Surgery Pt. 2

On to the OR. The last 2.5 weeks of my surgery rotation were spent assisting in the OR and taking care of patients on the floor. There were four other medical students with me and the last three days I was there, there was also another PA student. Each day we would round with the residents, go to morning report, and spend the rest of the day checking in on patients and following up on all the labs and imaging and whatever other things the patients needed. Each surgical case was supposed to have a student, and typically each student was assigned to one case if there were enough to go around for the day. As students we were to prepare for rounds, which were at 6 a.m., to present to the chief resident. I normally arrived at the hospital a little before 5 a.m. so that I would have time to change into my scrubs and read up on my patients and go see them before rounds started, and on most days I had two or three patients that I chose to follow.

The first day I knew that we were going to have rounds but I did not really know how the medical students worked and I didn’t know the situation of any of the patients. I was given one patient to present and I spent a good half hour looking through the patient’s chart, though I didn’t really know what to look for to adequately prepare for rounds. The chief that day had a reputation for being tough and short-tempered when he didn’t find something satisfactory or he found people to be lacking in competency. I was one of the last to present, and when my turn came, I started my first sentence strong…and then that’s pretty much where I ended my presentation. I was scared the chief was going to rip me apart, but he just looked at me, sighed, and said one of the interns (first year residents) would teach me how to properly present. It also helped that one of the medical students came to my rescue and told the chief it was my first day so I should get a pass. At the end of the day the students would split up the patient list so that we knew who we were going to present the next day. Since one of the students went home during the day because she was coming off of a 24-hour shift, we split up the patients without her and assumed she would pick up the rest. But the next morning, after I had already started preparing my presentations for my assigned patients, the student came and told me that one of my patients was actually hers so I had to take a new patient. In that moment I thought I was going to break down and cry. I was so nervous about presenting to the chief after failing the day before, and after I had worked so hard on perfecting my presentation, I had to rip it apart and start over for a new patient. But it turned out that that day we got a new chief who came from a different hospital, so that day the chief from the day before presented mostly all the patients to update the new chief. God is so merciful! By the third morning I was getting the hang of presenting.

The thing about presenting a patient is that anyone can read a chart especially if they have a lot of time on their hands; the main point of presenting is to update coworkers of any important information and to come up with a plan to appropriately manage the patient. Our goal was not to show how well we could read or gather information. The goal was to take the given information and use it to assess if the patient was healing well or not, if the patient needed any new or additional labs or imaging, if the patient needed new or additional medical management or therapy, and if the patient was ready to go home. Many times I would feel like I wasn’t really learning much through presenting. I didn’t really learn in those 2.5 weeks what labs or imaging I should order for each situation we encountered. I didn’t really come to know when it was appropriate to change a patient’s medication or when a patient was ready to go home. I didn’t come to a full understanding of how to properly manage a patient from pre-op to intra-op to post-op to discharge. What I did learn was that everything you do, every test you order, every medication you administer should be in the patient’s best interest, and it should be done with the goal of getting the patient out of the hospital and back to their normal lives as much as possible. In every situation, do your part in full completion and do not rely on others to get back to you about your patient. Your patient is your responsibility so you are the one who has to make sure the patient gets all the necessary tests done, is healing well, is not uncomfortable, is getting the adequate care, and so on and so forth. Other healthcare professionals (such as nurses, phlebotomists, imaging technicians and radiologists, therapists, etc.) are busy, and often things fall through the cracks so you have to personally make sure every aspect of the management is followed through accurately and thoroughly so that your patient gets the care he or she needs.

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Heart Problems

I’ve been at my new rotation site for three days and it’s completely different compared to my last few weeks. Right now I’m at a cardiology clinic for my internal medicine rotation. I’m not quite sure why my internal medicine rotation is at a cardiologist’s clinic but that’s besides the point. Since I am at a cardiology clinic, the patients I see are mostly a very specific population group (50 years old and older with comorbidities) and they mostly all have one or a combination of the following: high blood pressure, high cholesterol, heart valve problems, atrial fibrillation.

I’m trying to describe how I felt on Monday but my thoughts keep jumbling as I am try to organize my thoughts, so bear with me.

