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PopPen MPAS, PA-C

@populationpensive / populationpensive.tumblr.com

Co-founder and organizer of #PAblr on tumblr. Currently working in critical care. Formerly in burn medicine Crafter. Rabbit lover. Avid reader. See FAQs for questions - if not answered, ask away! This is a medical blog which details MY journey to becoming a PA-C, as well as a platform to connect with other people interested in the profession. Though, there are *some* pics of bunnies. Or science puns. You get it. ;-) **I do NOT give medical advice** I do write educational content for other providers and students. HOWEVER, I am more than happy to answer GENERAL health related questions or questions about my job/specialty/etc. Just don't ask me if you should see your provider for that mole on your back or something- if you are asking, you should go.

This is oaywalled but it made me weep with relief to see an honest recounting for once, so Iโ€™ve saved some good bits:

He's also not wrong about that last part. Or any of the other parts, but especially that last part.

There are of course potential genuine fanatics, the people so batshit they don't care - but they were already a risk and they were already looking to find people like him, so the risk with them remains stable.

What's important is that we know about him.

Iโ€™m really over social media posts about how you shouldnโ€™t listen to this problematic band or watch this problematic show or youโ€™re a bad person. Well I really couldnโ€™t give a shit.

My take on this is that nothing should be censored or canceled. You can watch or read something and get value from it. That value might be recognizing the bias the creator has or learning something from it. I can read Mein Kampf and not be a Nazi. I can watch House of Cards and recognize that Kevin Spacey is a predator.

Once we (as a society) start vilifying people for certain types of media consumption, we go down the slippery slope of censorship. That never leads to a good outcome. Ever.

Me: I don't get it. I thought I was doing a lot better than I was a few years ago. I'm like 10 times more on top of things than I used to be. How does everything feel terrible now?

The Tiny Me in OSHA-approved Hi-Vis Gear Who lives in my brain and pulls all the levers: Boss, it's the fascism. You're completely gunked up with cortisol due to the fact that your entire daily life is now underscored with a haunting awareness of the rapid erosion of your rights, dignity, and any and all social safety nets, and you're also bearing witness to the most vulnerable people immediately being persecuted. This creates a natural stress response that basically means you're going to continue having memory and organizational problems, as well as emotional imbalances.

Me: BUT I HAVE A BULLET JOURNAL AND I MEDITATE NOW.

Tiny OSHA Me: BOSS, THE FASCISM.

[video description: a video of a baby fox playing in a graveyard. end description.]

its okay babe i know things are pretty bad but one day a baby fox will frolick over our bones. the rubble, the decay, the decline....it will all be beautiful again

"The number of hours we have together is actually not so large. Please linger near the door uncomfortably instead of just leaving. Please forget your scarf in my life and come back later for it."

poem by Mikko Harvey

Today an elderly patient's daughter asked if I could guarantee that the blood I might need to give to the patient (in case the patient is actively bleeding out during the surgery, which had a pretty high chance of happening) is from a donor who hadn't been vaccinated against COVID.

Not gonna lie, I needed a moment to recover from that

There's been hesitation prior to patients getting bone marrow transplants that didn't exist before.

Typically you get all your childhood vaccines given to you again with new bone marrow.

When patients decline (still a tiny minority), some services then have to say well, we can't offer this too you, because the risk of dying is high and the resource is so finite. But it's the reality now.

I just can't.

We are practicing medicine in a country of cromagnons.

I had a patient do this recently. It was the most ridiculous thing I had ever heard. The patient and the family were conspiracy theorists on a level I hadnโ€™t encountered. Completely bonkers.

"Beam me up, Scotty"

Pt 1: *to a room of other psych pts* Your leader has arrived!
Pt 2: You ain't our leader! Who said that?
Pt 1:Why, I made myself your leader. Put your foil cap back on! I keep telling you to keep that thing on so you don't go crazy.
Pt 2:I ain't got no cap, you fool. You got the cap.
Pt 1:I keep telling you, wear you tin cap.
Pt 2:I don't need that. Watch out they'll beam you up!
Pt 1:"BEAM ME UP, SCOTTY!!!!!!!!!!!!!!!!!!!!!!!!"

From the Archives: All Aboard

This was from my days volunteering in an inpatient psych unit. I forgot how rewarding and amusing it was.

