Advanced PA Rotation in Transplant Surgery: Highlights

Ruth Pierre Louis, SHS ’16, talks about the highlights of her rotation in New York Presbyterian’s Transplant Surgery Department

August 03, 2016
Ruth Pierre Louis, SHS ’16, PA Program, Manhattan

In the clinical phase of the PA program, students undergo ten mandatory rotations – eight core and two elective, each for several weeks, at hospitals, clinics, or other sites. Ruth Pierre-Louis, SHS, Manhattan PA-S ’16 completed her advanced elective rotation in the competitive New York Presbyterian Columbia University Medical Center’s Transplant Surgery Department. Here are the highlights of her experience.

Most memorable task: "My first day on the transplant team, I was required to "hit the ground running." The first patient assigned to me was a 59-year-old female who recently received a double-lung transplant and had undergone a number of complications during and after her transplant. My task was to accompany her to the bronchoscopy suite along with my attending physician and fellow to observe and assist in her bronchoscopy with biopsy. During the procedure, the patient became hypoxic. The fellow and I took turns manually pumping oxygen into the patient using the bag valve mask while we called the respiratory team to come and assist. Finally, we were able to get her oxygen saturation back up. She was sent to the MICU for a week until she came back to our team."

Most useful skill learned during rotation: “When a patient receives a transplant, they must remain on a group of anti-rejection medications for life. During the course of this rotation, the lung transplant team taught me to not only manage these medications based on the transplant protocol, but also how to educate the patient about necessary lifestyle changes after their transplant in order to prevent rejection and infection. For example, there are dietary changes, such as a restriction on certain fresh fruit, public buffet style foods and deli carved meats that the patient must be aware of. The anti-rejection medications weaken the immune system, making the patient more susceptible to pathogens that they would otherwise be able to defend themselves against.”

Numbers: “We had 12 lung transplant patients in total on the unit over the four weeks I was there. Each PA cared for about 4 patients, though we all functioned together as a team. We worked 12-15 hours a day.”

Why I wanted to work in transplant surgery: “My father had renal failure and was on dialysis for 6-7 years before he received a kidney transplant, and so far it’s been ten successful years. It was so easy relating to the excitement our patients had after they receive a transplant. At the same time, it was also easy to relate to the sadness and fear of rejection, as well.”

How she secured the rotation: “When Daryle Blackstock, Senior Physician Assistant at New York Presbyterian Hospital, came to SHS to lecture on transplant surgery, I was just blown away by the lecture… During the lecture, he also told us about the challenging and competitive transplant rotation at Columbia University Medical Center (CUMC), where positions had been pre-filled for over a year. At the end of the speech, I emailed him to ask if he knew of any other transplant sites who would take a student who is very eager to learn transplant medicine. I ended up getting an invitation to join the lung transplant team at CUMC for a rotation from Daryle Blackstock himself. I was so excited…I couldn’t believe it!”

Staff culture: “Supervised autonomy. I learn the most when I’m actually allowed to get hands-on experience, to go ahead and do as much as I can with the PA team…At the same time, there was a lot of support, a lot of education. Everyone who worked there was so encouraging. The PA’s on our team, and even other PA’s on different teams - they were all happy to teach, to train, to say, go for it!”

Typical day: “It was a very intense rotation. By the second day of the rotation, you’re supposed to know almost everything about your patients, including all the different meds our patients are on—by heart. Starting at 6:30 am, we’d receive sign-out from the overnight PAs and review medications, trend vital signs, review labs and diagnostic studies. We’d go to the nurse’s station to receive sign-out for our patients then see each of our patients in their private rooms for a focused history, physical exam, and to see how their night was. We’d do all this independently. Then, we’d come back to the PA office and start writing our notes and prepare for rounds. Shortly after, we’d spend 3-4 hours on rounds where we presented our patients to the team and discussed goals, plans and barriers to treatment for each patient. After rounds, we would write orders, call and follow-up consults, change medication, perform patient and family education etc. We’d follow up with lab tests and imaging, finish up notes. Then it would be afternoon rounds: we’d go over the progress that day in the conference room with the lung transplant team, discussing our short- and long-term goals with the attending, the fellow, the PAs, and the clinical pharmacologist. I gave my own input, I discussed what I thought needed to be done, and that was strongly supported and encouraged. If they disagreed, it was a discussion, which provided a great opportunity for me to learn.”

Why I loved it: “This was my last rotation, so I already knew I wanted to work with critical patients, and I wanted to have a strong autonomy and a strong support system… so to have had all of that in this one rotation was amazing.”

Most valuable Touro classes for this rotation: "My physical diagnoses classes. The constant encouragement in those classes to ‘listen to the normal’ was very valuable, because it taught me how to isolate the ‘abnormal’ lung sounds. During classes, we’d put our stethoscopes on everyone—even though they were healthy and normal—so we’d be trained to detect when there was a problem. So when I heard rales, rhonchi, wheezing, and crackles in the lungs during my rotation, I was able to diagnose them."

After Ruth completed her rotation, she was offered a full-time position on the comprehensive transplant team at Columbia-NYP beginning summer 2016.