My fourth rotation was spent at Brookdale Hospital in the Emergency Department.  Over the course of the five week rotation, I was exposed to a wide variety of patients, providers and medical techniques that I believed helped to better shape me as a provider.  This rotation was very hands on and I was quickly integrated into the team and expected to help see patients and complete procedures beginning my first day.  The Brookdale ED has a residency program and I regularly worked with the senior residents and saw patients on their behalf, presenting them to the attending after completing a full physical exam.

Early on in the rotation I worked the day shift and worked across three different teams with in the ED.  The ED is divided into different sections – trauma as well as two medical teams in addition to fast track and pediatrics.  We were required to work a fast track shift and a pediatric shift and the remainder of the time in the medical teams and trauma team.  This rotation was a very different patient population in comparison to the others I’ve had so far and of course given the ’emergency’ setting people were more anxious and demanded to be seen urgently.

There were some residents that were more pleasant to work with than others and some that were better at teaching and prompting me to think through the medical management of the patient.  Early on I made it very clear to the nurses that I was interested in drawing blood and starting IVs so I could build my skills and ensure I was as proficient as possible.  For the most part, I had success with the drawing blood on the first time but there were of course patients that were more difficult.  Early on in my trauma shifts, I was nervous to start the line / draw the blood from the patients because I didn’t want to miss and prolong the access.  As I got more confident in my skills and ability, I would start the line and draw the labs with ease and feel alright about doing so (especially before the trauma surgery team arrived).

During my trauma shifts I also was expected to do the sutures when necessary and staple patients head when needed.  From a procedural perspective this was a great rotation and the patients allowed me to do everything as if I were not the student.   During my shifts on the medical side, I was expected to complete vaginal exams for all patients that came in with complaints and run pregnancy tests when there were suspected pregnancies.  With the doctor I was working with, I diagnosed an ectopic pregnancy via ultrasound.  One of the PAs I worked with taught me how to do a transvaginal and transabdominal ultrasound and I was able to locate the gestational sac and determine the heart rate of the fetus, which I was happy about!

I had a particularly hard time with the night shifts because of the adjustment of working day to night and then sleeping during the day.  Once I was there I was fine but I did not enjoy sleeping during the day and being awake all night.  If I were to work night shifts on future rotations, I would need to mentally prepare for that and ensure I got enough sleep during the day.  I learned that I do not want to work nights (and I am aware that new hires work nights a lot but I need to find a job where that is not the case).  I also noticed during the night shifts there was a different patient population in that more patients would come in with substance abuse issues.  Often times they required observation until the substance wore off but other times they required procedures or imaging because they hit their head and cut it open or had potential for a bleed. Other times they had underlying psychological issues and would scream in your face / threaten you until they were treated.  Security of course was involved and ensured that the staff was protected.

On the other hand, I found there were more pediatric emergencies that came in over night.  I did a lot of CPR throughout this rotation and I found it particularly challenging that there were often times that children required the CPR.  I’ve always wanted to work in pediatrics but I do not think the pediatric ED is for me.  I found the shock of the emergency to be overwhelming and watching the parents see their child in these vulnerable states was a lot to witness.  I really enjoyed my NICU rotation and I think the difference is that going in you know the NICU babies are in precarious situations whereas the children in the pediatric ED were completely fine 10 minutes prior to arrival and now are requiring life saving treatment.

During this rotation, given the pace and frequency I saw patients, I had to hone my presentation skills to highlight the essential information and ensure the doctor / PA I was working with had enough information to complete the note.  This was particularly important during my fast track shift and something I think I need to continue to focus on in my next rotation.  From the time I arrived at 7PM, we didn’t stop seeing patients until 4AM.  It was a constant flow and insanely crowded the night I worked.  The PA I worked with during this shift questioned me a lot more than most and forced me to think through things in a way that I hadn’t done so before. Another focus I will have as I continue my rotations is medication management.  I want to ensure I am making the right suggestions for antibiotic treatments for my patients and I want to continue to build these skills with each rotation.

I am thankful for this experience and really learned a lot during the 5-week period.  As I move onto my next / future rotations, I will take the experiences I had at Brookdale and apply them in other settings.  This rotation also helped me to see how I won’t practice (based on observing some providers) and allowed me the opportunity to build and maintain my procedural skills.  Given the broad exposure to different aspects / types of medicine, I think this was a great rotation to have prior to my family medicine rotation.

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