March 9, 2025

Mar 10, 2025

Lately, political writers have called attention to the tendency of billionaire Elon Musk to refer to his political opponents as โ€œNPCs.โ€ This term comes from the gaming world and refers to a nonplayer character, a character that follows a scripted path and cannot think or act on its own, and is there only to populate the world of the game for the actual players. Amanda Marcotte ofย Salonย notes that Musk calls anyone with whom he disagrees an NPC, but that construction comes from the larger environment of the online right wing, whose members refer to anyone who opposes Donald Trumpโ€™s agenda as an NPC.

Inย The Cross Section, Paul Waldman notes that the point of the right wingโ€™s dehumanization of political opponents is to dismiss the pain they are inflicting. If the majority of Americans are not really human, toying with their lives isnโ€™t importantโ€”maybe itโ€™s even LOL funny to pretend to take a chainsaw to the programs on which people depend. โ€œWe are ants, or even less,โ€ Waldman writes, โ€œbits of programming to be moved around at Elonโ€™s whim. Only he and the people who aspire to be like him are actors, decision-makers, molding the world to conform to their bold interplanetary vision.โ€

Waldman correctly ties this division of the world into the actors and the supporting cast to the modern-day Republican Partyโ€™s longstanding attack on government programs. After World War II, large majorities of both parties believed that the government must work for ordinary Americans by regulating business, providing a basic social safety net like Social Security, promoting infrastructure projects like the interstate highway system, and protecting civil rights that guaranteed all Americans would be treated equally before the law. But a radical faction worked to undermine this โ€œliberal consensusโ€ by claiming that such a system was a form of socialism that would ultimately make the United States a communist state.

By 2012, Republicans were saying, as Representative Paul Ryan did in 2010, that โ€œ60 Percent of Americans are โ€˜takers,โ€™ not โ€˜makers.โ€™โ€ In 2012, Ryan had been tapped as the Republican vice presidential candidate. As Waldman recalls, in that year, Republican presidential candidate Mitt Romney told a group of rich donors that 47% of Americans would vote for a Democrat โ€œno matter what.โ€ They were moochers who โ€œare dependent upon government, who believe that they are victims, who believe the government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you-name-it.โ€

As Waldman notes, Musk and his team of tech bros at the Department of Government Efficiency are not actually promoting efficiency: if they were, they would have brought auditors and would be working with the inspectors general that Trump fired and the Government Accountability Office that is already in place to streamline government. Rather than looking for efficiency, they are simply working to zero out the government that works for ordinary people, turning it instead to enabling them to consolidate wealth and power.

Todayโ€™s attempt to destroy a federal government that promotes stability, equality, and opportunity for all Americans is just the latest iteration of that impulse in the United States.

The men who wrote the Declaration of Independence took a revolutionary stand against monarchy, the idea that some people were better than others and had a right to rule. They asserted as โ€œself-evidentโ€ that all people are created equal and that God and the laws of nature have given them certain fundamental rights. Those includeโ€”but are not limited toโ€”life, liberty, and the pursuit of happiness. The role of government was to make sure people enjoyed these rights, they said, and thus a government is legitimate only if people consent to that government. For all that the founders excluded Indigenous Americans, Black colonists, and all women from their vision of government, the idea that the government should work for ordinary people rather than nobles and kings was revolutionary.

From the beginning, though, there were plenty of Americans who clung to the idea of human hierarchies in which a few superior men should rule the rest. They argued that the Constitution was designed simply to protect property and that as a few men accumulated wealth, they should run things. Permitting those without property to have a say in their government would allow them to demand that the government provide things that might infringe on the rights of property owners.

By the 1850s, elite southerners, whose fortunes rested on the production of raw materials by enslaved Black Americans, worked to take over the government and to get rid of the principles in the Declaration of Independence. As Senator James Henry Hammond of South Carolina put it: โ€œI repudiate, as ridiculously absurd, that much lauded but nowhere accredited dogma of Mr. Jefferson that โ€˜all men are born equal.โ€™โ€

โ€œWe do not agree with the authors of the Declaration of Independence, that governments โ€˜derive their just powers from the consent of the governed,โ€™โ€ enslaver George Fitzhugh of Virginia wrote in 1857. โ€œAll governments must originate in force, and be continued by force.โ€ There were 18,000 people in his county and only 1,200 could vote, he said, โ€œ[b]ut we twelve hundredโ€ฆnever asked and never intend to ask the consent of the sixteen thousand eight hundred whom we govern.โ€

Northerners, who had a mixed economy that needed educated workers and thus widely shared economic and political power, opposed the spread of the Southโ€™s hierarchical system. When Congress, under extraordinary pressure from the pro-southern administration, passed the 1854 Kansas-Nebraska Act that would permit enslavement to spread into the West and from there, working in concert with southern slave states, make enslavement national, northerners of all parties woke up to the looming loss of their democratic government.

