As a young girl, Jennifer Makuakane, DMSc, MPAS, PA-C, MT (AAB), watched her older brother be diagnosed with diabetes and the challenges he faced with that diagnosis. She saw how sad and upsetting it was for him to have to test his diabetes, especially in front of other people. Having a yearning to help her brother, she resolutely declared at that young age that she would find a cure for diabetes.
Now, many years later, and while not finding a cure for diabetes specifically, Makuakane is a physician assistant (PA) making a difference for people who need it the most.
But the path for Makuakane wasn’t straightforward or easy. It was a balancing act between being a wife, a mother, a student, and a healthcare professional.
Makuakane never felt like she could be a traditional university student; she had to work to pay for an apartment and for food. When Makuakane was 20 years old, she decided to join the military where she trained and became a laboratory technician. With the substantial amount of hours of training and working as a lab tech, she was able to complete a few courses through George Washington University to earn her associate’s degree in laboratory training.
Makuakane left the military after four years of service but continued to work for another 17 years with her degree. During that time, Makuakane got married and started a family.
However, after 17 years of working in a lab, Makuakane didn’t feel like she had done what she wanted to do. The older she got, the more she wanted to go back, learn more, and better herself. But as a provider and a mother, the choice wasn’t a simple one.
“As a mom, we tend to use our kids as an excuse to not care for ourselves and our own needs, whether that’s pursuing my own education and my own goals,” said Makuakane.
“I was married, got divorced, and then was a single mom. That was my excuse,” she added. “Then I got remarried, then I had kids, and I used that as an excuse.”
It wasn’t until someone told her, that she was only thing holding herself back. “And I thought, maybe they’re right,” said Makuakane.
Throughout her career as a lab tech and even in her personal life, friends would always come to Makuakane for medical advice, not because she always knew the answer, but because she would always help them find the answer. They motivated her to push herself to finally pursue a career in healthcare like she had planned as a young girl.
So she took the first step and decided to go to PA school. But the path to becoming a PA wasn’t clear cut either. Not knowing exactly what prerequisites she would need for PA school, Makuakane just started taking classes at Salt Lake Community College (SLCC) in Salt Lake City, Utah.
“I was working graveyard and going to school during the day, as well as volunteering at my kids’ school.” With balancing work, having a family, and taking college classes, Makuakane used that time to get into the rhythm of juggling all those priorities and the stress that comes with them.
After a semester, Makuakane understood what prerequisites she needed, but there was another major obstacle: she needed a bachelor’s degree to get into PA school.
One of her former coworkers had become the director of Clinical Laboratory Sciences at Idaho State University (ISU) and encouraged her to apply to the program. Since Makuakane already had an associate’s degree and military coursework, as well as 17 years of lab experience, she was able to enroll at ISU with quite a few transfer credits and waive the clinical coursework.
So while taking prerequisite courses at SLCC, working full time, and raising a family, Makuakane added another 16 credits of online coursework through Idaho State University. Her combined university coursework totaled 25 credits a semester, and she still continued volunteering once a week at her daughter’s school.
“It’s not ideal for every student,” said Makuakane. She credits her work schedule; she worked seven days and then had seven days off. “So I did a lot of school work during my week off…it helped me get ahead on what I could so I didn’t have to stress when I was at work,” said Makuakane.
And that wasn’t all. “My first semester, I was pregnant,” said Makuakane. “I gave birth to my son the week of Thanksgiving—the week before finals—with the support of family and faculty at Idaho State and SLCC. All my instructors were flexible with my family situation.”
After two semesters, Makuakane completed all of her prerequisites and earned her bachelor’s degree. “I was lucky,” said Makuakane. But luck doesn’t account for it all. Makuakane worked hard to balance caring for her family, working to provide for her family, and a substantial university credit load. And that was just the beginning.
By the time Makuakane applied to PA school, she had five children. So she and her husband sat down and talked about options for PA school.
She explained, “Some people apply to as many PA schools as they can, but I didn’t want to do that and be unhappy living somewhere we didn’t want to live. I picked schools that would be a good fit for the family and where we wanted to relocate to and raise a family.”
Having lived in Utah their whole lives, Makuakane and her family decided to only apply to schools outside of Utah to allow their children to experience life outside of the Beehive State. Then ultimately, she decided to apply to Rocky Mountain University of Health Professions (RMUoHP) to keep at least one Utah option.
During the onsite interview for the Master of Physician Assistant Studies (MPAS) program at RMUoHP, Makuakane was feeling frazzled. Her one-year-old son had been hospitalized with meningitis and was discharged the night before the interview and her husband had been traveling for work.
Before going into the interview, she decided not to tell anyone about what was going on in her personal life. “I didn’t want sympathy acceptance or them to know that I had personal challenges that might interfere with my success in school.” Walking in resigned, Makuakane said to herself, “If I flop, this is good practice.”
