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 have 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.

Rest and Renewal

I am so tired. I feel like ever since PA school started it’s just been a constant push to keep going with no downtime. Even during the two weeks of break I had between my competency exam and the beginning of rotations in June, I traveled to Minnesota for a church retreat and flew back to New York only to fly out again to California for a wedding and return the night before rotations started.

The past four weeks of my first rotation have been great overall, no doubt about it. Despite the relatively good hours, especially compared to some of my classmates, I feel like I really don’t have that much time to just breathe. I can’t even pinpoint why I feel so tired. Maybe it’s because I’m on my feet the entire time I’m working, or maybe it’s because I’m always frantically trying to search my brain for differential diagnoses and their treatments. Perhaps it’s because I don’t really talk to or hang out with people when I’m not working and I’m jealous of everyone on social media enjoying their summers. Or possibly because at the back of my mind there’s a constant reminder that I need to study for my end of rotation exams, I need to work on my assignments for school, I need to write for my rotations journal, etc. I’m thinking is a combination of everything.

I know I mentioned feeling isolated before, but it is quite a strange experience, feeling isolation during PA school. For example, right now my family is out roadtripping and the rest of my extended family is heading out tomorrow to join them while I stay back because of rotations. Usually in the summers my friends and I grab every moment we can to hang out and soak in as much sun as possible (well, those of us that want to get more tan), but this summer I’m not able to do that. My parents keep telling me that rotations is only for one year and afterwards I can do whatever I want. But after rotations come boards (more studying, great) and after boards come job hunting and adulting.

I suppose this is a good time for me to turn on some worship music and praise my Lord because even when my soul feels heavyespecially when my soul feels heavyHe is worthy of praise. He is the only one who understands and can say “I know,” and really mean it. When I sleep tonight I want my heart to be praising Jesus and when I wake up I will praise Him because He has given me a new day full of His goodness and mercy and help to continue onward.

The Art of H&Ps

In medicine everything is evidence-based, and labs and imaging and presenting symptoms are used evaluate patients’ physical state. When patients come in with a complaint, that’s what we start investigating. We look for pertinent positives and pertinent negatives and see if we can ask questions and perform physical exam tests to rule in and rule out disease processes to come to a diagnosis or differential diagnoses. It sounds straightforward enough on paper, but when I’m thrown into a situation in front of a patient, it seems as if all streamlined reasoning goes out the window.

This way of coming to a conclusion allows for sound diagnoses, but at this point in my clinical practice (meaning all of three weeks), I am still very much a novice at the art. In the classroom we learned to start off questions with the OPQRST mnemonic: Onset, Provocation/Palliation, Quality of the pain, Region/Radiation, Severity of the pain, and Time. When I first meet the patient I ask what happened or when did the pain start, and after that I try to ask the PQRST questions but sometimes I feel like I am winding around the questioning path before I feel like I’ve gathered an adequate amount of information.

This leads to some awkward oral presentations to my preceptor because I present with my partner and we start off with the presenting symptoms but sometimes jump around the normal presentation order because of the way we asked the questions. Thankfully, he is very gracious and mostly cares about what’s going on with the patient and overlooks our wacky history.

Another key to getting a good picture of what is up with the patient is avoiding making assumptions. Though it is not done out of ill intentions, even if it is done out of honest naivete, the history that the patient presents is tarnished. A few days ago, there was an elderly patient who came in with the chief complaint of vaginal bleeding. Immediately my brain went to a cancer of the female reproductive system. We continued with the history, how did it happen, has this happened before, is there pain anywhere, etc. It also so happened that the patient was not happy she was there and her son was trying to answer all the questions for her. Having family members around can be helpful, but it also makes it harder to know the real story. Anyways, we took the history and presented to our preceptor, and he reported to the attending and his response was, “How do you know it’s vaginal? It could be urinary or rectal.” I didn’t even think of the possibility that the chief complaint might not be the actual problem, though I did ask about the patient’s urination and defecation history. Turns out after a pelvic and rectal exam and after the patient urinated, the bleeding was actually coming from the urinary tract. From there the case became GU cancer until proven otherwise.

Even this early in the game of my clinical practice, my mind sometimes jumps to conclusions, which is something I’m working on avoiding. A patient came in with very nonspecific symptoms including a sore throat, cough, vomiting for a few days and was also giving me (and later, my preceptor) a lot of attitude because she had been waiting to be seen for a couple hours and felt very sick. From observation and speaking with the patient, my mind already made up in my mind the patient had a minor viral infection. My preceptor did a quick exam and waited for the labs to come back, but we both were thinking the same diagnosis. When the lab results returned, the WBC count was a little high, which made me stop because that made it seem more serious than I thought. But after a repeat exam, the diagnosis of a viral infection remained and the patient was sent home.