I walked in on the first day freaked out because cardio was not my best unit during didactic year and it’s also such an important component of a patient’s well being so I didn’t want to mess up. Also in this clinic I’m the only student except for when a med student comes for a few hours once a week. In the hospital I had other students I could turn to for backup or advice and it was comforting to have others alongside me. As the only student I cannot let anything slide because it’s my sole responsibility. This isn’t a problem, and I’m glad I am the only student, but it shakes my confidence.

The doctor who is my preceptor is a very experienced, knowledgeable, well-connected practitioner and professor, and I find him to be nice but also intimidating. Not because he is mean or unprofessional. It’s because I’m sure he expects a lot and I feel like I can’t live up to his expectations because I’m inadequate at taking histories and doing physicals, and I’m bound to mess up some progress notes. (Sidenote: he takes blood pressure in like 2 seconds and I’m in awe but also at the same time dumbfounded)

My first day there I got a quick introduction to the EHR system the doctor uses and he showed me how he wanted me to set up and complete the notes for each patient encounter. Then he briefly walked through how the clinic operated and what my tasks would be. Following that he had me go take a couple patients’ blood pressures and after a few patients he had me go take histories and do physicals on patients.

During that one day I was learning about the operational side of taking care of patients but also trying to figure out how the doctor wanted our workflow to be between him and me and what exactly I was supposed to do when I saw patients, and I was also trying to get my brain into cardio mode despite my poor grasp on all things cardio. Even little things such as wondering if I was supposed to go back out to tell him I had finished taking the blood pressure or should I stay in the room and wait for him to come see the patient made me anxious because I didn’t want to be that student that fumbles around. The schedule was also backed up so the undercurrent of needing to hurry up added to my stress.

This was such a change of pace compared to surgery. In surgery we spent a lot of time reading patient charts and getting to know their medical history and there would be a team of surgeons, residents, students, and other consulted medical professionals that would follow them for consecutive days regarding an acute problem. At this clinic, most of the patients are established patients who come every 3-6 months and the doctor knows their history. But for me to come in for a short period of time is hard for me and also for the patient because the continuity isn’t there.

Anyhow, the past two days I have gotten a better feel for the swing of things and I’m slowly adapting to properly conducting patient visits for this clinical setting. But I still have a lot to learn and I’m hoping this rotation will help me figure out how to ask all the right questions, hone my physical exam skills, and learn how to manage patients medically.

And to end with a random tangent…  

I was feeling so tired as I wrote this and I was thinking about my last week. Last Wednesday I worked 6 hours and then traveled 2 hours to end up at school and studied for 5 more hours. Then Thursday I went to school and studied the whole day. Friday was Rotation 3’s callback day. I took two exams and had class meetings and went home to pack for an out-of-town Christian conference. I drove 4 hours and arrived at the conference site at 8 p.m. just in time for the beginning of the conference. Saturday and Sunday I was at the conference and Sunday night I drove back and arrived back home a little after midnight. Monday morning I started at my new rotation site. And so far I’ve had 8+ hour days at this clinic and afterwards I go home and work on assignments for school and my preceptor. So though I’m not studying 12 hours a day, I still have a lot on my plate, and this is the reality of a PA student.

Surgery Pt.1

My apologies to all two of my readers for not writing about my experience this rotation sooner. For the past five weeks I was in my surgery rotation, and I was so tired from work I didn’t have it in me to write. The rotation was broken up in two sections: the first two weeks I was in the surgical clinic, and then the last two and a half weeks I worked in the OR and on the floor. Going in I was extremely nervous for multiple reasons. I knew surgery had a lot of GI, which was one of my least favorite systems, and had cases with a lot of labs, medications, procedures that I was not familiar with. Also, I was under the impression that I would get yelled at and would be under pressure to perform at a level I wasn’t at. All things aside, I was there to learn about what a surgical PA does and how to practice as a surgical PA.

When I first got to the hospital, the orientation process was not very orientating and it was kind of frustrating. There were things I had to figure out on my own such as getting access to different places in the hospital, getting access to the computer systems and learning how to navigate them, figuring out what time I should arrive where, etc.

