My second rotation was at Queens Hospital, where I rotated throughout the Pediatric Emergency Room, the NICU ( which was also linked to mother-baby), and the Pediatric Clinic that is available at the hospital. I will be discussing my experiences in each setting separately.

I started off my rotation in the Pediatric Emergency Room, I was scheduled to be there for the first three weeks. Overall, I felt that I learned the most in this aspect of my rotation. I was able to meet with patients that had no previous diagnosis of their problems and I was able to come up with a differential on my own. This was exciting for me because my previous rotation was at a long term nursing facility, where all the patients were diagnosed already, so it was more of a follow-up on a day to day basis of a pre-existing condition. In the emergency room, I got to see a wide variety of patients from different backgrounds, different countries, different ages, different disabilities and so on. I did not think I was going to enjoy this part of the rotation as much as I did, even though the procedures that I preformed were limited, I still got to experience a lot. In terms of getting to know the facility quickly (a goal that I had set myself up for from the previous rotation), I accomplished this without any trouble. One of my classmates had given me advice about how to get friendly with the nurses, so they would let me step into procedures, and at least let me watch. I did this immediately, and the nursing staff was absolutely wonderful. They were so kind and called me for every IV, foley catheiter, ABG, staple, ect, that was being done, because I showed them I wanted to learn and gain experience.

One of the slip-up’s that I had during my rotation included reading a rapid strep incorrectly. To make the story short, I was with a preceptor who somewhat showed me how to preform a strep test. She did not give me specific instructions but instead I watched. At the end, she said, and that is how you perform a rapid strep test. At the time, I thought I understood how to perform a strep test very well, but in actuality, I did not. The next day, I was with a different preceptor, and she asked me to perform a rapid strep test, and I completely messed up. I forgot to take the culture, I did not grab the specimen from the right place, I did not wait the appropriate time, and I was extremely embarrassed. My preceptor understandably was also upset, because I thought I knew how to preform a strep test when I did not. She mentioned that I should have spoken up that it was the second time that I was performing this test and I should have asked for guidance. I completely agree with her. I should have not assumed that I knew how to perform a test, just by watching it, I should have verbalized what I was doing so she could guide me.

I experienced many IV’s being placed, I did not have the opportunity to put one in myself, due to parent’s refusal to allow a student to poke their child with a sharp pin. I was working with a very experienced nurse and she thought me that the key to getting a good IV is that every detail of preparation needs to be taken care of before poking the child. The nurse would spend a total of 3 minutes preparing the material needed for IV’s, including CBC, BMP, Blood Cultures. This nurse was also very smart and while she was obtaining the CBC and BMP, she would also obtain the blood cultures, even though it might have not been ordered. The reasoning behind this is so the child does not have to get poked again, which is very legitimate. It was amazing to see this nurse work because even though she would spend lots of time preparing for the procedure, the actual procedure it self itself, took a few secs. I think this is especially important in ped’s because parents are always terrified and anxious when their child is being poked with a needle. Even though this may sound like an obvious task, to prepare before the procedure, many other nurses did not prepare as well, and I would see them struggle, which is why I learned to prepare to the best of my abilities when it comes to placing IV’s. When I asked the nurse, how she got so good at placing IV’s she mentioned that it takes lot of practice, and sometimes you get lucky, and other times, the vein could be right in front of you, and you miss it. My next rotation will be internal medicine, where there will be minimal parents to glare at me while I attempt to place an IV, my goals include to become very sufficient at placing IV’s in my next rotation.

