Once in a lifetime experience

Today I officially had my first OPEN surgery. It was a cholecystecomy, bowel removal, removal of a fistula, and bladder repair. All in one patient. A cholecystecomy is a procedure where you remove the gallbladder, in this case it was due to gallstones. The bowel removal was done because this patient has bad diverticulitis which is a condition that causes outpouching of the bowel. In this case the outpouching in the bowel caused a tract from the bowel to the bladder (a fistula). The first part of the procedure was another laparoscopy, the second part however was an open procedure. I actually put my hand in someones abdomen today and ran the bowel. It was really neat! The surgery took like 6 hours and by the end my feet, knees, and back were hurting but it was totally worth it.

Rotation#6: Surgery

On Monday I began my surgery rotation. This rotation is definitely different from the rest. You never realize how much you appreciate sleep until you have this rotation. While my days are not jam packed with patients like in OB, some of the surgeries can be long. I see about 3 surgeries a day. I have seen a gastric bypass surgery, hernia repair, and a port a cath placement (a port used to place medications especially for oncology/hematology patients). Many of the procedures are done using laproscopic surgery. For those that are unaware, laproscopic surgery uses small incisions with the aid of a camera in order to perform surgery. Unfortunately, since I am a student so I am on the low end of the totem pole. This means that I don’t get to do much during a surgery. Thus far I have been able to suture, place catheters, and hold the laproscope. I am loving the experience of scrubbing into a surgery, wearing a surgical gown, mask, and sterile gloves. I am thankful for having the opportunity; however, I can tell I don’t want to go into surgery in the future.

4 more months until graduation!!!

Life in the OB-GYN Lane

4 weeks in this rotation have gone by in the blink of an eye. At my specific site, I am not doing deliveries, so I have more gyn exposure. My doc does take pregnant patients and she follows them up until the point of delivery. In this office I have really gotten do to a lot. I have done paps, lots of bloodwork, fetal heart tones, and helped assist in surgeries. My doc does hyseroscopies, colposcopies, and LEEPs in her office.

My favorite part of this rotation is the pregnant patients. I love seeing the parents’ faces when they hear the babies heart beat for the first time. I also like seeing the new moms change from week to week. Pregnancy seems like an exciting and tiring process at the same time.

This rotation moves very quickly due to the patient volume. I see about 35 patients a day and there is just one doctor. To some that may not seem like a lot but each initial OB visit is at least an hour long and new patients take about 30 minutes, so time adds up. That does not even include surgeries. To me this rotation is more stressful than the ER because of the pace. After coming from the ER, however, it is no sweat. In the ER there was some waiting time when all the tests have been ordered but the results have not come back. At this rotation, I hardly ever get a lunch, I may sneak off for a few minute to grab something and go. At this point I am used to it and for the most part I am not even hungry anymore during lunch. While being at work is not tiring I crash when I get home. It is also very hard to wake up in the mornings.

What makes this rotation unique is that OB-GYN is a very personal process. In other rotations it was as well, but this rotation in particular is more so. People are very private about their personal lives especially their gyn history, they will only tell their Dr this information. Also gyn exams can be a scary thing for some patients. My Dr also acts as a primary care doctor. She keeps her patients in line with their weight, makes sure patients are maintaining important medications, helps with depression/anxiety, and even goes over treatment of osteoporosis and osteopenia. She does it all. What I also enjoy is that she likes to teach me. With rotation 5 almost over and rotation number 6 (surgery) on the way, I officially have 4 months and 18 days until graduation!

Graduation

Today marks exactly 5 months until Graduation!

What the Future Brings

As my ER rotation begins to come to an end I can’t help but think MAN this went by so fast. I have enjoyed my time in the ER. I found my time here to be probably the most educational and hands on. I learned how to placing IVs, suture lacerations, splint broken bones, draining abscesses, perform CPR etc. More importantly I learned to evaluate the patient while keeping in mind “what is the worst case scenario” and how do I prevent it from happening. I have had amazing moments and moments so horrible I would never want to relive. Ultimately, I will is miss this rotation and the people I have worked with. In the beginning I thought ER was not my cup of tea, now I am not so sure.