As a student I was required to attend morning report, which was a daily meeting with all the students, residents and attendings that worked with the surgical floor patients, surgical consults, and surgical ICU patients. For the first two weeks of my rotation I barely had a clue what was going on during the meetings. I had no idea who was who and I had no clue which patients they were talking about because I worked in the surgical clinic, and therefore I didn’t see any of these patients they were discussing. Slowly as I kept trying to follow their conversations, I started picking up small tidbits such as disease processes patients had, having an idea of what the doctors were seeing on imaging, figuring out management plans, etc. By the time I got to the OR portion of my rotation, I was able to grasp more of the discussion and I was able to gain information from the meeting that helped me care for my patients better.

In clinic there were many different clinics held throughout the week. There were usually two or three PAs working with one attending and the different clinics were vascular, general surgery, breast, head and neck, thoracic, hand, colorectal, and ENT. Patients came for surgery consults, to be assessed if they were good candidates for surgery, and to follow up after their procedure was done to assess adequate healing and progress. PAs would see their own patients, take a brief history and physical and the attending would pop in to see the patient quickly, address any more technical/surgery-specific questions, and then leave the PA to wrap up the rest of the visit. Some attendings saw their own patients, some attendings only saw patients with the PA. As I observed and took part in caring for the patient, I felt like I could do this in the future. I enjoyed getting to see all different types of people and medical issues, and I liked seeing the difference the surgery would make to help the patient’s ailments. However, I felt that since the clinic was so problem-focused, I did not utilize a broad range of knowledge and skills while seeing these patients. This isn’t necessarily a problem, especially if what you are doing is adequately helping patients, but I also felt that this would possibly become monotonous over time.

Overall the time I spent in clinic was good. I was able to interact with patients, perform histories and physicals, practice documentation, and work with other PAs and doctors. The clinic setting was at a good pace, not too rushed, and the hours were very reasonable (9 a.m. – 3 p.m. Monday-Thursday, 9 a.m. – 1 p.m. on Fridays). What I did not enjoy as much was the excessive complaining and grumbling from clinic staff. I felt like this was somewhat a stumbling block for productivity for not only the staff member who was griping, but also the rest of the workers in the clinic, and it most definitely affected the patient’s impression of the clinic. I feel this is typical in any place of work, and I’m glad I witnessed it to become more aware of office politics and happenings, but it did affect my view of the clinic.

To be continued…

 

Progress (Notes)

During this rotation part of my position as a PA-S at the clinic required me to complete progress notes for all the patients that I saw. After about the first week of the rotation I was instructed to see patients on my own. I would greet the patient and then subsequently follow the clinical approach my preceptor taught. Then my preceptor would come see the patient with me and after his history and physical we would formulate an assessment and plan.

Progress notes were written and stored on a computer software, and my preceptor structured the software so that there were many templates that would be used for filling out the progress note. For example, if the patient presented with and was diagnosed with GERD, I would type in “esophageal reflux” in the template search bar and then click the arrow to populate the note. That template would automatically fill out the chief complaint, history of present illness (HPI), physical exam, assessment, and treatment. This was useful but I also thought it was sometimes too generic or not detailed enough for the patient’s specific presentation. Typically I would use the template and then go back and edit the HPI so that it included details the patient said during the interview.

Oftentimes the treatment would be appropriate for the patient, but sometimes the doctor would change it to tailor it to the patient’s particular needs. This was good, but I did not really learn how to know what to change the medication to or how to adjust the medication dosage. This is something I still need to practice.

This clinic has only been in the area for about two years and the number of patients seen each day is not overwhelming, which is great for my pace at this time in my clinical experience. On the days where I would see patient after patient, I would not be able to complete the progress note until after the rush of patients. By that time I would maybe have three or four patient encounters to complete. Usually during the patient visit I wouldn’t type the HPI while talking to the patient so during the lull times I finished up notes.

I found it to be a little repetitive and a lot of work, though I recognized the importance of a good note. Sometimes when I read older progress notes from previous patient encounters it would be difficult for me to get the full picture when the HPI basically only consisted of the template’s description. The whole point of the note is to communicate to other health care providers a comprehensive picture of the patient’s condition. If many details are too vague or left out, it makes it very difficult for the provider to fully understand the reasoning behind previous visits assessments and plans, and also it is annoying for the patient to have to explain themselves visit after visit.

