I was initially supposed to complete my Emergency Medicine rotation as my third rotation back in March, but it was postponed as a result of the COVID-19 pandemic. While I was disappointed about that initially, I think this was really to my benefit for my experience in the rotation; I was able to complete almost all of my other rotations and get hands on with suturing, stapling, NG tube placement, IV placement, and other common procedures, as well as being able to elicit a much better history and physical and come up with broader differentials than I would have been able to do in March. With the experience of 7 other rotations under my belt, I felt really well prepared to go into this rotation, which is a specialty of interest for me that I hope to pursue upon graduation. I was also really excited to be going into this rotation with my classmate, Lucas, since I had gone a few rotations being the only student from the program on that site.

The set-up of this rotation at NYPQ was a bit different for me than my other rotations thus far; I was assigned to 15 shifts either on the Blue, Green, Red (higher acuity), or pediatric teams, often with different attending physicians and residents each shift. Of course there was a lot of overlap, but it was interesting to have to establish a relationship each shift with whoever was new to me for that shift, and also a bit intimidating. I also got to do 4 overnight shifts in a row, which I surprisingly enjoyed.

One skill that was mostly new to me that I got to practice this rotation was using the bedside ultrasound. I mostly practiced on patients coming in with urinary retention to perform bladder scans, but I was able to practice ultrasound-guided IV placement and bedside echos. I was extremely lucky to have patient attendings and residents who were able to walk me through using the probes and how to optimize the view. It was very different from the simulation ultrasound program we used during the Clinical Skills course at the end of the didactic phase of the program, but I was glad to have had that baseline knowledge going in. While I am not yet proficient at using the ultrasound machine, seeing how often it is used in the emergency setting has motivated me to seek further training in this modality.

From my urgent care and surgery experiences, I was definitely most looking forward to suturing in the ED because it is something I really enjoy doing. The way the daytime ED is set up, however, lacerations that are not trauma calls or not too overly complicated actually go to the ED South (EDS), which is the urgent care setting, so these were not patients I was actually meant to see with my teams. Fortunately, I was allowed to keep an eye on the EDS board and walk over whenever I saw a laceration to see if I could repair it. Each time I did this the PAs working in this area were very agreeable to let me participate. Unfortunately for me, however, each time I attempted this, the lacerations were more complicated than we initially thought so that ortho or surgery were called to repair them due to nail and tendon involvement. This was really disappointing for me, because I thought I would end up going the whole 5 weeks without suturing at all. During one of my pediatrics shifts, though, Lucas came over from his team for the day and told me that they had a patient with a pretty large lower leg laceration from a metal grinder if I wanted to repair it. I felt so grateful to him for this because he essentially gave up a procedure to me, and that really goes to show the character of the people we have in our class. He even stayed with me during the suture repair in case I needed anything, which came in handy when I ripped my sterile gloves and did not have another pair on my person. The patient actually allowed me to take pictures of the before and after, which you can see below:

After that experience, I was able to do a few more laceration repairs, most notably a 12cm forehead laceration that required a suture ligation and a 2-layer closure.

Being a student in the Emergency Department is an interesting balance of being involved in the team without getting in the way. For this reason, at the start of each shift I made sure to introduce myself and establish how the residents and attendings preferred for me to participate. I always led with the fact that I preferred to go see the new patients on my own and do a history and physical exam so that I could then present the patients, provide differentials, and propose a plan. They were agreeable for on most shifts and I was only told to follow one specific person for one shift, which was still a great learning opportunity.

The thing I found I need to work on most from this rotation was the plan in terms of what diagnostic testing and labs absolutely need to be done. In the classroom we definitely emphasize what we could see on different labs for different conditions and all the possible diagnostic modalities, but practically it is wasteful and not feasible to do any and all tests that come to mind. I really had to get used to that for my first couple of shifts, so I made sure to check each patient’s orders in the EMR to see what the appropriate tests were for that patient.

I really enjoyed the emergency medicine setting. Especially coming from the long-term care setting, this really reinforced for me that I want a more fast-paced environment that has more diversity of cases. I am thrilled (and terrified) to be so close to the end of the program so that I can hopefully get back into an emergency department as a licensed provider!