This blog entry is a little different than all my other entries. As my student experience begins to end I can’t help but think about life working as a PA. What specialty will I go into? Where will I practice? In what state? There are so many questions. I have a little less than 6 months to graduate and my answers to all the above questions are “I don’t know.” I thought by now that I would have had some life altering moment where everything became clear and my path would be chosen for me. It is a blessing and a curse that I have loved all of my rotations, I still have 3 to go. I know that this means I have chosen the right profession for myself. Being a PA will allow me to work in multiple different specialties if I so wish. The flexibility was one of the main reasons for choosing the PA profession. I like having this option, however, I never thought I would need to utilize it.

Let me explain further. So far there are pros and cons to every rotation. For example, I enjoy monitoring my patient’s progress over years and seeing them grow. In the ER mostly you ship a patient to other departments. This means you may never see them again and the ultimate outcome may be unknown to you. In primary care it is the opposite you are the “gate keeper”. You need to be aware of symptoms that warrant a trip to the ER. You are in charge of making sure your patients have their colonoscopy at 50 years old if they have no family history or risk factors. You need to make sure you patients take their medication and follow up for blood work to track their progress. Primary care requires a lot of balance and coordination with other specialties. On the plus side there is more time to build a rapport. These examples are just scratching the surface.

As one can see there is a lot to think about for my near future. In the meantime, I am setting up my elective rotation, I have decided on dermatology. I find the skin fascinating and challenging. Dermatology was the first topic in our clinical medicine class and the topic I enjoyed learning the most about. I am a very visual person, rashes you can see and feel. However, it is challenging because some of the dermatologic conditions look alike and subtle differences in a person’s history can change your diagnosis and treatment. Important questions like have you travelled recently? What came first the rash or the fever? or Are there any recent changes in medication? etc are key. At the same time dermatology is not all about rashes, it can be about acne or skin cancer or simple cosmetic issues that affect a person’s daily life. My elective is in June-July, I hope it ends up being a great fit. If I end up not enjoying it I know that it can only benefit me in the future.

ER: My first hospital rotation

           I started my ER rotation about two weeks ago and so far it is going well. Out of all my rotations this has been the biggest adjustment for me. I am not used to the “treat them and street them” approach. I am not sure if it is because it is my first rotation in a hospital or if ER is just vastly different from my other primary care rotations. Coming from rural PA, ER seems very fast paced but I enjoy that. I am never sure what will come through the doors. Most of the time, surprisingly there are cases that we consider “non-emergent”. However, I have had some true emergencies, on my second day I performed CPR. Unfortunately, the patient did not make it, and I experienced my first loss. The worst of it is confronting the family. No matter how hard you look at it there really is no easy way to lessen that burden. My preceptor did do an excellent job at telling the family.
       On a happier note, I have really gotten to do a lot on this rotation: sutures, staples, abscess drainage, splinting, cleaning a wound etc. I have also gotten to work with a lot of PAs! In the ER I am working in there is a fast track and the regular ER. The fast track is for cases like broken bones, lacerations, abscesses, and more quick fixes. I like it there the most because I get to work with PAs who have been preparing me more for the regular ER. For example, I have gotten a lot of tips on my presenting skills. For those that are unaware, my job currently is to see a patient, get a full history, do a physical exam and come back and present this to my preceptor or the attending on staff. This is your chance to show your stuff so to speak and make a diagnosis and treatment plan. As a student, I have found a lot of times you are correct and many times you are not. This is a processes that over time gets easier. In the ER I have found that you need to be quick, concise, and to the point otherwise the attending will lose interest or rush you to get to the point. Getting tips on this process is crucial! So far I have gotten only positive comments and constructive criticism. All of which have really helped me in the ER. For example, in primary care and in school I am used to using the head to toe approach. Meaning, when you present and when you do your physical exam on patients go from head to toe. In the ER, unless it is for a case that is pretty simple, I was told "go for the meat". Meaning, if someone comes in for back pain go straight to that when you are describing your physical findings, then go to other body systems.
       So, far I am enjoying my experience but I am not sure ER is for me. There is something about tracking a patient throughout their life and sharing that bond that primary care physicians have with their patients. In the meantime, I am getting the most out of my experience and enjoying the people I have met along the way.

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.