I remember one day after work I went home and I told a friend that I realized being a PA is a lot of work. Of course I knew this going in, but oftentimes in class I only thought about making the diagnosis and coming up with the management plan that the documentation portion of a PA’s duties went over my head. In my first rotation I never wrote the notes, so when I got to primary care, my tasks were such a contrast to emergency medicine. I would not say that I really enjoy writing notes but I know how important it is to a patient’s medical care, and I would not skimp out on work just because I felt like it was a lot to do.

 

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Primary Lessons

It’s been hard to figure out what to write about throughout this whole rotation. I feel it was easy to reflect upon all the different things I experienced and learned from working in the emergency department because it was my first rotation and I saw something different every day. Here at the family medicine private clinic, I find it harder to pinpoint things I have gained from working in this setting.

Many patient visits are very routine. Patients come in for physicals or for routine blood draws, or to review recent imaging or blood test reports. These encounters are all fine, but when I am speaking with patients I don’t really feel like I’m accomplishing much. It’s strange. I know that as a primary care provider, I am the first line medical contact for the patient. There’s a relationship that is supposed to form between the patient and his or her primary care provider. As a primary care provider, I am supposed to treat the patient in a way that shows I care about them, their well-being, and I am there to support them medically. But I don’t feel this trust relationship is reciprocated, as in the patient is not invested in me as a trusted figure in their life. I feel like they come just to see if they have any illnesses and/or to get medications. And yet, I still want to make sure they monitor their chronic illness and they complete all preventive medicine measures to ensure they’re healthy and to catch diseases early.

Even though sometimes I feel like what I’m doing is not making that big of a difference, I feel strongly that no matter what, it is important to do your job well. If not, there were be repercussions. A few days ago, I saw a patient who came for a vaccination and also mentioned that her last menstrual period was more than 2 months ago. After a confirmed negative pregnancy test, I looked at her problem list in her file and did not see anything unusual that would correlate with her menstrual period, though she did mention she felt fatigue often. The patient also said she was not taking any medications currently. I thought the best course of action would be to call it amenorrhea and do a workup for it. But after I presented the patient to my preceptor and after further conversation with the patient she mentioned she ran out of her thyroid medication. This changed the picture entirely. The visit ended up being much different than how the patient, and I, had expected it to go, but in the end everyone was on the same page. Whoever saw this patient in the past did not indicate in the patient’s file she had some sort of thyroid dysfunction and did not educate the patient about her medication. Because these things were not done, neither the next provider (me) nor the patient was able to follow through properly to take care of the patient’s health.

Thankfully the patient’s condition is not extremely serious and she is able to get back on track with treatment and my preceptor was experienced enough to get the whole picture and properly advise the patient. For me, I learned the hard way to not overlook anything in the patient’s chart from previous visits and to always check lab values. It’s hard to do especially when you’re rushed to see patients, but a quick glance at values is much better than not pulling them up at all. My preceptor semi-scolded me for not fully investigating the presentation and lab values and documents, and therefore not realizing the patient had a thyroid problem. The feeling of failure was not pleasant, and from then on I was again determined to always strive to do my best work, all the time.

Practice

At the current clinic my preceptor has this clinical approach:

5 Fingers

  • Chief Complaint
    • This is documented in the patient’s own words. It reflects the reason why the patient came to the clinic.
  • Problem List
    • This shows the past medical history of the patient. By going through this, the practitioner has a better idea of what is already going on with the patient and this will allow you to have a better idea for diagnoses when they present with symptoms.
  • Medications
    • It is important to review what medications the patient is currently taking, what have they stopped taking, and if it matches up with the medical history.
  • CDSS
    • This stands for Clinical Decision Support System. There are some guidelines recommended by the government in order to practice good preventive medicine. These ones are in the top portion of the CDSS tab. The bottom portion encompasses additional preventative medicine the clinic would like to include in the patient’s care.
  • HPI
    • After you have gone through the first four “fingers” you can evaluate what the patient presents with in a comprehensive way.

Physical Exam

  • No matter what the patient presents with, it is imperative to always do at least a brief physical exam of all systems. There may be incidental findings which would be missed if only a focused physical exam is done. These findings may be serious. Patients will only respect you more for being thorough.

“See something, do something”

  • This means if you see something, even if the patient doesn’t complain of it, you should implement some sort of treatment for it. Patients may not be aware of the problem, but if you find it, you should act upon it.

