First draft

[Guest louisweil]

I know this needs to be condensed a bit, give me some feedback please!

 

Every patient you meet has something to teach you, whether the lesson is explicit or becomes clearer upon reflection. Wearing my EMS uniform, I was perhaps the least qualified to talk to these two family members about the next step in their father’s medical care. This particular patient transport involved transferring him from a nursing home, where he had been in waning stages of health for some time; he received tri-weekly dialysis and had been bedridden since suffering a stroke several years earlier. That day, I wasn’t transporting him to dialysis, I was taking him to his final resting place: a hospice unit within a local medical center. Whether by some failure of leadership at the nursing home or a coping mechanism being used by the family, they seemed to be completely unaware of the plan for their father. Not only did they not recognize the word hospice when I spoke it, they didn’t seem to have been told a thing about their father’s current state. My heart ached for them. How could they have been left out? This patient’s plight taught me that when a healthcare provider of any level fails to give a patient (or their family members) a good idea of what is going on, they have fundamentally neglected their duties.

 

I took my time forming opinions and gathering knowledge before choosing to explore the medical field. My desire to work as an EMT sprouted from an eagerness to help others in crisis. I  frequently met people on what was one of the worst days of their lives. I have an anthropology degree, but my enthusiasm for anthropology dwindled as I saw a future paved with isolated, dense writings that would only be read by other anthropologists, likely improve the lives of no one but those involved in publishing them. The common thread was my interest in people and their stories, which along with my interest in anatomy, brought me to medicine. Clinical relationships taught me that patient care has the capacity to bring people closer at their most vulnerable, when the most good can be done for them. The challenge of helping people through these ordeals is one I have embraced wholeheartedly.

 

 

Working for a private ambulance company I quickly learned my place in the hierarchy of medicine. Beginning on the bottom rung of healthcare as a frequently ignored transport EMT gave me invaluable perspective and experience. Patients shared with me their real, valid concerns as well as a unique outlook on their treatment. I served as their advocate and became sensitive to the details of their care. I took that responsibility to heart and it hasn’t deserted me. As my company also ran community 911 calls, I frequently found myself in a slightly more integral caregiver position. In order to reach my best performance, I honed sharp communication skills which helped me relay patient reports to other healthcare providers. Again, I found that the most important thing providers can communicate is a consistent and accurate story or narrative, based in both investigative skill and trust. Taking this in from an EMT’s perspective for a few years, I saw the ceiling of my certification -- the limit of what I could do to help a patient -- facing me more clearly. So I began searching for my niche within the tiers of the healthcare world.

 

 

My first close contact with a PA occurred when I was volunteering in a busy emergency room in North Philadelphia. This was the same ER where I would later spend thousands of hours as a tech assisting bedridden patients, being a crucial communication link between them and their providers, filling in as the relentless heartbeat for those in cardiac arrest, acting with a team with providers to work up critical patients brought in by Philadelphia Fire and Rescue, irrigating head lacerations, calming children with superficial scratches, as well as comforting adults with deeper wounds -- both physical and psychological. I built trust by hearing concerns and bringing nourishment when appropriate, establishing rapport enough to draw blood for tests from even the most skittish patients.

 

 

As an eager Emergency Room volunteer, I watched the PA I was shadowing comfort the 45 year man with swollen lymph nodes and back pain while doing her physical exam, asking focused questions to obtain his history and explore the patient’s current complaint. She listened to what the patient had to say. I was with her every step of the way, mirroring her assessment skills, and marveling at her precision. I saw clearly that a provider didn’t offer only clinical advice, but also comfort and counseling. The patient’s young daughter and his wife sat worried by his side. He had missed work for a couple of days at a job that required some heavy lifting. The PA ended up prescribing him a course of antibiotics for a UTI, and something to help with his pain. She offered clear explanations and a brief lesson in microbiology. He was sent home with discharge instructions, reassurance, and a medicinal means to solve his problem. I felt she had not only done her healing duty, but had exceeded expectations and attempted to ease the patient’s mind. This part of healing is frequently left out of algorithms in medicine.

 

 

The role of the PA has become increasingly important: trained as generalists, they can operate at their full potential in the ER, seeing a diverse array of cases each day. The attending physician continues to play a crucial part in parsing the specifics of a challenging disease or condition and can always be relied upon for a second opinion. This system strengthens the care team while simultaneously helping the PA do more for the patient. The PA functions as a primary provider, while attendings continue to offer expertise, support, and perspective.

 

 

A physician assistant’s skills lie in the practical: the effective, honed, hands-on care provided to patients of all sorts. This is something I see in myself to an incredible degree. My desire to educate  patients about their medical issues parallels my desire to help them solve these problems. Thus far, my scope of practice has been limited. An emergency medical technician at the ground level can administer only basic care. The best PAs I have worked with do much more than simply treat problems. I have seen many providers in action and gleaned countless important lessons. For one, the simple acknowledgement you show a patient in distress is worth [far more than] the seconds it takes to deliver it. Establishing the balance between being a caring person and a caregiver is, I feel, the best way to gain a patient’s trust, and ultimately makes treatment more effective. If a patient doesn’t trust you, they may not tell you their full story, leaving out or even denying crucial details that could aid you in their care.

 

    The path to PA feels like a culmination of my efforts in every way. All of the energy I have put into patient care, learning the flow of an Emergency Room and determining how best to stay afloat in that challengingly unique environment has equipped me with the skills to be a well-balanced provider. I am able to think critically, to use my skills to break down barriers. Two years of health science courses have prepared me to observe clinically the things I’ve absorbed academically. My dedication to familiarizing myself with the coursework helped me to persevere through working night shift while maintaining a daytime class schedule for a year. At times it was challenging, but the balancing of priorities is a thing I will certainly bring with me to a rigorous, intensive PA curriculum. Nothing I faced thus far has been easy: I am prepared to accumulate the knowledge that will allow me to become a great provider.

 

    Working with a PA taught me to be prepared for any possibility. On the bedside table she arranged a suture kit, a stack of extra gauze sponges, and the thick black suturing thread. As she numbed a young woman’s face with local anesthesia, the patient showed only a slight grimace. Two razor blade cuts marked the areas just above and just below her right eye. This woman had been attacked, and narrowly escaped with her vision. The PA mentioned what a lucky situation that was, and the patient was quick to agree. I watched the thread pulling lacerations closed and thought that not only was this the type of work I can see myself doing well, but that it is what I am meant to do.

[UGoLong]

I enjoyed your essay; it gave me an idea of who you are and a little of how you got there. 

 

I would take the brackets off the phrase near the end. Also tell me a little about how you got your prereqs done while you were getting that experience. 

 

Best wishes.

[Guest louisweil]

Thanks for your feedback. I definitely want to make it more readable, and I think eliminating things like brackets would help that. Also, my sGPA is a tad low (3.2), so I should probably address that in my working-while-taking-classes portion.

[medmeg]

I thought it was good!  The trick is finding which areas to leave out though...