Happy PA Week!
I can’t believe how quickly October rolled around. This year’s PA Week just hits a bit differently as we’ve all been battling the ongoing pandemic and the never-ending PPP trolls and Reddit subthreads… it’s honestly just all exhausting.
Regardless, I’m here and still practicing as a PA. I really thought this time around I was going to leave clinical medicine and return to my public health hat, but here we are.
I’m soon approaching the end of my 90 day probation period (time really flies). Just like my entire PA career has been, onboarding always throws curveballs at me (First job, SP retired on my first day, last year COVID worsened and I ended up working pretty much entirely inpatient and shortly after starting this position, one of the girls left to go on maternity leave AND we ended up with a second COVID surge)!
Initially, the new job was super chill. We only had 2 surgeons and they were alternating PTOs. The hospital essentially shut down or we were limited to urgent/emergent cases only… so it gave me a chance to adjust (somewhat) to my new specialty. However in the last month, I feel like we’ve just been drowning in clinics or have very complicated cases in the OR.
So what is it like in my new role? Well… I wear many hats (or more like 3).
First of all, let me tell you! Call life sucks! I repeat. CALL. LIFE. SUCKS. I’ve avoided it for as long as I could, but it’s hard to work in a surgical field and NOT be on call. My first call weekend was on Labor Day and it literally was Labor Day. We had an emergent awake trach. At this point, I have yet to be a first assist….but there I was. At 6:30 AM, getting a page from the ED stating that I had to report to the hospital stat for uncontrolled hemoptysis.
In my practice, we manage admit/discharge our surgical patients, managing their mediations (insulin, BP, fluids) and all. For the more complicated patients with cardiac or pulmonary issues, that’s when we’ll consult for a hospitalist, but generally everything is managed by the admitting surgical team. Essentially, as the inpatient APP – you’re expected to round on any surgical cases that we admit to the floor, communicate orders with staff, see any new (head and neck) consults and relieve the OR APP for cases that go on past 5 PM.
Similar to my set up in my previous role as an ENT PA, we see our patients jointly with our attendings. I see the patient, get a complete history and physical exam. I return to the team room, present the case to the attending, discuss the game plan and we return to the patient’s room together and I perform the flex scope exam.
Ha ha. I remember my second day of clinic when one of my attendings goes, “Ngan, you’re next! Go ahead and scope the patient.” Rusty as I was, it was exciting to know that I can still drive a scope down someone’s nose. And more recently, being told that I can “scope better than a seasoned ENT physician.” Well I don’t know about that, doc! But thanks for the boost of confidence!
Working at a cancer center, you really do get a feel for an interdisciplinary team. We work very closely with our nurse navigators (who help our cancer patients navigate through the system/appointments). We also have joint visits with SLP and nutrition to plan and prep patient for pre and post op recovery.
I’m still learning the ropes in the OR. I find my feet a little bit more as each week passes. Since I’ve started, I’ve been in about 50 cases ranging from simple direct laryngoscopies with biopsies to crazy flap cases for tongue resections/bone drilling.
We currently have a new attending to join our practice so our roles have all shifted temporarily to be more of a second assist. I’m also waiting for my loupes to come in and help with my closures and identifying the nerves. Good golly, am I blind! Some of our surgical closures borderline plastics techniques and while it can be done without loupes, I definitely struggle with a few more unnecessary throws.
In this role, we’re expected to prep and get the patient ready in the right position, we help close the case and do post -op evaluations. In short, the hours are long…very long. With the latest COVID surge, to make up for lost time, our cases are now with an earlier start time at 7:30 On average, our flap cases can sometimes take up 10 hours…so as you can see. The days at times can be very tiring.
While I may have cried and had a break down once or twice since I’ve started, reflecting back on these past few months, it’s amazing what I’ve accomplished in such a short amount of time. I’m so grateful to finally be in an environment where I am learning and thriving. I have an amazing team that continues to push me every day.
Overall, I really do feel like my years of training is finally being paid off. The patient population is so rewarding. Initially, I thought working with oncology patients would really kill me emotionally. But H&N cancers do have a pretty good cure rate. Seeing some of our patients and their strength really pushes me to be better and makes me realize how blessed I am.
So in a nutshell, that’s what I’ve been up to these past few months.
Unfortunately, until things slows down a bit, I will not be as active on social media and continue my #teachingtuesday
Happy PA Week again, friends! I hope you feel valued wherever you are! Our communities need you!!!