The traditional approach we learned in school is termed SOAP, which stands for subjective, objective, assessment, and plan. Basically it’s what the patient presents with, what you find, the diagnosis, and treatment plan. When taking the history (as I’ve written about before), it usually starts with the present illness, then past medical history and medication, surgical history, allergies, family history, and social history.

The approach that my preceptor has adapted is actually very similar to the overall SOAP format but within the “subjective” portion, the five fingers approach is a little different. Because my preceptor reviews the patient’s problem list first, this gives an idea of what he’s working with. If you have a blank slate, it’s hard to know where to start, but if you already have a landscape it allows you to more accurately map out a direction where to go. For example, if a patient comes in complaining of a cough, instead of going through all differential diagnoses for causes of a cough, you could look at the patient’s medical history. Perhaps this patient has a history of hypertension and is taking an ACEI which can have a dry cough as a side effect. After you review the medical history and medications and address any preventive medicine measures, you go through the history of present illness and ask appropriate questions to lead you to a diagnosis. Of course, this is not to say that you don’t explore other differential diagnoses when the patient already has a medical history.

I think it’s important to always do a brief physical exam even when it doesn’t seem warranted. Incidental findings could be the only way a patient finds out early about a cancerous growth or a concerning condition. In my personal experience, I once saw a doctor for a sick visit and she happened to palpate an enlarged thyroid. From there I had an ultrasound and learned I had a thyroid nodule. Though it’s not cancerous, I’m grateful the doctor was thorough and brought this medical problem to my attention. To contrast, I went to a different doctor for a physical exam and to get a medical form filled out for school. He barely even looked at me, checked off everything on the form as normal, only listened to lung and heart sounds, and signed and stamped his name on the form. This was after I knew I had an enlarged thyroid, so I knew he missed findings during the visit.

At my rotation I’ve been told that a lot of the patients come to the doctor but they don’t want to hang around—they just want to get in, get a prescription, and get out. One of the people I’ve been working with told me to work fast because the patients don’t want to stay a long time. I have mixed feelings about this because I understand people have lives, but also this doesn’t allow the practitioner to do a good job. If you don’t allow your practitioner to do his or her job, what is the point of visiting? And to be quite honest, I only had one patient where she was actually in a rush to leave. All the others never mentioned to me that they didn’t have time to talk to me because they were short on time. Though this isn’t to say that we should take all day to talk to one patient. In my opinion, being thorough never hurt a patient, and patients will recognize your genuine care for their well being.

In the past three weeks in a family medicine clinic, I’ve been able to practice more medicine and interact with patients in a way that allows for more patient interaction based on the principle that as health care providers we are to care for the entire person so that they will live healthy lives. I stand behind this and it’s nice that I get to build this foundation as part of my clinical experience.

New Rotation, New Challenges

Rotation 2 for me is primary care in a private clinic in the “Chinatown” of Brooklyn and the first week and a half at my new rotation site has been rocky. Going in, I knew primary care was going to be different from emergency medicine but I didn’t realize how different.

There have been a couple obstacles that I’ve had to figure out how to handle, one being my preceptor not being at the clinic to teach me sometimes. For example, my preceptor did not show up the first two days I went to the clinic. Because he didn’t show up, it was hard to know what I was even supposed to do. There’s another guy at the clinic that sees patients but he’s not my preceptor and his approach to seeing patients is different to what I was used to in the ED and is also different to my preceptor’s, which I found out on the third day of the rotation. So after two days of learning how this person saw patients and documented patient visits, I had to mentally switch processes under the tutelage of my preceptor. My assigned hours start at 10 a.m. but sometimes my preceptor doesn’t show up until the afternoon, so there have been days where in the middle of the day I switch methods to match the person I’m working for.

Another issue has been a language barrier. On some days I’m thankful I wrote down I could converse in Chinese when we signed up for rotations back in February, but on many days, especially at this clinic, I wonder why I did that to myself. Many of the patients, especially if they’re seeing the other person at the clinic, speak a different dialect of Chinese that I cannot understand, so oftentimes I stand to the side lost in translation. This makes it very difficult to follow the conversation and visit for obvious reasons, and it also makes it very difficult to write the progress note for the patient visit. There have been days where many patients in a row speak the foreign dialect and then when I’m trying to catch up on notes I have to stop every sentence to double check with the person who actually spoke to the patient.

