My internal medicine rotation at New York Presbyterian Queens Hospital offered many new and exciting experienced as well as challenges. The majority of patients being treated were elderly with many comorbidities. Aside from their chief complaint, many of them had a long list of additional health problems that needed to be managed. This was the first rotation where I got so much hands on experience handling and managing such complex medical cases. In addition to the complex cases, I was able to get experience with interdisciplinary cooperation that was necessary for proper care of the patient. Each morning the PA would round on each patient with the nurse and nurse manager so that everyone was on the same page in regard to patient care. Additionally, this rotation also offered me many offer opportunities to practice procedures. I was able to successfully complete several ABGs as well as insert a NG tube. I found that the biggest challenge I faced this rotation was learning when to let a patient go. I encountered several patients that died during this rotation, there was one in particular that stayed with me. The patient was a 90-year-old male with a long list of comorbidities. The patient and his family agreed that it was time for comfort care, he was ready to move on. Despite this, the doctor kept the patient on steroids, which was essentially preventing his death. Although the PA confronted him about this and explained that this treatment was not in line with the patient’s wishes, the doctor did not remove the order. The doctor was not ready to let this patient ago. Eventually, the PA along with other providers convinced the doctor to remove the order. The patient died that night. This is a patient that will always stick with me. As I finish PA school and begin my career, I will keep this patient in mind to make sure that I am making the decision that is best for my patient, even when it is difficult.

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