For my second rotation, I was assigned to North Shore University Hospital for Internal Medicine.  This rotation was different from what I initially expected it to be and I was pleasantly surprised at the variety of different practices I was exposed to while on service.  Throughout the rotation, I worked with several different teams to gain insight into the different roles a PA may have within this hospital.

For my first two weeks I worked with an Internal Medicine PA who rotated through different medicine floors in the hospital but also worked in the Emergency Room treating patients who’d been admitted to the Medicine service but did not yet have a room assignment.  I was surprised a role like this occurred, and hadn’t thought about the actual logistics of admitting patients and ensuring there are enough open beds in the hospital to have a place for the patients in the Emergency Room to go once they had their initial treatment.  It was interesting as someone who’d previously worked in an ED to see the Medicine patients waiting a day or so to get a room and now being a part of the Medicine team treating them before they made it up to the floor. In the Emergency room, I worked with the ED staff but Medicine providers so it was an interesting mix of treatment strategies and approaches to caring for patients.  It was challenging at times because patients were frustrated that they were sitting in the ED for a day or two when they’d been ‘admitted.’ There was a certain finesse that was required with some patients to make them comfortable while they waited but to also ensure they received the best care. My preceptor had me and the other students rotating with me present early on for the patients I was caring for and I decided I wanted to work on fine tuning my presentation and following a particular structure when giving report.  Initially I found myself jumping around a bit during these presentations, which was probably difficult to follow; however, as I progressed through the rotation I was cognizant to be better each time and present the patient clearly and confidently.

On other days, I was assigned to work with the PAs on the inpatient floors.  I really enjoyed this and felt I was better able to build a relationship with the patient by seeing and working with them each day.  The consistency of having a patient day after day allowed me to build the rapport with the patient and his/her family and form a bond that, I felt, led to better treatment.  I was involved with writing notes and provider hand offs each day, engaged other services to help consult on patients and helped the nurses with blood draws / tasks to ensure I was getting the most out of this rotation as possible.  I was grateful to have spent a few days with the cardiology team to learn / appreciate murmurs and to see how interventional cardiologists can place stents, complete TAVRs in the Cath lab without opening the patients chest. After spending a few days in the heart clinic, I am significantly more confident in my ability to hear murmurs, which was something I substantially improved upon during this rotation.

During this rotation, I spent a week on the Hematology / Oncology Service, which I am so fortunate to have had the opportunity.  I am very interested in pediatric oncology, and although this was a patient floor, there was so much I learned from the team and I am so grateful for this week.  I worked with the PAs & NPs on the service and went through rounds with the broader team each morning. The drug regimen for these patients are often protocols associated with trials and are very structured.  That said, many of these patients have associated comorbidities that required treatment and working with the team and understanding the thought processes associated with these treatment plans was inspiring. While on this floor, I also worked in the Bone Marrow Transplant Unit and saw stem cell transplants occur and patients in isolation because of how drastically depleted their immune systems are compared to a healthy patient.  I learned about bloodless transfusion protocols because we had a patient who was Jehovah’s witness and the additional approaches that went into treating this patient. During this week, I learned a lot about the legalities of giving blood / stem cells and the policies the hospital enforces to protect their patients.

My fourth week on the rotation was spent in the Medical ICU and was very hands on for me.  I worked with an NP during this week that had been a MICU NP for 35 years. He really challenged me to know my patient and had me present at MICU rounds to the entire team each morning.  He asked for my recommendations and my thoughts and pushed me to think about how all of the body systems are impacted by his illness. I was responsible for calling consults for my patient, completing his physical exam each day and working with the broader team to ensure everyone was clear on his care plan.  He showed me how to do bedside ultrasounds and to read them and evaluate for lung abnormalities and had me assist with central lines. I really liked to duality of procedural work intertwined with the medicine that I experienced in the MICU. The human aspect can sometimes be lost but I felt that this team was caring and also did an excellent job explaining the medical conditions to the families but also working quickly and efficiently to provide the highest level of care.  

For the last week of my rotation, I worked on the Kidney Transplant team with NPs and PAs that worked on the inpatient floor caring for patients pre & post renal transplant.  I’ve always been very interested in organ transplants and think it is such a powerful life saving treatment. The team is growing and had new PAs being trained while i was there so learned a lot about the medication regimens the patients are undergoing but also the anti-rejection medications they are required to take after receiving an organ.  It was interesting because some of the patients I’d seen on the HemeOnc floor were receiving the same anti-rejection medications after their stem cell transplants and felt great to be able to make the connection as to why they needed this medication and have contributions to share with the team. The transplant team had me present my patient at their grand teaching rounds, which was nerve racking because all of the attendings on the service were there.  However, it went really well and it was exciting for me to see how much I’d grown in presenting over the course of the five week rotation, especially after I’d set it as a goal during my first week.

Internal medicine is a very broad rotation and covers every discipline in some way or another.  I really enjoyed my rotation because it allowed me to see so many different subspecialities and how they all intertwined together allowing providers to provide quality care for patients.  As I continue with my rotations, I want to take the skills I learned in practice and use them to treat and care for future patients. I want to ensure I am building trust with my patients and forming collegiate collaborative relationships with other providers in order to give the best quality care for each patient seen.  

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