Many times I have had a hard time interviewing patients because they seem to not trust me. Just yesterday, I was reviewing a blood test report with a patient and also going over his past medical history and everything I told him was medically sound but he didn’t seem to buy what I was telling him. When the other person came into the exam room and repeated everything I told the patient, he readily received the information. After the person explained everything, the patient told him he liked chatting with him. The person I work with told me many times Chinese people don’t trust me because I look young and when I smile I look like a kid. I kind of took offense to this initially (internally, of course) though I admit I look young. But in my opinion, it’s not something I can change, and I never had that problem at the ED in my past rotation. So now I’ve become more conscious of how I carry myself and also how I present the medical information to patients.

Clinically the greatest challenge has been learning how to turn medical information into practical and applicable knowledge for the patient. For example, when I see that an ultrasound report shows ovarian cysts, I understand what that means. But patients don’t care so much about the pathologythey want to know is it dangerous, is there any medication for it, does it require surgery, etc. In the classroom we didn’t really learn how to explain findings to patients and how to navigate treatment/management plans, and my preceptor assumes I already know how to practice on my own, so in my mind I’m going “Help! I don’t know what to do!” while I plaster on my professional face and try to say something that makes sense and is helpful.

In the ED we focused on very acute illnesses but in primary care we focus a lot on chronic illnesses and preventing diseases. Therefore communicating with the patient is paramount for patient compliance and cooperation, which leads to their wellbeing.

Thankfully my preceptor enjoys teaching, and by observing I’ve gotten some ideas of how to talk to patients. I still have a lot to learn—not just to solidify my medical knowledge, but also to become skilled at asking the right questions, motivational interviewing, and formulating the best plan of action for the patient.

Failing

After my end of rotation exams on the 27th, I was so glad to have a weekend free of rotation thoughts and it was so good to unwind. Unfortunately, my relaxation ended when I got the exam results back for the two exams I took. For the non-elective rotations, the preceptor evaluation makes up 60% of the rotation grade, the end of rotation exam makes up 30% and 10% is for completing some tasks and attending callback day. To pass the rotation you must score 75% or higher. My score for the emergency medicine exam came back listed under “raw score” but it seemed more like a percentage from the report sheet so when I calculated my score for the rotation it showed I just passed by a matter of points. After I thought about the report, I started wondering if the raw score was a percentage or if it was a true raw score of the number of questions I answered correctly. Since the test was out of 120 questions, the percentage would be even lower and that would mean failing the rotation. Failing the rotation is bad enough but if I failed a rotation I would also be graduating a few months late because I would have to repeat the rotation.

Once I had this possibility in my mind, I got very nervous within. To me, failing school is a true failure in life. I know this has been a very big obstacle for me especially in the past didactic year and it weighs on me a lot. I become so occupied with not failing because I am so scared it will happen. In the past year, this has been something that I’ve struggled with because the majority of me wants to hand over the control to the Lord but then there’s a small sliver of me that can’t let go of all the accusatory thoughts. Thoughts such as “you don’t deserve to pass,” “everyone is smarter than you,” “you don’t try hard enough,” etc. Even sharing these posts was a big step for me because I feared that people would witness my inability and would maybe see me failing a rotation or not being able to complete PA school. One of the hardest things I had to experience was the fact that no one outside of my classmates knew what I was going through in school, so this was something I had to carry by myself. For the most part I tried not to let this stress show through because I didn’t think it would benefit anyone and I really did pray and commit these thoughts to the Lord every day.

These thoughts come up more strongly some days more than others, but thank the Lord He is my protector and my sustenance. He is capable of protecting my thoughts and providing strength to continue.

It still isn’t confirmed that I passed the rotation, but I am at complete peace. While I was thinking about the possibility of having failed the rotation and needing to be held back a bit, I kept thinking why this would happen. I asked the Lord about it and I didn’t get a clear answer but I was led to pray that His overcoming life would bring me out of my sadness and bring me to know Him more. I think that was more precious than had I just been thankful for completing one rotation.

On most days I wish PA school could be smooth sailing but I know this season of my life has become much more meaningful because through it all I’ve seen how faithful my Lord is and how much He knows me and cares for me.

