding my breath, is the time between that punt and when I hear the baby cry.

new skill - Knot tying. I have learned the two handed knot. Mr. (my eagle scout husband) calls it a lancet knot. I practice it all the time because I don't want to forget.

Looking forward to learning the one handed knot.

My verdict on the viability of Labor and Delivery as a post-PA school job option: I don't think so. It is cool to be able to say you helped 2 babies come into the world today, but it is hours of waiting and then seconds of terror. And the hours are so long.

What I have gotten to do/see: sew up a laceration, watch one vaginal delivery, 3 c-sections, watch and do ultrasounds, use some spanish

What I hope to do: cervical exams, catch a baby, use more spanish, tie a knot!

Pre-Rotation Jitters

After some self-reflection I have realized my way of dealing with stressful,overwhelming things is to focus the majority of my worry on one small distinct entity. With rotations looming what am I most concerned about at this point? Long schedule? looking like a fool? know the burning questions are when am I going to eat, and what. I am a Faires. It is a valid concern I think getting up at 3:00 a.m. when does one have breakfast and what about coffee. But no reasonable person would be worring about this when there are bigger fish to fry! I just thought my way of dealing with this new stressor was interesting.

Siesta = Fiesta

I get precious little time off during the 36 months of PA school (Officially the end of didactic year!). Tomorrow begins my two weeks of summer break before rotations. During the break these are my plans:

• Go to Fayetteville with the Hubby to show him the Farmer's Market, Willy D's, Dickson St, JBU, and secretly accomplish my plan of helping him fall in love with the place so we can move there!
• Catch up on my thank you note writing at a fun coffee shop downtown I have been meaning to try
• Shop! for new pants and shorts (I need pants that fit, I have been wearing my sis' pants because I haven't been shopping since I lost a lil weight)
• Read!
• visit my sis in her new Metropolis
• be a better wife and actually cook B/L/D for my Mr.
• Go to the Turbo Kick class at UTSW that I never get to attend Wed's at noon!
• Hopefully get to spend some time with friends that live here in the Metroplex that I have been too busy to connect with lately!

So excited!