Rotation 1: week 1

My first week here in Alaska has been absolutely amazing.  Aside from the snow-capped mountains and gorgeous weather, I work with the most inspiring, intelligent people.  I have a total of three preceptors, but I am learning so much from all the staff members.  Each one is so eager to share whatever knowledge they have, and that certainly is enriching my experience here.

Juneau is a small, rural town with a population of about 30,000.  There is one 55-bed hospital, and there are no cardiologists or Ob/GYN physicians.  There are a total of two radiologists who read everything from mammograms to ultrasounds to nuclear medicine studies.  The family practice providers deliver babies, do pap smears, suture minor lacerations, and everything in between.  The family practice clinic is the one stop shop for all medical intervention not deemed an emergency.  And I am so fortunate to be rotating in this kind of environment.  To work here one needs to be a jack of all trades.  There really is no such thing as specialization.  Everyone trains to practice medicine outside of their expected scope of practice.  The amazing thing is they all do a hell of a job.  I’ve never seen such competency.  I feel honored to be working with such intelligent, educated providers.

I spend four days of the week at a local family clinic and one day of the week at the local hospital.  I didn’t expect to be thrown into the fire so quickly, but my preceptor seems to think I’m more than ready.  So far, I’ve given vaccines, removed skin tags, heard murmurs, done breast exams, and seen patients all on my own.  At the hospital I work with the radiologist and look at dozens of films, scans and nuclear medicine studies.  What an opportunity!  I’m having the time of my life! 

It has been a challenge integrating all of the information I’ve learned in the classroom and applying it to a patient.  For instance, a young girl came in complaining of a cough, SOB, fatigue, myalgias, and sputum production.  On physical exam, her breath sounds were equal on both sides, however I heard abnormal sounds on the lower right section of her posterior chest wall, the same location that caused her pain when I palpated.  In the very same spot I heard egophony, and this caused concern for pneumonia.  She looked and sounded ill, but not toxic.  In retrospect I should have taken more time to listen, but I knew the sounds were abnormal as soon as my stethoscope touched her back.  I presented my case to my preceptor, and she immediately diagnosed her with bronchitis/walking pneumonia.  Not bad for the first case of the day, but my differentials need a lot of work.  I should have had at least five diagnoses on my list. 

This weekend I intend to rest and study.  My body still has not adapted to the 4 hour time difference.  I really haven’t had time to adjust, but I’m so busy when I’m at the clinic that I don’t recognize just how tired I am.  I love learning and I love using my hands.  My preceptor said to me yesterday, “You’re going to love being a PA!”  She’s absolutely right!