My sixth rotation was long-term care at New York Presbyterian Queens. I did my long-term care rotation in internal medicine at this hospital. I worked three twelve-hour shifts on different weekdays and did one week of night shifts. While the PA’s I worked with each day changed, the days were similar. In the morning we would chart review on patients, and I would often get a list of the patients we were going to round on, that way I could understand a background of each patient. After a while of chart reviewing, we would spend some time rounding on each patient. Since each PA had at least ten patients, it allowed me to see a variety. I saw patients for admission in the emergency department, in ETAP which is early treatment of admitted patients, and on various floors. I would sometimes go into the room myself, especially in ETAP, to check on the patient, which allowed me to review the history and why they are in the hospital from the patient themselves. I learned a lot about the importance of making sure the patient is stable during your shift, checking up on patients and reviewing charts during this rotation. I also learned the importance of addressing each problem in the plan, as you want to make sure the patient is receiving all their home medications and that no problem is less unaddressed.

In comparison to my last rotation in urgent care, which was heavy on procedures, this rotation did not have as many procedures because the patients usually already had what they needed done. However, this rotation helped me understand how to take care of patients with multiple comorbidities and the importance of working as a team with multiple different specialties and clinicians. Additionally, I worked on stroke team for a week and became NIHSS certified. I enjoyed going down to the emergency department to see the stroke cases and see how despite there being many team members around the bed, it was extremely organized. It was also amazing to be able to see the CT head performed in real time and see the immediate images to determine whether the patient had a hemorrhagic stroke or not. In two separates cases we did not see this, but we saw that the patients had subdural hematomas.

One experience that I will remember is a 91-year-old female who had dementia. I wrote one of my H&Ps on this patient. I saw her as an emergency department admission and then saw her several days later while she was on the floor. It was nice to be able to follow-up on the same patient several days later. As I wrote in my site visit summary and journal article summary, it was important for me to see this type of patient, as I feel like I do not know how to fully take care of or converse with these patients. Another memorable experience was when I saw a woman in her early 30s with lymphoma and febrile neutropenia in ETAP. She was dissatisfied with the way she believed she was being treated and felt that the hospital was forgetting about her. Understanding the severity of febrile neutropenia and that the patient needed a better private room on the floor, the PA was very understanding and provided the patient with the best contact in ETAP to help with the situation. Being able to not only help patients from a medical standpoint but understand the frustration of feeling forgotten while in a hospital is something I will continue to be aware of as clinician.

While on this rotation, I was also grateful for the few lectures I was given with my fellow PA students. Whether it was about reviewing labs or EKGs, it was helpful to have these impromptu lectures when a PA was available to give them. I hope that the PAs I was able to observe saw that I was willing to review charts and learn what I could from each patient. This rotation allowed me to learn about the complexity of patients with multiple comorbidities and understand how many different teams are involved and need to coordinate to provide the best care possible for the patient. I will use the knowledge I gained from this rotation when I return to NYPQ internal medicine for my internal medicine rotation. However, for my next rotation in pediatrics, I hope to continue to look at the patient as a whole and take the time to interview the patient to gain the best insight into the patient’s current concern.