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A Day in the Life

Dawn Colomb-Lippa, PA-C

The author is Professor of Physician Assistant Studies at Quinnipiac University, Hamden, Connecticut; practices orthopedics at Tribury Orthopaedics, Waterbury, Connecticut; and is a member of the JAAPA editorial board. She has indicated no relationships to disclose relating to the content of this article.

Many years ago, when I was planning a career change, I knew one thing for sure: I wanted to teach. I knew that my next move had to put me in a field in which education was guided by practitioners. I wanted to be able to help students learn what seemed unlearnable—and for me, that was teaching gross anatomy. Now I spend my days playing multiple roles: PA professor, orthopedic clinician, and mother. There is really no such thing as an “average” day in my world, but here I try to describe as close to my average day as I can.

6:45 AM

Today is the first day of lab, and I should be on my way, but I forgot my notes, as usual, and so I have stopped off at the PA program. A full hour before lab is supposed to begin, a small group of unfamiliar faces is gathering here in Hamden—but the lab is downtown in New Haven. I guess they are carpooling. These students, although unknown to me now, within 2 weeks time will be as familiar to me as my own children. We are about to begin a semester of Human Anatomy together, which will bind us in a shared experience forever. My role as an academic advisor begins early this year, as one of the students on my list seems anxious. “Can I talk to you for a minute, Prof Colomb-Lippa?” He doesn’t know yet to call me what everyone does: Prof CL. After some sputtering, he confides that he is nervous about dissecting an actual human. His grandfather just died this spring, and he thinks the dissection might be difficult for him. I advise him to keep his mind on the science of the dissection and to try to remember how supportive his grandfather would be of him as he begins his training as a PA. And, as an afterthought, I ask him to let me know if he is going to pass out. He seems to feel a bit better, but we’ll see.

7:15 AM

I park in a municipal parking lot and begin the quarter-mile hike to the lab. My backpack is filled with a portable autopsy saw, scalpels, a change of clothing, and a human skull. I hope to high heaven that I don’t get frisked by one of the New Haven bicycle cops. When I get to the lab, I am greeted by the mortician, a man I have known for 11 years now. He tells me there is a crowd of nervous-looking young adults forming outside the lab. Without having met them before, it is clear to me that they are our new PA class. Bright faces, eager to learn, with a slight hint of fear. “Good,” I think. “They are ready to begin.”

7:30 AM

I have changed, and I enter the lab. Not one of the now over 50 students in the hallway follows me. Entering the lab alone, the quiet feels almost holy. It may seem strange, but this feels like home to me. I open the lab table and begin the process of unsheathing the cadaver. The students’ faces pop into view through the small window in the door. I signal for them to come in. Slowly, they filter in, some in scrubs, some in T-shirts with obscure sayings on them. I am getting old, no doubt. The students register that I am now standing in front of a prosected dead human. I assign them to tables in groups, and the realization of the fact that they, too, will be dissecting a human is evident on their faces. I spew the opening phrases of lab, including the rules and regulations, the need for respect of the body, and an overview of the tremendous task we are about to begin. My lab instructors help the students open the tables and meet the gift that has been left to them by people they will never meet.

2:00 PM

The entire class survived the first cadaver lab unscathed, including my advisee who lost his grandpa just before arriving at PA school. The students have completed the full posterior dissection of muscles and the spinal cord, and now they change their clothing and leave for another class on campus. I feel bad for their EKG professor because I know the class is tired and they smell. A student stops to ask me if she can make an appointment to meet just to be sure she gets off to a good start in her summer classes. She quietly confesses that she has a learning disability and she doesn’t want to fall behind. We set a day and time to meet. This is a proactive student, I think to myself, but she has a long haul ahead of her. I will refer her to the Learning Center, among other things.

I clean up, make a quick phone call to the PA program to be sure that no students have withdrawn after today’s muscle and bone marathon, and change my clothes in order to head to my clinical job as an orthopedic PA.

3:00 PM

Generally, I am nearing the end of my 9-hour clinical day by now, but today I am coming in to see a few quick patients who were scheduled to see one of my supervising physicians. A trauma threw off the OR schedule, and Dr. F. is just beginning the arthroscopy that was scheduled for 10:00 AM. I start with Mrs. M., an older woman who is known to the practice for years now. Her degenerative joint disease has worsened in her right knee. It’s time for a replacement, but like so many folks in her situation, she is 100 pounds overweight and pushing a deadline: her son is getting married in 2 months, and she would like to be mobile for the event. I give her a steroid injection and set her up to come back in 2 weeks to talk surgery with the doctor. I know the steroid will do little good, but it will give her time (and evidence) to decide on a replacement sooner rather than later.

3:15 PM

Two quick viscosupplementation injections and on to Mr. F., a 14-year-old runner with hip pain. I am meeting him for the first time today, but it is clear to me that his mom is worried about his complaint and equally clear that he is not going to stop running anytime soon. His exam shows some joint laxity, asymmetry of hip alignment, and a thoracic scoliosis. When I mention the “s” word, his mother becomes even more concerned. The patient’s sister had terrible scoliosis requiring surgical correction, and Mr. F. just “passed” a scoliosis screening at school this week. I send him off for some x-rays. I’ll call mom tomorrow with the results, which no doubt will be positive.

3:45 PM

A phone call: Ms. C. just had a mini-open rotator cuff repair, and she wants to know if she can take off her sling. Also, she has questions about “what exactly was done” in the operating room. This will not be a quick one. I convince her she needs to wear that unfriendly sling for another 4 or 5 weeks; and I give my best simplified explanation of the functional anatomy of the rotator cuff (a subject covered in several hours of lab and lecture for my PA students), followed by a crash course in the use of biodegradable anchors in cuff repair (a subject covered in years of orthopedic fellowship). She buys it. I will see her next week to get her stitches out and start her in PT.

4:00 PM

An add-in: Mr. R., a patient of ours, has fractured his foot at work and was seen several days ago in the emergency department. He brings his films with him, which show a Jones fracture of his left foot. He has never been told he has diabetes, but he also does not see a primary care provider. He says that he has “circulation issues,” which spells “undiagnosed diabetes” or “peripheral vascular disease” to me, either one a bad indicator of this fracture’s ability to heal with conservative treatment. I talk to him about the options and the possibility of failure of conservative treatment. Nonetheless, he does not want to have an operation if not needed. I put him in a nonweight-bearing short leg cast as a trial and give him crutches. I’ll see him in 3 weeks and see what’s going on at that fracture sight. My fingers are crossed!

4:15 PM

Mr. R. was my last patient of the day, so I have a quick look around to see the mess of charts and equipment I need to straighten up. “Leave it, I’ll get it,” I hear. Thank goodness for our wonderful medical assistants, because I do have to shoot out and get my 4-year-old from day care and meet my 6-year-old at the bus stop. Now I begin my third job: mother. This one pays very little, but the benefits are amazing. And I think there may be room for advancement (grandmother!).

7:30 PM

I put my daughters to sleep and quickly check my e-mails—which often is a mistake. I have 24 new messages since 2 PM, and many of them are from students. Most have questions. Which atlas is best for comparing structures? What is the Web site for ordering those thick gloves? One catches my eye. In the subject line, it says “thanks.” It’s from my advisee. He wanted to thank me for meeting with him this morning. He was nervous, but he did fine in lab and is really excited to go to open lab tomorrow night to review structures. He also says that I was right—his grandfather would be proud of him—and he thanks me again. I am glad I checked my e-mails. JAAPA