The NYPQ emergency department is amazing. Since this was my first rotation, I was a bit hesitant to start at such an esteemed location so soon. Yet, I love challenges and I was excited to finally break free of my dedicated pandemic studying. I gained so much practical and professional experience from my time at NYPQ. And most importantly I feel as if I grew as a future medical provider.

My schedule at NYPQ was different each day. I had a different attending each day and worked with many different residents. Sometimes there was some overlap which allowed me to work with some attendings/residents more often than others. I had one dedicated trauma shift, two pediatric emergency shifts, two urgent care shifts and the rest were all in the main ED. I especially enjoyed working three consecutive night shifts in the main ED. These night shifts offered more time for one-on-one teaching opportunities and I really got to bond with my attendings and the residents.

One skill that I learned well during my first week at the ED was patient presentations. I was a true amateur in my first week, and the senior resident would have to interject and help me finish my presentations. As I practiced more and more, I became quite adept at formulating a concise and medically relevant story for my presentations. Surprisingly, all my attendings were very receptive to my improved presentations and that gave me more opportunities to discuss management and treatment plans with them. This facilitated trust and I was able gain more insight as to how they quickly determined the patient’s disposition. Soon they were having me interpret lab values, CT or the XR results of the patient I presented. In the last 2 weeks I added WikiEM and MD-Calc into my repertoire. These applications helped me stay organized during very hectic shifts. They also helped me further understand the senior resident’s management plan.
I also tried to make it my focus to practice as many procedures as possible. I was able to practice putting in IVs with assistance however I still feel as though I need more guidance with performing the venipuncture. Often, I can find a good vein, but the angle of my needle would be wrong. Or the vein followed a different tract. This is something that I need to improve on in the future. I also became more comfortable with administering local anesthesia and placing sutures. As well as removing sutures. I got to participate in helping with 2 central lines, 2 LPs, and an intubation. After the intubation, the senior resident let me place an OG tube! I also got to help the ortho residents reduce elbow/shoulder dislocations. They even let me reduce a medially dislocated right 3rd toe on my own! One of the skills I wish I got to practice more was bedside ultrasound. There was a ton exposure to bedside ultrasound during this rotation, I saw numerous FAST exams, and I became somewhat familiar with recognizing organ structures on US. However, I wish I got more practice with using and handling the probe.

There are many things that I will remember from this rotation. One of the most memorable patients that I had was 31-year-old female who lying in bed and audibly crying. She was covering her face with her jacket and when I asked her to pull the jacket down, she was visibly uncomfortable. She has had a terrible headache for the past 2 days that began during intercourse. The slightest amount of movement and exposure to light would make her extremely uncomfortable. This was one of the worst headaches she has ever had in her life. As I began to put the pieces together, my senior resident came in and immediately took the patient to CT. I did not even have time to present to him, but he already knew that it was most likely a SAH.

Another case I found interesting is regarding a 32-year-old male with no PMH, SH, or history of drug use. He was brought in by EMS for suspected stroke symptoms. The patients’ wife noticed that her husband’s face was dropping, his tongue was swollen, and he had difficulty speaking. This was a 3:30AM stroke call and when he arrived the rapid survey was not very encouraging of a stroke. The patient did have difficulty speaking, but he also had tremors and his teeth were chattering. He was unable to sit still and appeared to be asleep. Collateral information from the wife corroborated no known drug history. However, she mentioned that he had sustained a puncture wound from a nail to his left hand. He was given a tetanus shot during that visit as well. He was trembling so much that it was difficult to get the CT. He kept trying to get up. After multiple, I mean multiple, bouts of sedatives his CT results were insignificant. Within minutes of getting the CT he woke up again and this time he would keep spasming, screaming, and howling (actual howling). I had to help the team hold him down for an hour and half. They ended up heavily sedating him and intubating him as I helped hold him down. It was a very confusing case. Was he having a stroke before? Was it tetanus? Was it MS? Guillain Barre? Night terrors? They still have not been able to find anything on him and he is in the MICU to this day. This case made me fall in love with medicine even more. To get this person the help that he needed we had to figure what he had. I went in everyday hoping for some new clue.

I really enjoyed my rotation at the emergency department at NYPQ. This was by first rotation and it really reinvigorated me and inspired me to want to learn and do more. I loved the pacing of the ED and would like to work in a similar environment in the future. I am excited for my next rotation in internal medicine.