A railroad lawyer from Illinois, Abraham Lincoln, remembered how northerners were โ€œthunderstruck and stunned; and we reeled and fell in utter confusion. But we rose each fighting, grasping whatever he could first reachโ€”a scytheโ€”a pitchforkโ€”a chopping axe, or a butcherโ€™s cleaverโ€ to push back against the rising oligarchy. And while they came from different parties, he said, they were โ€œstill Americans; no less devoted to the continued Union and prosperity of the country than heretofore.โ€ Across the North, people came together in meetings to protest the Slave Powerโ€™s takeover of the government, and marched in parades to support political candidates who would stand against the elite enslavers.

Apologists for enslavement denigrated Black Americans and urged white voters not to see them as human. Lincoln, in contrast, urged Americans to come together to protect the Declaration of Independence. โ€œI should like to know if taking this old Declaration of Independence, which declares that all men are equal upon principle and making exceptions to it where will it stop?... If that declaration is not the truth, let us get the Statute book, in which we find it and tear it out!โ€

Northerners put Lincoln into the White House, and once in office, he reached back to the Declarationโ€”written โ€œfour score and seven years agoโ€โ€”and charged Americans to โ€œresolve thatโ€ฆthis nation, under God, shall have a new birth of freedomโ€”and that government of the people, by the people, for the people, shall not perish from the earth.โ€

The victory of the United States in the Civil War ended the power of enslavers in the government, but new crises in the future would revive the conflict between the idea of equality and a nation in which a few should rule.

In the 1890s the rise of industry led to the concentration of wealth at the top of the economy, and once again, wealthy leaders began to abandon equality for the idea that some people were better than others. Steel baron Andrew Carnegie celebrated the โ€œcontrast between the palace of the millionaire and the cottage of the laborer,โ€ for although industrialization created โ€œcastes,โ€ it created โ€œwonderful material development,โ€ and โ€œwhile the law may be sometimes hard for the individual, it is best for the race, because it insures the survival of the fittest in every department.โ€

Those at the top were there because of their โ€œspecial ability,โ€ Carnegie wrote, and anyone seeking a fairer distribution of wealth was a โ€œSocialist or Anarchistโ€ฆattacking the foundation upon which civilization rests.โ€ Instead, he said, society worked best when a few wealthy men ran the world, for โ€œwealth, passing through the hands of the few, can be made a much more potent force for the elevation of our race than if it had been distributed in small sums to the people themselves.โ€

As industrialists gathered the power of the government into their own hands, people of all political parties once again came together to reclaim American democracy. Although Democrat Grover Cleveland was the first to complain that โ€œ[c]orporations, which should be the carefully restrained creatures of the law and the servants of the people, are fast becoming the people's masters,โ€ it was Republican Theodore Roosevelt who is now popularly associated with the development of a government that took power back for the people.

Roosevelt complained that the โ€œabsence of effectiveโ€ฆrestraint upon unfair money-getting has tended to create a small class of enormously wealthy and economically powerful men, whose chief object is to hold and increase their power. The prime need is to change the conditions which enable these men to accumulate power which it is not for the general welfare that they should hold or exercise.โ€ Roosevelt ushered in the Progressive Era with government regulation of business to protect the ability of individuals to participate in American society as equals.

The rise of a global economy in the twentieth century repeated this pattern. After socialists took control of Russia in 1917, American men of property insisted that any restrictions on their control of resources or the government were a form of โ€œBolshevism.โ€ But a worldwide depression in the 1930s brought voters of all parties in the U.S. behind President Franklin Delano Rooseveltโ€™s โ€œNew Deal for the American people.โ€

He and the Democrats created a government that regulated business, provided a basic social safety net, and promoted infrastructure in the 1930s. Then, after Black and Brown veterans coming home from World War II demanded equality, that New Deal government, under Democratic president Harry Truman and then under Republican president Dwight D. Eisenhower, worked to end racial and, later, gender hierarchies in American society.