But Makuakane was surprised. “The faculty were so amazing that it helped distract me from what happened at home. It’s ironic because RMUoHP was the one place I didn’t want to go with it still being in Utah. But I felt so comfortable that I knew if they offered me a seat, I would accept.”
When Makuakane got the acceptance call, she accepted and enrolled.
“The first two weeks were the hardest,” said Makuakane. “I cried more than I ever have in my entire life.”
Makuakane would get home late from school and then her husband would go to work a graveyard shift. “So I’d come home and he’d go to work, and I’d be frustrated constantly because I had to study…I yelled a lot at my kids. I felt like a terrible mom.”
With five children to care for, a husband working graveyard, and now an advanced graduate degree course load, it all became too much.
So Makuakane made a decision. “I came home from school every day and I was mom. I was mom until 9 p.m. Then when they went to bed at 9 p.m, I went to bed. I woke up at 3 a.m. and studied until 5 or 6 in the morning.” Then she went to school.
They decided that her husband would quit working while she was in school, so their family of seven had to live entirely off of student loans. “That was rough. Because there were financial challenges, we had to consider cutting back on things,” said Makuakane.
Her children had to give up playing sports or find sponsors to pay the fees. They downsized their home and cohabitated with family to split living expenses. “There were a lot of sacrifices we had to make,” said Makuakane.
It wasn’t easy for her as a parent, and it wasn’t easy for her children. “My daughter was understanding because she was older, and my younger boys had to adapt,” said Makuakane.
Makuakane recalled a meeting she went to when she first entered the MPAS program. One of the faculty told the new students, “This is only 28 months of your life. If your reason for doing this is your family, then are you and them willing to sacrifice for 28 months? That’s not too long in the grand scheme of things.”
For Makuakane, she knew that was how she would survive. “I knew if I went back to school, it was about pursuing my dreams. But if there was the possibility to work less in the future because I was making more money, then there were opportunities to benefit my kids.
“My kids adapted well, despite the sacrifices. We went forward with everything with a positive attitude. We didn’t just tell them we had to sacrifice; we focused on the positives—that when mom goes to school and graduates, she’ll make more money, and then we can do more fun things. We had a very positive mindset,” said Makuakane.
“And now,” said Makuakane, “they’re reaping the benefits.” As a PA, she has Wednesdays off and dedicates the entire day to spend it with her children.
She adds, “It’s been a good example for my daughter. She’s seen how important it is to go to school and to reach for your dreams. It doesn’t matter how old you are or if you stumble. It’s about getting past the mental roadblock.”
Makuakane thinks back to one of her clinical rotations, which took her to Hawaii for six weeks by herself. One day, she decided to undertake one of the nation’s steepest hikes, a six-mile hike up to a breathtaking view of Hawaii.
As she was hiking, she thought, “I can’t do this out of shape and by myself.” She stopped next to a guardrail where someone had written, “½ way keep it up.”
At that moment, looking back at the beauty of the valley, Makuakane reflected on everything that she had done in her life, with her family, doing all the work to get into PA school, and the seemingly insurmountable coursework to become a PA.
“When I looked back, it was still worth it. It was still full of so much beauty—all of my challenges to get me to where I was. There were a lot of tears. I regretted not doing school earlier, but I realized if I did school earlier, I wouldn’t have had the focus without my kids. Because they were my focus. My challenges are what made all of it worth it, no matter how much it took to get there,” said Makuakane.
Two months after that arduous hike, Makuakane graduated from the MPAS program.
While waiting for her official PA credentials, Makuakane used the time off to enroll in the RMUoHP Doctor of Medical Science program. She graduated with her clinical doctorate in August of 2020.
Currently, Makuakane works at the Bone and Marrow Transplant Clinic at the University of Utah’s Huntsman Center. She uses her education, skills, and life experiences to provide compassion and care to patients.
“Professor Jon Baird always said that patients don’t have to choose us to be the ones to provide their care. They can choose anyone. So we should be honored to be part of their care. In my situation, they are choosing for me to be part of one of the most difficult experiences they’ll face in their life. They’re choosing to build a relationship with me in possibly the last few months of their life,” said Makuakane.
One of her first patients as a PA was a young mom who ended up passing away. “I got to know her in the hardest time of her life. She shared her time with me, her smiles, her good and bad moments,” said Makuakane.
All of the challenges that Makuakane overcame to become a PA and balance her family with her career have paid off.
“No matter how hard it gets, it still feels like a blessing knowing that I was a part of that,” said Makuakane. “It’s definitely a gift that these patients give me. I know they’re grateful for what we do. But I’m grateful to be a part of it.”