My fifth rotation was Emergency Medicine at Metropolitan Hospital. This was my favorite rotation yet! The environment was fast-paced and exciting, all the PAs, residents and attendings were welcoming and eager to teach and both the providers and nurses happily allowed me to do procedures.
This rotation was very different from my last where I was on the medicine floor, following patients. It took me a day or two to adjust to the nature of the ED and what they’re goal is – to rule out diagnoses that will kill the patient and just treat what is acute. I had to get used to focusing myself, and many times the patient, on what brought them in today – not the diabetic neuropathy that they’ve had for 5 years or their shoulder which has been hurting on and off for months. In the beginning I’d go back to the provider, whether the PA resident or attending, and present the entire case but at the end they’d still be asking me, “but why are they here now?” I soon learned to focus on only the acute and pertinent.
I really enjoyed the chaos and excitement of the ER. One interesting case I saw was an elderly woman from Equador who was brought by her son to make sure she was well to go back to Equador as she was experiencing slight dizziness. She had a pacemaker but she was found to be in third degree AV block and her heart rate was 36. I was present as the attending and some residents put in a transvenous pacemaker, a procedure they rarely do in the ED.
Two of the procedures I got to do was suturing and I&D. I performed both horizonal mattress and simple interrupted on a laceration to the R arm of an actively suicidal 32 year old female and an I&D on the L side of a man’s chest. When we were cleaning the arm of the female with the laceration, the resident asked her if it was okay if a student helps stitch her cut. She told the resident she didn’t want any students working on her and I had to work hard to hide my disappoint. Fortunately, a few minutes in she changed her mind but it was something I had to overcome, not to act disappointed and understand where she’s coming from.
A skill that I worked on this rotation was taking a thorough, detailed history and then being able to present it without reading from a paper. Whenever seeing a patient, especially in the first few weeks, I would jot down some details of the history so I wouldn’t forget but when presenting I would make a real effort to try to give over the story as a conversation and less from right off the paper. As I saw more and more patients I even tried to not write down as much on paper, just speak to the patient and present to the provider with what I remembered. I had never worked on this skill before so it was difficult to remember the important details and present in an orderly, concise way but I definitely improved!
In my last rotation reflection I said I’d like to focus on the assessment and plan portion of the H&P when seeing patients. I can confidently say that, with the help of the providers pushing me and asking “what do you think is going on and what do you want to do for this patient,” I have improved at not just getting a history but going through the work-up and plan. I would like to further improve this skill on my next rotation!
