My ninth, and final, rotation was Internal Medicine at NYPQ in Queens, NY. I was excited that my last rotation was in internal medicine, a broad specialty covering anything and everything so I could review various disease processes before I take my PANCE. I was also excited about the many procedures the PAs are able to do. I truly enjoyed this rotation as I followed many different PAs, got to learn from many providers and loved that the medicine floors were mainly PA-run!

We got to spend 4 weeks in medicine and 1 week on stroke team, assisting the stroke PA on call with all of the stroke codes, consults and accompanying patients to the cath lab and stroke floor. It was really interesting getting to see all the different presentations of patients that warranted a stroke code and getting to see the neuro exam performed dozens of times. I liked the fast pace and the urgency to get the patient to CT scan and CTA if necessary. One patient that stood out was a 64 y/o M who presented with a vertebral artery occlusion in the ER the night before. He was given tPA which subsequently and fascinatingly led to a basilar artery occlusion. After MRI, it became clear that he had a basilar artery stroke which occurs in less than 1%. He was rushed to the cath lab and had a TICI 3 but had also found a vertebral artery dissection and needed to perform angioplasty. That was a really unique case!

Being able to follow the PAs who perform many procedures, I got to do 2 procedures I hadn’t done yet – NG tube insertion and an ABG. The patient I performed the ABG on was actually a patient I presented an H&P on for my second site evaluation so it was exciting to be able to take a full history and physical from the patient, perform the ABG myself, interpret the results and aid in making the diagnosis as the results differentiated new onset CHF from new onset COPD in this patient.

One PA that I worked with worked mainly with patients in the ED who were admitted to the floor. A lot of these patients spent time in the ETAP unit – Early Treatment of Admitted Patients. One patient was a sweet, elderly man with a history of dementia presenting with signs and symptoms suspicious of meningitis. I had always learned that a sign of meningitis is nuchal rigidity but I never felt what a meningitis-like stiff neck felt like. The PA told me to go try and flex the patient’s neck and it truly felt stiff as a board, his whole upper body flexed forward when attempting. That was a theme of this rotation – getting to see a lot of what I learned in the clinical setting.

Something I feel I improved on in this rotation was putting the patient’s history, comorbidities, presentation, labs and imaging together to make diagnoses. As I approach my boards and working as a certified PA, this is a skill I will hopefully improve in as I get more experience and I was thankful to be exposed to that a lot on this rotation!