I met Professor Melendez at York for the midpoint evaluation following a night shift!  We discussed some of the more interesting cases I’ve seen and how they’ve definitely prompted me to think more and more about what I want to do and how what we learned in the classroom applies to the clinical setting. I presented my first five drug cards to Professor Melendez and went into detail about all of the assigned portions of these drugs but also how I’d seen them utilized in practice.  I noted to him (and he agreed) that I found it easier to remember something (whether it is a drug card or otherwise) when I’ve seen it in reality. I related each of my drug cards back to particular cases I’d seen and we were able to discuss those cases to solidify my understanding.  I also presented a case about a patient with abdominal pain and discharge.  Given this is a patient of childbearing age, I was sure to ask and subsequently present on the patients gravida and para status and ensure I had a full obstetrics and gynecologic history in addition to obtaining information about other abdominal review of systems.  What was interesting about this case was that this patient was pregnant and unaware of this fact prior to coming to the Emergency Department.  I had to let her know she was pregnant and subsequently treat her for STIs, which was causing the abdominal pain, she contracted from her partner.  Given Professor Melendez’ specialty we had an interesting conversation surrounding the characteristics that ‘make something an STD’ and a conversation as to why Bacterial Vaginosis is not technically an STD but rather a bacterial infection that can be caused by sex.

For my final site evaluation, I presented another case and the remaining drug cards to Professor Melendez.  The patient I presented for my final evaluation was definitely one of the sicker patients I’d managed over the course of my ED evaluation because of her associated co-morbidities and vague presenting symptoms.  I reviewed the patients past medical history and discussed the case thoroughly and walked through why certain decisions were made in the ED (after consulting several teams in house).  Ultimately, the patient I discussed had symptomatic anemia and required a blood transfusion.  As a result, I presented an article that discussed the morbidity associated with blood transfusions and highlighted transfusion thresholds and strategies that guide red blood cell transfusions.  Given these protocols are different for each hospital and sometimes different within these departments, it is important that we (as future providers) familiarize ourselves with protocols and delivery methods for how blood is transfused, especially given the side effects that can occur.  I also presented my remaining five drug cards and walked through why I’d selected these drugs for the Emergency Room rotation.  Professor Melendez asked me several questions about these medications and thankfully I was able to answer them all.  Again, I attribute that to my linking these medications and their use to cases I’d seen in clinical practice.  I find I remember the drugs, their mechanism of action, their indications and adverse reactions better that way.  As my rotations continue, I hope to strengthen my procedural skills and continue to hone my ability to write an H&P, I think it’s important that we learn how to document prior to starting our job and these rotations allow us to do that in practice.

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