Death, Dying, and Hope

I just found out that a faithful minister who served at my church and throughout the world went to be with the Lord after a short, intense course of treatment for stage IV colon cancer. I still am in shock. My heart aches for his family, and I know many, many people around the world have heard and are saddened to hear the news. This brother served with everything in him, and his strength was from the Lord. The fire he had inside him for the Lord, the things of the Lord, and the God’s people never dimmed, even in his last days. When I think of his ministry, I see a testimony of how God loves His Church and how the Lord works for His people. It is a somber time, but it is also a time where we can have peace because we know he is now with our Lord.

His passing, I feel, is a wake up call. Our days on earth are numbered, so what does it mean to make our days count? If my goal is to gain Christ, how should I spend my days so that at the end of my life, be it soon or far away, God is pleased with me?  When others look at me, do they see a person owned by the world or do they see a reflection of Christ?

I often think that since I am young, I have many years yet to live. But really, who knows? My grandfather was born the same year as the brother I mentioned but he passed away from liver cancer when he was 44 years old. The other day we had a patient who suddenly had a cardiac arrest while she was at home, and after about two hours of trying to resuscitate her, she was pronounced. A friend asked me about how it affected me morally to witness death, and I responded that since I didn’t see the patient alive because she was brought in unconscious, I was okay. What affected me more was seeing the patient’s family members weeping and asking us to just try one more time to bring her back. During a discussion with my classmates and professors today, death and dying was brought up and there was a consensus that in the field it’s completely different to see the test questions manifest as life and death situations and it can be hard to handle.

My head is all over the place, but I hope the thoughts of my heart have come through. Life is not easy, whether it’s my own life or the lives that I take care of. It is fragile and it is short, but it is also full and precious and a gift. It is a chance to experience all that God created and it is a time to find and fulfill purpose. Though I am currently a physician assistant student, I am also a daughter, sister, friend, classmate, stranger, etc. and in my life I’d like those around me to at least have a glimpse of the wonder, grace and love of Christ through my actions and interactions.

The End of a Beginning

So today was the last day of my first rotation. Reaching this small milestone also meant leaving my new friends, which was my least favorite part of today. I really couldn’t have asked for a better rotation to start the year. I had the best preceptor, the staff was great, and I got to see and do so much. In the beginning I was terrified of having emergency medicine as my first rotation, and now it’s hard to leave.

My preceptor was fantastic. From the very first day he was the most approachable guy, the most patient and encouraging teacher, and a great practitioner to his patients. When we reflected on all the procedures we did the past few weeks, he rattled off everything we did, almost more proud of my progress than I was. It really is such a blessing to a student when the preceptor is a teacher, a cheerleader, and an experienced clinician all in one. Not only did we have a great time seeing patients, but we also had a great time during the lull between patients.

In addition to my preceptor, the other PAs and doctors were all welcoming and kind to us students and even took time to teach, share cases, and answer questions when the opportunity arose. It was helpful to observe the way they practiced, and it definitely did not hurt to have extra instruction and professional opinions. I interacted less with the nurses, but they were all nice for the most part and taught us how to do venipunctures/IVs, so I’m indebted to them. There were also many other staff members who were key in helping us interact with patients and have the best experience possible. I have a feeling this might not be the case at many other sites, so I don’t take it for granted.

With regards to the specialty of emergency medicine, it has its pros and cons. Emergency medicine is a specialty that is fast-paced and deals with the present situation. I think it’s a good match for people who enjoy medicine and don’t seek out building lasting relationships with patients. There is quite a bit of hands-on work that goes on, which I find enjoyable. As for turnoffs or drawbacks, the emergency department is a smelly, dirty, noisy place. Sometimes the patients are difficult, possibly uncooperative or belligerent. Since we often do not know the patient’s medical history, it is sometimes challenging to treat without knowing the whole story. Most days are long and intense, but the thrill of not knowing what is coming next and being able to get down and dirty while practicing medicine is enough to keep many going.

All in all, I will miss the never-ending action and the many laughs with the staff that went on at this rotation site. Would I consider becoming an emergency medicine PA? Perhaps. It’s too early to say. But this rotation will hold a special place in my heart, and the following rotations will be hard to beat.