I completed my LTC rotation at the Internal Medicine unit at NYPQ. This was my third rotation, and my first rotation in an inpatient setting. Although it was not a typical LTC rotation, most of the patients I saw were geriatric patients with multiple health issues. 

I really had the opportunity to learn a lot about medicine and a practitioner’s thinking process throughout this rotation. My preceptor spent time going through labs with me and helping me figure out why the values may be off and what to do to treat the issues. I also learned how to write notes, reconcile medications, and compile discharge summaries. 

A big challenge I faced was communication barriers with patients. This included both language barriers, which was very common in this hospital, as well as barriers in patient understanding, which was something that came up frequently. For language barriers, there were interpreter machines available, and though at first I had difficulty using them properly, I got better throughout the rotation at learning how to navigate them, still focus on the patient as I spoke as opposed to on the interpreter, and yield the information I needed with the least number of words. Cognitive difficulties proved to be much more difficult, and this was something that I had never really dealt with before until this rotation. Many of the patients were NOT alert and oriented x 3- many patients came in with altered mental status, confusion, dementia, in addition to some patients who had aphasia, in which case it was both difficult to communicate with them as well as to figure out how much they can understand. Thus, it was often extremely difficult to get a thorough history, or any sort of history at all. Even checking in on patients to find out how they are doing and ensure they are on the path towards recovery proved very difficult with many of these patients who could barely understand and could barely communicate. Very often, language barriers and cognitive issues came together, which made it doubly difficult to communicate and get accurate information. Though I did get better at communication with these patients throughout the rotation, often we had to rely on family members, other health professionals, PE, labs, and imaging results to give us a better picture of what was going on. 

Something I was very much exposed to during this rotation was the importance of being there emotionally, not just for patients, but also for their family members during difficult times. For the last week of my rotation, I was on the stroke team. I had several situations where families rushed in their family members who had been perfectly fine just a few hours ago and suddenly were not moving, not talking, and not being themselves. Through the hustle and bustle of trying to get a proper history and physical and rush the patient to CT and proper testing in the shortest amount of time possible, the anxiety of the family was often pushed to the side. Something I learned about myself is that I am acutely aware of how sicknesses, especially sudden occurrences like strokes, can really cause a great emotional toll on the family. As the doctors and PA’s were yelling information at the families, because everything was urgent and rushed, I, as a student, had the opportunity to stay with the families a little longer, explain information a little more slowly, and be there for emotional support during these difficult moments. I really felt like I was able to make a positive impact not only on the patients, but also on their distraught family members, through these moments, and I hope to be able to remember this and incorporate it into my role as a PA, even during crises and urgent rushed situations. 

I was exposed to some different techniques in terms of procedures during this rotation. Since many patients in internal medicine are elderly and/or very sick, it is often very difficult to do a simple procedure such as venipuncture. I saw/had the opportunity to do and assist in blood draws and IV’s from all over the body, including the hand, the foot, every part of the arm, and the neck (external jugular vein). I also saw how to use an ultrasound to help guide the needle when it is difficult to find a vein. In addition, I saw how to do an ABG on a patient with rolling arteries, and learned to guide the needle at a little bit more of an angle in order to have a greater chance at getting to the artery. I hope to use these new techniques in practice to do “simple” and necessary procedures on more difficult patients. 

A memorable experience I had was with a patient who went into hypoglycemic shock. I had seen the patient just a few hours before and she was laughing and communicating completely normally with me. When we went into the room after discovering that her glucose was low, she was completely unresponsive, with her eyes open but zero sign of communication. A rapid response team was called, as multiple practitioners attempted to get venous access in order to administer dextrose (She was a hemodialysis patient, so one arm was already out, and the veins on the other arm were very difficult.) I was impressed by how everyone in the room approached the situation with a sense of urgency, yet calm. After about 10 tries from various clinicians, they were finally able to get access, and after administering dextrose and pressing on a pressure point, the patient came back to herself suddenly and completely. As we wheeled her to CT scan, she kept saying- “I died and you brought me back to life.” She was so thankful and we were all relieved. This situation showed me some of the high points of being a PA- we are dealing with people’s lives and we can legitimately save them. It also showed me the importance of remaining calm and collected, even in stressful situations and even with failures. If everyone had gotten anxious, especially with so many failed attempts, further damage could have occurred, and who knows how the situation could have turned out. ` Finally, my perspective changed as a result of this rotation, as I saw that illness can affect anyone. It is often too easy to think that the sickest people are those that are lower class, uneducated, and do not take proper care of themselves. But throughout this rotation, I saw multiple patients, many of who were younger in age, who were very educated and were taking the proper steps to take care of themselves, but were very very sick. I saw doctors, nurses, and PA’s who had full insight into their medical problems, but could only do so much for them. Although it is definitely important to educate people on proper health practices and prevent health issues as much as possible, and engage in patient education practices such as smoking, alcohol, and obesity counseling, it is humbling to recognize there is only so much we can do. We need to do our part to protect our health, and the rest is out of our hands.