Rural PA for Family Medicine

I hope all my readers had a nice Thanksgiving! It felt great coming home in the middle of my rotation to see family. I am currently in LaPorte, PA working at Sullivan County Medical Center. I must be one of the luckiest girls on the planet because this is the third rotation that I absolutely LOVE! For those who have never heard of LaPorte, it has a little over 300 people in the population. Some would say that this would make the rotation boring; on the contrary, I find it a perfect place to learn. While I am a second year PA student, I still find that I have a lot more learning to do, working in a more slow paced environment allows me to learn techniques correctly. The small town atmosphere is a definite adjustment, I am about 45 minutes away from everything: grocery store, shopping mall, and chain branch restaurants. What I love about this area is its simplicity. Many that live here do not earn a large amount of money, however, they are a very giving community. Many times I have been asked by patients to come to their homes for dinner or to celebrate a birthday. The staff has also been given many delicious desserts and presents from patients. LaPorte is located in the woods so many patients come in with stories of bear hunting and deer spotting. One patient even named and feeds a few black bears each year. She took a picture after she fed three bears sitting at a picnic table. Sounds like some fairytale story I know :). I have personally seen a total of 4 bears (mom and three cubs) and probably 12 deer in a total of 2 weeks.

Two weeks ago there was a health fair that we were involved in at the local high school. We gave the entire community free immunizations. I must have given 50+ shots that day, which was great practice for me. While my encounters with “patients” were short I was still told a little of their life story and always told thank you after giving them their shot.

In this rotation I have also had the pleasure of working with 4^th year medical students from PCOM. Their rotations are 4 weeks long and mine are 6 weeks long so I have gotten to know two groups of medical students. It is great to finally work with students who have more experience. I really feel like we all worked as a team to help treat patients and educate each other. Since we all live together we all have “family dinners” each night and even make a fire to make some s’mores during the cold nights up here. There is a tradition for all the groups who stay and work in the medical center, you have to complete a puzzle, autograph it as a group, and hang it up in the house. The first group of medical students and I successfully completed our puzzle and hung it up in the hallway of the house. My name will be forever a part of this medical center for future students to see. I hope that future students will love it here as much as I did.

Rotation 2: Pediatrics

I love Pediatrics! I find great pride in not only diagnosing and treating little ones, but also creating a sense of ease for parents. So, essentially, at the end of the day I have treated two patients. What could be better? While I don’t have children I can see that it is equally as taxing on parents as it is rewarding. While a normal bump and bruise may mean nothing to us it is at times a call to the ER for new parents. It is my job to provide anticipatory guidance. I tell parents what to expect and how to deal with issues as they arise or how to avoid potential problems. For most parents it’s easy. For others, a takes a while to get comfortable with the fact that parenting is difficult and they need help. Trust is important in this relationship more than anything else. Everyday I work through parental concerns involving toilet training, tantrums, school rebellion, sibling rivalry, nutritional guidance, bed-wetting and constipation. Sometimes my response is as simple as “Try these techniques, if they do not work come back and we will work through another solution to the problem.” The simple act of being there in the process means a great deal.

As I am getting toward the end of this rotation I, again, am amazed at how fast time flies. I remember being so timid when I first started this rotation 5 weeks ago. Now, I can see three or four children in one room. When you get comfortable in a rotation it is really hard to tear yourself away from it. I know that this is what I have to do to complete my degree, but it does not make it any easier. Some of these children I have seen multiple times and seen them grow. Today I had a 10-month-old baby girl want me to do a full physical exam while holding her hand. Yesterday, I had a child whose arm got stuck in a chair in the waiting room. There is never a dull moment. I am sure I will have more crazy adventures on my next rotation, Family Medicine.

One rotation down, pediatrics to go

I can now say that I have successfully completed my internal medicine rotation and passed the final exam! I am so excited that I am one step closer to becoming a PA. I still have 6 more rotations to complete and then my elective rotation. My last days in Jenkintown, PA in internal medicine were great. I feel like I really started to get into a rhythm. I even got to see some repeat patients that I had already built a good rapport with. Internal medicine gavee me a solid foundation for which to take with me to future rotations. I was very sad to leave because I had grown close to the staff, patients and the doctor there. I was given a nice thank you card from the staff and a few hugs goodbye. I went through my evaluation with my preceptor and was pleased that he thought I did a great job on the rotation. My last day was Wednesday, September 21st. On friday the 23rd I took my final exam, which was tough, and then our class had a few introductory lectures in order to help us prepare for our certification exam after graduation. It was nice seeing all my classmates and teachers. It was great to hear about different rotations and experiences. It was interesting the wide range of topics all the way from delivering a child to seeing their first patient pass away.

Currently, I am on my pediatrics rotation at Virginia Beach, VA. I love the setting over here. While the pace is slower than internal medicine I really like the doctor I am working with. She is willing to teach me at every opportunity. She takes time out of her day to go over a topic a day with me. The doctor is also very personalble and friendly so working with her is a breeze. I enjoy the patients that we have seen so far. It is so differnt than internal medicine. The volume of medications and past medical diagnosis for these patients are significantly less for the most part. It is a hard adjustment to go to tiny little bodies for physical exams but I am managing so far in this first week. The patients are adorable, I love seeing them smile. It breaks my heart to see them cry when giving immunizations. Soon, I will be doing immunizations myself on patient...eek. The other day we had to give a 9 month old 3 shots, proir to this she was smiling and laughing and just so delicious. Seeing her streaming tears and high pitched screams almost made me want to cry too. I know this will take some getting used to, for now, I am taking it one day at a time and enjoying the experiences as they come.