In terms of patients, I never had a patient that I did not like. How can I not like them, they were just kids. With that being said, there were some parents that really surprised me when it came to taking care of their children, and it was really sad. For example, there was a 6 year old girl, who was brought in by her father, that came in for bacterial conjunctivitis. When the father was questioned about the patient past medical history, he could not answer, and it was not due to a language barrier, but instead because he did not know the patients past medical history. He kept telling the practitioner and I to ask his 6-year-old daughter about her own past medical history. This was a very smart six-year-old and was able to answer majority of our questions, but as a parent, I think it is unfair to the child to place that kind of responsibility on them. My preceptor was also very disappointed in the father and mentioned that he only participated in signing the discharge papers. There was an interesting patient that I encountered during my rotation in the emergency room. He was 16 years old and had a past medical history of being on an autistic spectrum. He was brought to the emergency room because he cut his wrist with a broken glass bottle. He was very tall and wide, and to be honest I was a little scared to be close to this patient because he was having episodes of anger where he would start yelling and cursing at everyone. I was the one that cleaning the wound and applying the dressing on the patient. I was shaking while wrapping the bandage around the patients forearm because I was so scared that I might do something wrong and he might just punch me in the face or something. But as I was wrapping the bandage, the patients mom was talking to the patient and telling him to calm down, and that I was trying to help him, and because the patient was a good patient, he listened and stopped yelling and was telling me if anything was hurting him or if I was wrapping the bandage tight enough. This patient was admitted to the psych unit soon after. From this experience I learned that just because a patient looks intimidating, and might be acting abruptly, that doesn’t mean that just because I am small and tiny, and I might not feel safe around the patient, that I do not have to provide medical care. I actually felt really bad that I even thought that way about this patient in the first place, because it was not his fault that he was autistic and happened to be super tall. Going forward, my goal is to be less judgmental about the appearance of patients and the provide optimal care equally throughout.

After having spent three weeks in the emergency room, with many different preceptors, I was then transferred to NICU. To be completely honest, the NICU was a very depressing place for me, and is not a place that I would like to work in the future. Even though I adore infants, it was really hard for me to keep my emotions separate from my medical judgement in the NICU. All the infants were all so sick, which is why they are in the NICU in the first place, but still, it was heart breaking. They were all so tiny and a majority would have apneic episodes, and I would just run around like a chicken informing the nurses and they would just be like “yeah, that happens sometimes, but it gets better”. They were right. By the time the nurse would check up on the infant, their O2 saturation levels would rise, but every time this would happen, my stomach would drop, and it was just hard for me to see that. On the bright side, I did get to see three C-sections during my NICU stay, and they were all awesome to watch. One of them really scared me because the infant had the umbilical cord around his neck, was completely blue, and was not moving the first 30 seconds of birth, but after stimulating the infant enough, the Apgar score was 9 and the infant was not admitted into NICU. The C-section itself was an amazing experience to watch, and really peaked my interest in both surgery and OB/GYN, both of which I had no intent on being interested in.

My final destination in my pediatrics rotation was the clinic. Generally speaking, there is a lot to learn in the pediatric clinic, but I wish we had more specialties scheduled rather than primary care. I learned much more in cardiology, pulmonology, genetics, and endocrine, than I did in regular primary care. One of the primary care preceptors that I was assigned to actually transferred me to a genetics specialist because she said that I would not learn much from just being exposed to the vaccination schedule. She was right. I think one shift of primary care would have been sufficient, while having more experience in either the emergency room or with a pediatric specialty. The reason why I am saying this is because in regular primary care, you did not see an actual disease, 95% of the patients came in for a well visit, but for a specialist, there was something that was wrong and you can actually see, hear, feel it. It was a much better learning experience. Also, I noticed that the parent’s level of participation and interest in the child was also much higher in the specialty fields. It is probably due to the fact that because the child has an active disease, the parents need to be more proactive in learning about their child, but I was much happier with the parent population in the specialties. My favorite specialty so far was cardiology, and it might have to with the preceptor that I was with, who was a great teacher and explained each patient thoroughly. I have also had an interest in cardiology since day one, so this confirmed that I like hearts. I realized how skilled you have to be in order to perform and read an echo as a heart doctor, which made me think about taking an ultrasound course after the completion of the program. Overall, I think it was a great experience and that we should be introduced to more specialties.

My experience in pediatrics was amazing. I got to see many different kinds of patients, work with different preceptors, see different points of views, and just loved the overall friendly vibe of the place. One of the unexpected factors that I came upon was how different each branch of pediatrics was. For example, the emergency room was a world of a difference from the NICU, which was a world of a different from the clinic. Before starting pediatrics, I guess I did not realize how specific a pediatric specialty can become. I realized that I would not work well with kids, and I think it is because I feel bad for kids very quickly. If they cry, as a mom, my first instinct is to calm them down, but you can’t always do that with kids. You have to be very strict sometimes, even being their practitioner, and get the job done. I do not think I will have that issue working with adults, but we will find out. I look forward to treating patients on my next rotation of internal medicine at NYPQ.

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