My internal medicine rotation was amazing. Without a doubt this was one of my favorite rotations because I got to work alongside a PA on floors managed entirely by PAs. This rotation not only fortified my commitment to working in internal medicine in the future but it also gave me the assurance about becoming a PA. I witnessed PAs taking complete responsibility in caring for patients, writing orders, interpreting labs/imaging, and consulting with specialists/attendings when appropriate. All of my preceptors made me feel welcomed and took interest in my learning experience. I was consistently coached by the PAs on how to follow up with patients, interpret labs, and write detailed notes. I was happy to be entrusted with a set of patients and I often felt that I was of value to the team. I learned how to write detailed discharge notes and became very familiar with the process of admission.

One of the most memorable moments I had was during the week where I was working with the stroke team. One of the first patients I saw was a covid-19 patient who sustained a stroke secondary to the hyper-coagulable state that the infection put her in. She seemed unresponsive, preferred to look only at her left, and she unable to verbally communicate. My preceptor continued to speak to her and to my astonishment when the she was asked to raise two fingers, she did! She was unable to communicate but she was receptive to her commands. 

As the week progressed I became more familiar with recognizing the different types of strokes, the risk factors associated with their development, and I became more experienced with utilizing the NIH stroke scale. In the last few days we were called to the ED to examine a patient who was found in the morning, by her daughter, with altered mental status, slurred speech, and facial droop. Her last known normal was before she went to sleep. She was out of the window for tPA but she had an LVO and was a candidate for thrombecomty. I was given the chance to fully follow this patient and I was able to see them perform the thrombectomy. After the procedure she was TICI2b with 75% re-perfusion. It was amazing to see how a PA worked within a medical team and coordinated care for this patient. 

Throughout my time with the stroke team I tried to involve myself as much as possible. At one instance we had a 78 year old mandarin speaking man who was unfamiliar with his medication history, he was a candidate for tPA and I took it upon myself to call his pharmacy to get his medication list. I found out that he was on Pradaxa and I informed my preceptor who was really impressed. Due to his use of NOAC he was ineligible to receive tPA as per hospital protocol. Additional ways that involved myself was by writing discharge notes for as many patients that I could. This was incredibly difficult at first but through guidance/feedback from my preceptors I became more comfortable with them as the rotation progressed. I also took it upon myself to follow up on patients after rounds especially if they mentioned a new concern. I would interview them, conduct a physical, and present my findings to my preceptor.

I enjoyed time at my NYPQ IM rotation and I gained a sense of appreciation for medicine. There is so much to learn and everyday was a challenge that I looked forward to. I would love to work in internal medicine in the future.