Before beginning my internal medicine rotation I wasn’t exactly sure what to expect. I know that internal medicine covers a broad spectrum of healthcare which was different from my most recent rotation in ob/gyn. Reflecting back on my experiences I realize now how integral the internists and medicine PAs are for the care of patients. They are truly the people who lead a patients care and ensure that every necessary thing, including procedures and consults, are done. I began to think of the medicine team as the ones who are the “screws” that hold all the parts together to make sure it does not fall apart. This understanding has been a big part of what I learned over this rotation.

I got to see a broad spectrum of patients ranging from terminally ill cancer patients, to patients with simple diverticulitis. One of the unique parts of this rotation is that I, as the student, got to deal with many of the patients on my own and deal with the issues that came up on my own. For example, the patient with simple diverticulitis that I mentioned above wanted to leave AMA. The PA I was working with that day sent me to speak with the patient and educate her regarding why she should stay. It was the first time I had to deal with that type of situation, but I think that because she sent me in on my own I gained from the experience exponentially more than if I would have watched her deal with it. I spent some time explaining to her the importance of having a safe discharge, what needed to be done before that could happen and validating her concerns. My time spent with her convinced her to stay and left the patient thanking me. I left the conversation feeling accomplished and happy with my work. It reminded me that medicine is not only about physical health, but also mental and emotional care. Another patient encounter I had never experienced, but will definitely remember and learned from is a patient who came in with post-op pain and requesting opioid pain control. This patient admitted to being addicted to opioids and saying that noone wanted to help him because they will not give him more. In the moment, I was not sure what the best way to continue was, and I chose to educate him regarding the possible side effects of opioids while validating his pain and frustration. This patient scenario allowed me to discuss a difficult topic with my preceptor. Both of these patients are ones that provided essential learning experiences and will definitely stick with me in future rotations and as a certified PA. I will continue to remember the importance of nurturing the mental and emotional status of my patients and recognize that communicating with them often times helps resolve many issues.

Another part of the rotation that was really good was that my preceptor tried to get her students into different cool procedures. I will never forget that on my first day she sent me and another student to a code blue. This was the first code I was witnessing and at first I was just observing. The other student jumped in to do chest compressions and I was impressed at his commitment to learning. I wanted to also do compressions, but I felt nervous being that I never did them before. I was nervous that I would not do them correctly. After some time (being that it was a code that happened over a half hour, this likely was only seconds to minutes), I decided to put my apprehension aside and do it. That was one of the most accomplishing things I have done over rotations. I knew I wanted to learn, which is something that is so important to me, and despite my anxiety I chose to do it. The nurses there were very kind and were guiding me as I did it. One thing I wish the nurses in North Shore University Hospital knew was how much I, along with all the students I was with there, appreciate them. It is so much easier to learn and improve with positive reinforcement which is something they showed daily. This patient did not make it, and this was the first time I encountered a death. To see the respect that they provided to the patient with a moment of silence was inspiring and will stick with me.

Another skill I got to do for the first time was placing an NG tube. This was for a 91 year old patient who needed sustenance. She was very weak and could barely sit up on her own. She was not either able to assist in the placement by swallowing. I was not able to place the NG tube, and neither was the PA. This patient was coughing which expelled the tube every time we tried. She was also crying out in pain. Technically, the NG tube placement was unsuccessful but I learned a lot. I saw the compassion that the PA had for the patient and how to keep the patient aware of what was going to happen next. Doing this is just as important as the actual completion of the procedure to ensure that your patient is doing well.

Overall this rotation exposed me to a lot of experiences for the first time. They all tie back to ensuring that the patient feels respect and that they are taken care of emotionally. I was able to practice these skills on my own over this rotation by dealing with patients with more difficult cases. I also was able to challenge myself to do things that were uncomfortable for me. One way I would like to improve in the upcoming rotations is to not even hesitate before doing something. Although I talked myself into doing chest compressions, it was an opportunity that I almost missed out on due to my apprehension. In the future, I will give myself one or two minutes to worry about the outcome, but then remind myself how capable I am and what I’ve done and then go and do whatever it is that is available for me to do and learn from.