I can’t believe it. Well, I guess I can because I’m physically at the hospital seeing patients. But still, what? On Monday I started my emergency medicine rotation. Prior to starting I went to their Human Resources department and got clearance and corresponded via email with my preceptor. I figured on my first day there would be some sort of orientation program to get acquainted with the hospital, the emergency department (ED), hospital procedures, etc. Instead, my preceptor gave another student and me a quick tour (as in: here are the exam rooms 1-16, here is the supply room, here is the staff bathroom) and soon after we were sent to see our first patient.
Since my classmate and I both have the same preceptor, we see all of our patients together and usually switch off when doing procedures. When I took patients’ histories on Monday, I really didn’t know where to begin. How do I even ask what’s wrong with the patient? How do I ask a follow-up question to arrive at a conclusion? Remember to ask about past medical history, surgeries, medications. Do I ask about social history? Family history? What did I forget?? After we gathered all the information we deemed adequate, we would report back to our preceptor. Usually our preceptor would ask what was up with the patient and most of the time he would ask us a question about some aspect we didn’t think to ask the patient. Then our preceptor would accompany us back see to the patient and he would bang out an entire H&P in short amount of time. I’m still in awe of his ability to make the patient feel comfortable and also get to the bottom of the chief complaint and perform an exam in a swift and efficient manner. At the same time, I feel so inadequate at interviewing patients and knowing what exams to do for a focused physical.
In school all the procedures we practiced were done on models and plastic or rubber models are not exactly the same as humans. So far I have done, to name a few, a foley catheter insertion on a male patient, female pelvic exams, ultrasounds, male rectal exams, wound care, fracture splints, sutures for a laceration, suture removal, and venipunctures and IV placements. In my opinion, venipunctures and IV placements have been the most challenging because my skill has not been honed combined with the fact that not everyone in the ER has easy veins. My preceptor is really open to letting us see as many patients and do as much as we want which has been a great help in adjusting to and becoming familiar with PA life. It’s been a learning curve, but I love the rotation so far.
At my ED, there are two attendings and two PAs during the shift between 12 p.m. – 7 p.m. All the doctors and PAs I’ve met so far are all really great to work with and are very knowledgeable, skilled, and calm. These three characteristics are imperative to effectively treat the wide range of ER patients. Some come in with a minor scratch or come in due to trauma. Others come in with infectious diseases. Others come in because they were found on the streets or are intoxicated. Others come in from other facilities and you’re not really sure why they’re here. Some cases are very straightforward and have very cut-in-cloth plans. Others present with very nonspecific symptoms and workups may or may not help with diagnosing. Sometimes cases are very critical and complicated to stabilize and/or treat. On my second day a patient coded and it was so different than what I imagined. In my EMed and ACLS classes I pictured codes as a big event with controlled commotion but in actuality it was a fairly mild scene with the attending giving orders, a nurse giving CPR, and other nurses helping with medication administration. I found it funny that since the patient had already been admitted, a different team was supposed to be responsible, but they didn’t make it quick enough. By the time the whole crowd of attendings and residents made their way to the ER, the patient had been brought back and stabilized.
Another obstacle that is very apparent in New York City is the language barrier between many patients and the practitioner. I would say my Mandarin is conversational, meaning in a clinical setting I can ask patients all the normal questions about their presenting symptoms and history but certain terms such as specific body organs or specific medications I’m not very good with. So far I’ve helped interpret and have also conducted several H&Ps in Mandarin, which I never thought I would be doing when I was growing up in suburban Minnesota.
Every morning when I walk from my car to the emergency department nerves wrack my stomach, but I am completely embracing this rotation. It’s a challenge medically and mentally and also physically (I get hungry during my shift and my body gets tired from standing) and yet I am so grateful for the awesome experience I have had thus far.