Both these instances made me stop in my tracks and reevaluate what I had been doing by failing to thoroughly investigate details and forming opinions in my head before seeing the whole picture. Of course, having differential diagnoses in mind help guide the history and physical, but it is also important to cover all the bases before coming to a conclusion. Needless to say, I have much to learn and a ways to go to become a fully competent PA.

The Epidemic is Real

After telling people I’m currently working in the ER, the question, “What’s the craziest thing you’ve seen so far?” has come up quite often. In the past two weeks I have seen a lot of cool stuff and a lot of boring stuff, too (no offense to the patients). I suppose I was least prepared to witness patients who come in from abusing illicit drugs, such as heroin, and are often on more than one drug. The opioid epidemic is quite apparent in New York City, as well as throughout the rest of the country. According to a report published by the CDC, between 1999 and 2014, the number of opioid overdoses has almost tripled in the United States. Of the 47,055 drug overdose deaths that occurred in 2014, 61% involved an opioid (1). A report from the New York State Department of Health estimated a crude rate of 6.1% of outpatient emergency department visits were due to an opioid overdose and a crude rate of 3.2% of hospitalizations were due to an opioid overdose (2).

I have not personally interacted with these patients when they have come to the emergency department but I have observed them. The first time I witnessed a patient on heroin, the patient was aggressive and not at all cooperative. He kept yelling at everyone, especially at his mother, cursing at everyone who tried to talk to him and touch him. It was quite interesting to watch the doctor and nurses work amidst the chaos and aggravation. I remember the nurse assigned to the patient’s bed had an extremely frustrated look on his face because he was nearly wrestling the patient to give him sedation medication. Once the patient was sedated he slept for a few hours and when he woke, the same happened again, only the following times it took even more medication to sedate him. It was hard to watch this patient, who was a healthy young guy, succumb to some white powder.

The National Institute on Drug Abuse lists drowsiness, mental confusion, nausea, constipation, respiratory depression, and euphoria as the effects of opioid abuse. Additionally, “restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and involuntary leg movements” are withdrawal symptoms that may occur with opioid dependence and addiction (3). Though these are the effects listed on paper, I feel they are far more detrimental. The patient’s family was distraught with worry and fear because their son/brother turned into a monster of sorts under the drugs and he had threatened to kill them at home. So even though the patient was experiencing the effects of drugs in his body, everyone around him was being affected to varying degrees, some more than others.

Another patient who came in on heroin was extremely physical and it was a little frightening to witness. He had handcuffs on his wrists and was restrained to the hospital bed but even then, I felt like if became even more enraged he could have turned into the Hulk right then and there. Because he was thrashing and yelling so violently, three built men (two security guards and one policeman) had to hold him down while he was given sedation medication.

When working with patients, you have no idea what you will see next. These two patients were most definitely difficult to manage and their cases were anything but predictable. Indeed, these two scenarios were like nothing I had ever seen before, but I would prefer that these encounters not just end as a riveting story. They beckon increased awareness about the opioid epidemic that is occurring right now, an epidemic that stems from addiction that can start from a regular or longer-term prescription. Not only awareness is needed, but also education for prescribers of opioids, people prescribed opioids, people abusing opioids, and support systems to know what to look for, where to look, and where to turn to for assistance. My heart hurts when I see patients in a state where their bodytheir liveshave fallen to such a dangerous addiction. Prior to rotations I had heard and read about the opioid epidemic, but seeing it in person is something else.


References

  1. Rudd RA, Seth P, David F. Morbidity and Mortality Weekly Report (MMWR). Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm?s_cid=mm655051e1_w. Published December 29, 2016. Accessed July 8, 2017.
  2. New York State – County Opioid Quarterly Report. https://www.health.ny.gov/statistics/opioid/data/pdf/nys_apr17.pdf. Published April 2017. Accessed July 8, 2017.
  3. Which classes of prescription drugs are commonly misused? NIDA. https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/which-classes-prescription-drugs-are-commonly-misused. Accessed July 8, 2017.

 

Free Time

Free time is a funny thing. The other day someone asked me what my hobbies were and what I did in my free time. I actually had to stop and think for a while, and when I answered, I told her I haven’t had free time in a really long time so I didn’t really know what to tell her. Having to study every open moment I had was torturous, yes, but it came with the territory of being a physician assistant student. I ended up telling the person who asked me the question what I used to like doing on weekends and breaks.

