Hi, My Name is Amy. I'll be your PA today.

We are officially seeing patients as EMPA Fellows. For most of March we have been completing training shifts in preparation for flying solo in the coming weeks. Each of us is scheduled with an experienced PA, NP, MD or DO. The idea is to strengthen our clinical judgement and skills while we lean on them for support, learning the flow of the ED, along with the electronic health record systems used at each hospital. So far, the learning curve has been exactly what I expected, no cakewalk, but moving in the right direction.

Actually seeing patients has been an adventure, the hospital I am at this month is in the inner city, lots of Spanish-speaking only patients. I spend a lot of time tracking down a translator or using the phone service, I need to learn Spanish. Arabic and French are beautiful, but not really helping me right now. It’s a brand new fellowship, and honestly, it doesn’t seem like a lot of people knew it was happening. Usually at the beginning of a shift I need to first decode the scheduling to figure out what section of the ED I’m in, then find whatever provider is working there and introduce myself. They will then ask what I am and what they should do with me, and so it goes.

Being in PA school is taxing, this is discussed ad nauseam, how it requires work and dedication. But by the time you've arrived at that point, you've already been accustomed to being a student for a long time. It's a familiar grind that your brain has been in the practice of doing forever. Learn things, regurgitate specific information and skills onto a prescribed exam, move on. The habits are there, you only need to add simple determination. But learning how to be an EM clinician instead of a student, to sift through the experience that is a tired, elderly woman with belly pain, or a crying, feverish toddler, and decide quickly what could be the most dangerous situation present that day, along with the appropriate questions and diagnostic tests to rule those situations in or out, is a lot of times overwhelming. I am a typical new grad in that the last thing I want to do is miss a deceptively benign-appearing medical emergency right out of the gate.

Last night was the end of my first few shifts spent working nights in the ED for me. I thought I might feel sick or bored working night-shift. But that didn't happen. The first night it was non-stop from evening until 0600, and I had the absolute best time. I was never tired, I was never bored, there was always something to do. It was wonderful. After leaving work I had the entire day to do anything, I could nap for a few hours in the morning, then enjoy a leisurely afternoon before the next shift. Part of the many reasons I was drawn to medicine initially was that hospitals are running 24/7, they are not bound to the traditional 9-5 lifestyle, and in that I find an enormous amount of freedom.

Overall the first week of working was a lot, but wonderful. I had a great first day, felt good, worked fast, and even took home a virus that effectively destroyed my head and sinuses for the next ten days. I like to call it my "every five years flu", or whatever it was that had taken up residence in my skull. The result was how most people are when they are sick, consider it a win if they can physically be present at work, but don't expect much beyond that. That was probably me for the rest of the week, barely functioning at a time when I was being most scrutinized by every coworker, patient, and especially every provider trying to mentor me. I do not think anyone was impressed, which I found disheartening, and perhaps partially blamed myself for incompetency. Last night, sometime during my shift, my brain began to stumble less, and function more. I was able to move faster, explain things in a coherent manner, and interact while displaying at least some semblance of a personality, instead of the dead-appearing robot I'd been for days. I felt like it wasn’t hopeless, and I was figuring things out. I was sleep deprived, but stoked.