Some take away points about this rotation:
1. Little sleep.
Now, this was not the first time I was working many 12 hour shifts, but it was the first time that all the shifts varied (7a-7p, 9a-9p, or 12n-12m). This time change was difficult for me to find a rhythm for and made me both tired and unproductive. I was unsure about how to use my time effectively for about the first two weeks. In addition, this location was about 50min from Albany which made early shifts even earlier and late shifts even later. At first I thought that it would not take much effect on me but toward the end of the rotation now, I live for my random days off. Up until now, I have not drank any caffeinated beverages to get me through but I am starting to understand why others need it now. On my third 12 in a row I noticed I was struggling to keep my eyes open.
2. It's OK to not know.
This was a very difficult concept for me to grasp. For years as students we are scolded for simply answering "I don't know," but in rotations it is okay to admit to having knowledge gaps. Thinking of it in the perspective of the attendings, they would rather have us come ask them for help when we are practicing than decide to do a treatment that is not effective, correct, or possibly harmful. They want us to know where our areas of weakness are to seek help and even study up in those areas. For right now though, we are still students and have many areas where we need to grow.
3. Rule out emergent things
Making differentials is the largest part of ER medicine. The differentials guide your testing and even interpretation of results. It may seem silly but even in the most mild cases of conditions life threatening things need to be ruled out. For example, someone with chest pain needs to be sure they do not have these five things: myocardial infarction, pulmonary embolism, aortic dissection, pneumothorax, and esophageal rupture. In a case of chest pain, these five things are the majors that will kill the patient quickly if not treated properly, which is why they need to be ruled out as soon as possible with an EKG and Chest X-ray in addition to common lab tests. After these killers are ruled out start thinking about some other issues that could be going on, positive or negative ROS symptoms could lead you in a good direction to whatever the diagnosis potentially is.
4. Unique to this experience
This ER is nice because it has the main ER but also an observation unit for patients that need to be held for only 1 day. Typically these patients are chest pain rule outs where a repeat troponin is needed 4-6 hours after the first one to officially rule out MI. Instead of keeping these patients in an ER bed taking up space, they are moved to the observation unit to be watched safely and comfortably before they go home. This hospital also gets a lot of mental health patients since they have a mental health floor. Due to this they have a little area where mental health patients can stay in the rooms safely. These rooms are different in that they have nothing on the walls, no cardiac monitors with cords (that could become dangerous weapons to the patient), no cabinets for the patient to climb on etc. There is just a bed in the center of the room with a TV embedded into the wall for their pleasure while they stay. The patients change into "mental health" pants and shirts and are under supervision of specially trained nursing staff. Most of the time each patient is seen by psych and their mental health care is determined by them. Finally, this ER position for PA's also includes Rapid Care (Urgent Care) centers around the region. I was only placed at this site for two shifts but it was probably part of some of my favorite experiences. I am still not 100% sure why I like urgent care so much, but I think its something about how fast paced it is to get the patients in and out so quickly, how each provider can see up to 50 patients a day! In addition, there is a lot of opportunity for procedures and xray reads.
All in all, this experience was definitely memorable and created nice foundation for the rotations to come. Now, I still have two days left but there were countless things that I have learned on this rotation that will forever stay with me even after I start practicing. I will always be grateful for this unique ER experience.