With ER being my first rotation, each day I was exposed to something new and got to strengthen my clinical skills. It was exciting to be able to implement what I had learned at school like pelvic exams, IV placements, IM injections, splinting, urinary catheters etc. into real life practice. In addition to the medical side, I saw how a hospital functions and got to witness the dynamics between the PAs, attending physicians, residents, nurses, and other healthcare aids. I was asked multiple times what field I was thinking of going into and if ER was an option. It honestly had not been a field I was considering, but after this rotation I am reconsidering.

In the ER almost everyone got an IV and I was eager to get the practice. Every time I saw a nurse wheeling a tray with the IV kit, I would run up and ask them if I could do it. I found the most difficult part to be finding the best vein to go into, whether it feeling for the vein or knowing that certain veins were too superficial to go into or when an ultrasound guided IV was necessary. In a lot of my first tries, I would have to readjust my needle until I saw some flashback or until a nurse needed to step in to help. As I got more practice and watched how each nurse did it differently, I started to get more comfortable inserting IVs and one nurse actually let me perform one on a patient with dementia, who was slightly resistant to having the procedure done. Another procedure I was thankful to have performed was suturing a laceration and assisting in performing a nerve block. The nerve block was something completely new for me and I was nervous to perform it, but I reviewed the procedure with the 3^rd year resident precepting me beforehand and she watched me closely as I did it. For the suturing, I give credit to York for being so particular during our suturing lab because I felt comfortable and confident when I performed it in the hospital. The feedback that I got back was reassuring and encouraging. 

Being able to perform procedures was one part of clinical rotations that I was excited for, but the other part was interacting with patients. I like to spend time and speak with them, but it didn’t match the pace of the ER and my preceptors, at the beginning, would comment that I spent too much time with the patient when I felt that I hadn’t spent enough. I also found it difficult to transition from taking full histories to very focused ones because it required me to be able to quickly form differential diagnosis so I could ask the correct pertinent negatives and positives. I would often gather more information than the preceptor needed, and they would comment that my HPIs had more than enough information. I know the ED is very problem focused and the goal is to determine what the patient is here for and does the patient need to be admitted or not. I asked for tips from the other residents and PAs, as well as other PA students rotating with me, to help me improve on working more efficiency. By the end of the rotation, I became more conscious of my time with patients and I learned to work fast, but I am eager to see how taking a history in the ED compares to my other rotations.

A reason why I wanted to rotate at Metropolitan Hospital was because of their diverse patient population. For most of my patients, I needed to use a translator. I found it challenging at first to balance talking to the translator while maintaining that connection with the patient, especially when things wouldn’t translate or there was bad connection. As time went on, I became more comfortable with having a translator there and would speak directly to the patient as if the translator wasn’t there. A lot of patients spoke Spanish and I quickly realized how much of a disadvantage I was at not knowing how to speak even a little bit of the language. From listening closely to conversations and observing gestures when certain words would be said, I eventually could pick up, minimally, on what was being said. I decided to invest in a medical Spanish book to review a couple of times a week, so that I can get started on building my vocabulary for my future rotations and for when I start working.   

Another area I would like to improve on is becoming more proficient in medical criterias and when to use them. The three I remember being asked about the most was the Centor criteria, Ottawa ankle rules, and the NEXUS criteria. I quickly remembered what these criteria were when my preceptor asked me about them, but I didn’t automatically think about them on my own when working up the case. There are so many resources out there and I have a lot of them downloaded on my phone that I have just not utilized enough in my learning. My preceptor highly recommended the use of MDcalc. For my upcoming rotations, I plan to become more familiar with these applications and how I can use them to my advantage in getting the most out of my rotations.

I wanted to end my reflection with sharing one memorable patient I had. She was a 40-year-old woman who had originally told the nurse she had abdominal pain but had actually come in seeking help for her heroin addiction. She had relapsed a year ago after being 10 years sober and had been using every day since. She lost custody of her kids and has been living in a shelter. I saw a lot of patients come in for drug overdoses or if they needed a place to detox from drugs or alcohol, but this patient was the only one that I saw who came in seeking help. It was also the first time I assessed for depression and possible suicide risk, with my preceptor present. It helped me gain a new perspective on these patients and the challenges that they face on becoming sober. It also strengthened my desire to learn to work with compassion with all my patients as I go through my rotations.