First Rotation

I started my first rotation on August 15th in Internal Medicine. So, far I love it! It is really nice not being in the classroom each day, but more than anything, it feels great making a difference in people’s lives. Each day I meet new and amazing patients. Each person has their own personality and way of interacting with their Doctor and myself. If there is something that I learned from PCOM other than a huge knowledge base, it is a way of interacting with patients that seems almost second nature. All those standardized patients we were giving over 3 terms taught me well. One may think it is easy; you are just having a conversion with someone about their health, but, this is not true. You are giving patients the opportunity to trust you enough to be honest with you about their personal health and habits. This is personal information. It takes asking the right questions and using the right tone to get the appropriate answers to find out their diagnosis and treat them. Another great aspect of this rotation is my preceptor, he is amazing. I aspire to be loved as much as he is loved by his patients. He has had patients for over 15 years because they believe and trust in him. I have also seen him tackle multiple obstacles with patients. Diagnosis seems only part of the difficulty in medicine, because once you find this diagnosis you have to explain it to the patient, go through the treatment and see if they are willing to change their habits and accept the treatment. Many cases patients don’t believe in taking medication. Especially for hypertension, high blood pressure, it is called the “silent killer” for a reason, most patients feel fine. We try to explain every day that hypertension is a very serious diagnosis that needs medical treatment and life style changes. On the other side, there are patients who are relying on you to help them and will do anything you say to not be in pain. Sometimes you have to play the part of a friend and just listen or be a shoulder when they cry. The other day I met a woman who was in so much pain she could not stand or even sit without fidgeting to get into a comfortable position. Unfortunately, there was not much we could do for her pain that would be a cure all. However, she was appreciative of our time and through her tears she told me “your smile means a world of difference and it’s an act that many of us do that costs nothing, thank you.”

Offically a 2nd Year PA Student

Yesterday we had our last exam of the term, officially making me a Senior PA student!!! After our exam we were able to celebrate by getting a survivor brunch provided by the school. Here we got a free gift and were given a nice speech from the faculty. After, we took multiple pictures to remember this day of accomplishment. We all could not stop hugging one another and wishing each other good luck on our upcoming rotations.

It is so strange to think that the next time I need to go back to school is in 7 weeks to take my internal medicine rotation final exam. It will be strange not seeing my classmates and teachers every day. I really feel like we have all become a family. We have seen each other through tears and praised each others accomplishments. I feel like now I will be stepping into an unknown world filled with new people and new faces. Honestly, I am anxious, but I know that these last 14 months prepared me well. I am excited to treat patients and to be part of a medical team. My first rotation is in Jenkintown, Pa in Internal Medicine. I know this rotation will be callenging but a different sort of challent from what I have been used to. Before my interal medicine rotation begins, my classmates and I have been rewarded with a few days break to relax and enjoy some of the things we have put off for the last few months. I am going to Disney in Orlando, Fl! See you all on the 15th!

Oral Boards and my Birthday

Since the beginning of PA school, there has been this test that people dread. That test is oral boards. It is something that we start studying for months to weeks in advanced. This test takes place in the last term of PA school and it is your final for clinical medicine III. There are multiple diseases that you have to studying and your grader choses two to test you one and you have to verbally go though, definition, etiology, epidemiology, pathophysiology, signs and symptoms, diagnosis/ labs, treatment, and complications. All in 15 minutes per disease. We also get a chief complaint like "cough", and have to spit out 20 diseases or so that cause cough. You have to make sure that when you rattle off 20 things that cause a cough that you throw in oral board topics so that you can get your final diagnosis. COPD is an oral board topic, these topics can change every year, and that causes a cough for example.

Yesterday we had oral boards and it was extremely stressful. The day was filled some crying due to all the emotion built up for this event. However scary it was, our teachers tried to relieve as much stress as possible, some even handed out candy. In the end we PASSED! It is so exciting that the test we most feared is now behind us and we only have 2 finals left before we go on rotations! Last night we all went out and celebrated this accomplishment. Also, yesterday was also my birthday, so we celebrated that as well. It was so nice to go out and relax with my classmates. We all hugged one another and took pictures, it was a great night. I am proud of everyone and how far we have come! What a great birthday present this was.

Stress and Surgery Day

It has been a while since I last wrote on here. School has been a little crazy lately. We are coming to the end of the didactic phase, August 5th is our last day. There is still a lot before then, and stress is high amongst myself and my classmates.

This past friday was fun though, we had surgery day! Each of us were in groups and assigned to a "surgery" later that day. We had to look up everything about that surgery in order to report back to our preceptor for intense questioning about the surgery, complication, indication, etc. While preparing for that we did rounds with our attending. We saw 4 patients, they were our teachers, who all pretended to have complications post surgery. I think our teachers enjoyed this part, they went all out: having pretend IV lines placed, foley catheters with yellow highlighter colored urine, fake incisions, the works. It was pretty funny. After we saw those patients we wrote up notes on them. Anytime during this day there were two people on call who got called to dispense orders for those 4 patients. That part was the hardest because we had to think on the spot over the phone how to treat our patient. Once, we were called in and had to examine the patient. Finally, we ended the day writing up a post-operative note for our patient having surgery. My groups surgery was a carotid endarterectomy.

The day was really fun and not as stressful as I was expecting. It was a nice way to ease into our real surgery rotation during clincals. I think the students had as much fun as our teachers. Oh, and we had to come in at 6am to start rounds on surgery day making the experience even more realistic.

Well, we have a hard 2 weeks ahead of us, hopefully we will all come out unscathed and ready to take on rotations on August 15h.