That is the world that Elon Musk and Donald Trump are dismantling. They are destroying the government that works for all Americans in favor of using the government to concentrate their own wealth and power.

And, once again, Americans are protesting the idea that the role of government is not to protect equality and democracy, but rather to concentrate wealth and power at the top of society. Americans are turning out to demand Republican representatives stop the cuts to the government and, when those representatives refuse to hold town halls, are turning out by the thousands to talk to Democratic representatives.

Thousands of researchers and their supporters turned out across the country in more than 150 Stand Up for Science protests on Friday. On Saturday, International Womenโ€™s Day, 300 demonstrations were organized around the country to protest different administration policies. Senator Bernie Sanders (I-VT) is drawing crowds across the country with the "Fighting Oligarchy: Where We Go From Hereโ€ tour, on which he has been joined by Shawn Fain, president of the United Auto Workers.

โ€œNobody voted for Elon Musk,โ€ protestors chanted at a Tesla dealership in Manhattan yesterday in one of the many protests at the dealerships associated with Muskโ€™s cars. โ€œOligarchs out, democracy in.โ€

Heather Cox Richardson puts current events in the context of history. Her daily letters to America are a part of my current events reading.

Peace

I wish that everyone could die the way my patient did.ย 

They were compassionately extubated, started on a fentanyl drip, and kept comfortable with classical music dancing through the air. They were surrounded by their spouse and children. The love for him was so evident, so pure - it filled the room with a sense of warmth and comfort.

The residents and myself stayed with the family who shared so many lovely stories. His favorite books, favorite foods- how he met his wife. As he lay there dying, with a BP of 40/20, he was so peaceful. His wife held his hand and tucked back his hair.ย 

โ€œYou are beautiful and there is nothing to be afraid of.โ€

With a light gasp, he was gone.ย 

I have seen so much death. Much of it lacks dignity. It is violent. It is prolonged. People suffer. This death was not that. This death was so refreshingly beautiful and quintessentially humane that it reaffirmed everything we hear about death but donโ€™t want to accept.ย 

That death can beautiful. That death can be peaceful, even joyous. That death is inevitable but it doesnโ€™t have to be scary.ย 

I wish every person could die this way. That they could be celebrated by those that love them and cared for them. There is still pain for the family. There is still grief. However, besides being born, this is THE universal human experience. We are all destined to die- I just hope we all are lucky enough to experience it in a dignified and loving way.ย 

From the Archives: Peaceful Passing.

To the New PA-Cs

Hey there.

You passed your boards, you got that job, and you have that badge that says PA-C. There is so much excitement at this time but also a lot of anxiety. There will be a day where it will hit you: "Oh shit, I have to make a decision. This patient's care is actually in my hands." That can be a scary feeling.

Please know that I see you.

The first 6 months is so hard for so many reasons. You'll feel dumb. You'll wonder why you're allowed to practice. You'll make mistakes.

You'll also have many successes. You'll learn a lot.

Keep asking questions. Keep learning. Keep seeing every patient as a learning opportunity. Take time for yourself. Breathe.

The more you experience, the more confident you'll be. It just takes time.

I believe in you.

Hang in there.

Year 6

If you had asked me in 2012 if I would be posting a "Year 6 as a PA-C" entry, I would have thought you were off your rocker. Truly. I had so little faith in myself that I could do the thing that, had it not been for sheer grit, I probably wouldn't have.

As I pass this milestone, I have a lot of thoughts. This blog, for one, was the origin of making me feel like I could, in fact, do the thing. Our little Pablr community has grown and the people I interacted with on here were a major part in making me feel like I had a shot. While I post relatively infrequently (because life), I value what this forum has given me. I probably could make a year 6 post without to be honest.

So, about that Year 6.

Hyperbaric Medicine (HBO)

I'm sorry, what is that?

I have a side hustle as a hyperbaric medicine provider and I am here to give you the down and dirty!

Sometimes referred to as HBO (hyperbaric oxygen), hyperbaric or dive medicine is a specialty that utilizes oxygen at high pressure to treat a variety of conditions, primarily things involving wounds. We place a patient in a chamber, deliver 100% oxygen to them, pressurize the chamber, and keep them in there for about 120 minutes. Since oxygen is the number one thing you need to heal a wound, we use a lot of it to try and speed up the process.

From the Archives: Hyperbaric Medicine

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