Oftentimes PA school has harsh effects on not just a person academically but also interpersonally. It’s sort of like you’re removed from what’s going on around you for a whole year. Sure I texted, messaged and called friends and family, but exchanges were sparse and short in duration due to, you guessed it, limited time, and also because I didn’t want to be distracted during my studying. That sounds bad, but you know how conversations can get carried away and take your attention away from your work? In order to finish studying at a reasonable time each night, I didn’t allow myself to text too much. Naturally, if communication is limited, relationships will become more distanced. But also through this trial I could see who was a true friend, the type of friend that would make an effort to empathize and keep in touch despite my situation. Admittedly, I was not the best friend to others because my schooling took so much of my time and effort, though I tried to keep up with friends as much as I could. Throughout the entire year, my family was amazing. They encouraged me, prayed for me, and made an effort to go through the year alongside me, which meant everything.

I think I’ve become somewhat of a hermit because now I see free time as an opportunity to catch my breath and rest. This usually works out because in the past three years of living in New York, hanging out with others was not really something I did. Now that I have additional time during the day and many weekends free (depending on the rotation), it’s a weird feeling. Last night I was reading snippets of an emergency medicine textbook and went through old notes while I ate ice cream in bed. And today I’ll do the same, minus the ice cream because I finished it yesterday.

Don’t get me wrong, I’m very thankful for the past year and I love what I’m doing right now. There are just aspects of PA school that I feel aren’t talked about as much and it’s something I have learned to come to terms with. I would never do the past year over again, but if I could go back and prepare myself and my friends and family better, I would. But then again, I had no idea what I was getting into. Perhaps after I’ve settled into rotation life I’ll give an update about free time hobbies.

It’s Offitchal

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.

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The Calm Before the Storm

Hello!

My name is Phoebe Ke and I am a Physician Assistant Student.

That’s what I’m supposed to say when I introduce myself to patients I see while on rotations. So yes, my name is Phoebe Ke. I recently completed the third year of my college education, and more importantly, the didactic year of Physician Assistant (PA) school at St. John’s University in New York. What that means is for fall and spring semester I went through 16 units of clinical medicine and took classes such as Pediatrics and Geriatrics, Emergency Medicine, General Surgery, Ethics, and two semesters of Health History and Physical Diagnosis. Ask any PA student and they will tell you PA school is no joke. For example, spring semester we had 32 hours of in-class instruction meaning nearly every day we were in class from 8 a.m. to 3 or 4 p.m. Anxiety levels were high and the number hours of sleep gotten were few. For months on end it was class, study, sleep, repeat.

Didactic year was by far my most difficult academic experience. No matter how many times I tried to explain PA school to someone, either he or she would balk or would not fully comprehend. Yes, the 7-8 hours after class spent in the library were very necessary, as were the 14-hour days studying in the library on the weekends. The only time I had off from class or studying was Friday evening Bible study and church on Sundays. If I thought my brain was tired by the end of September, my brain was completely fried by spring semester finals week. Each semester had an average of 18 exams which broke down to about an exam a week. Two weeks ago, we took a competency exam which tested everything we learned in the past two semesters. Thank the Lord I passed despite being completely drained mentally. Looking back, it was a long, long difficult year, but every time I flip through my eight three-ringed binders of material and Pance Prep Pearls book and many powerpoints, I’m amazed at all the hours spent poring over notes, the number of exams taken, the friendships that grew and many memories made that brought me to the closing of didactic year and the beginning of clinical year. It’s all God’s grace, I’m telling you.

I’m currently embarking on a year-long experience where I rotate through ten different rotations, each five weeks long, to gain experience and exposure and to put what I learned the past year into practice. This journal is an account of my clinical year as a final component for my Honors Program requirements. I decided that as excited I am that the Honors Program faculty will be reading this (Hello Mr. Pennacchio and Dr. Forman!), I would also share this with my peers, whoever was curious of or interested in the PA world, or if no one else wanted to read I would be fine with that, too.

This coming year I will be immersed in these specialties: emergency medicine, primary care, surgery, internal medicine, oncology, orthopedics, geriatrics, OB/GYN, and pediatrics. All these rotations will be completed through various clinics and hospitals in Queens, Brooklyn, and Long Island. Butterflies and the urge to pee are common these days because I’m excited to get out into the field but also nervous since I feel my competency as a health care practitioner is far below what it should be. Nevertheless, that’s what this year is all about—learning from other practitioners and my own mistakes, growing as an individual and health care practitioner, and enjoying this incredible adventure to becoming a physician assistant.

If you continue along with me, awesome! If not, that’s cool, too. Hopefully you gain something—perhaps a look into the Physician Assistant profession, insight from a current student, or maybe an interweb friend. Until next time!