Second Year Student Blog: Nicole Bush

Wednesday, January 7, 2015

Nicole Bush
Nicole Bush, PA-S

There are four days left until winter break and although the break is much needed, I am somewhat sad that I won’t be starting another rotation in a few days.  So far, I have completed 5 months of clinical rotations and already the growth is palpable. I began rotations feeling anxious and uncertain of what to expect.  I had learned so much during the didactic year, but I couldn’t help but feel patchy in my knowledge.  At times, it felt difficult to cram the information into my brain.  However, what I have most enjoyed about the clinical year thus far is piecing together the concepts and details learned during the didactic year through direct patient care and experience.

I am currently finishing up my first month in internal medicine.  I wasn’t sure that inpatient medicine would interest me, but I have been surprised with how much I’ve enjoyed it.  On a typical day, I wake up around 5:15 AM. Rounding begins at 7:15 AM; however, it is important to get there 30-45 minutes prior to pre-round on the patients you are following. Rounding involves visiting each patient’s room with my team to review the case and any changes in the assessment and plan. As a student, you usually have 1-2 patients to follow and present to the team during rounding. The rest of the day is spent writing progress notes, making follow-up appointments, forming discharge plans, and admitting new patients. Depending on the day and whether my team is admitting new patients, I could be working as late as 5pm to 9pm. When I get home, I unwind with my husband by cooking dinner and exercising or watching an episode of a favorite TV show – and then it is back to studying. I often try to tie my nightly studying to a patient I have seen earlier in the day so that I can be more prepared the following day when examining the patient and when presenting to the team.

While some of the days on internal medicine seem impossibly long, the depth of knowledge I have gained has been invaluable. Internal medicine is generally not “fast medicine”. There is sufficient time during the day to look up information you are unclear about regarding a case. This allowed me to more fully understand the clinical presentation, work up, and treatment for several disease processes. In addition, one of the most gratifying parts of this rotation has been the continuity of care. I enjoyed following my patients from start to finish. Often patients came in with a serious problem and they left when it was fixed or improved. The patients were always very grateful for the careful attention we gave them during their admission. Hearing patients tell you that you have helped them is an incredible reminder of why you are spending long days and nights working and studying to become a PA.

Attending PA school at Duke has been an experience I never could have imagined for myself five years ago. I have done things that in my previous life I never thought I would have the knowledge or confidence to do. While I felt anxious before the clinical year, I now realize that Duke has prepared me more than adequately for rotations. After sitting in the classroom for one year and trying to decipher so much medical information, I wondered if I could know or remember enough to adequately treat patients. I now appreciate that it takes seeing patients in a clinical setting to solidify those many concepts I learned during the didactic year.

I am excited for the rest of clinical year – 8 months until graduation! It isn’t graduation that excites me, it is the fact that I still have 8 months to learn and grow in my medical knowledge and skills. I can only imagine the evolution that will take place over the remainder of my clinical year as I transition from student to provider.