The most appealing aspect of becoming a PA was certainly, for me, the variety of positions one could have—surgical, office, or hospital—and in a wide variety of specialties. Unfortunately, I was interested in so many things that when I graduated I was not sure where I wanted to go. I accepted a position in thoracic surgery in Chicago. When my husband and I relocated to Pittsburgh 2 years later to be closer to his family, I couldn't see myself doing anything else. Although I work in one of the community hospitals in the University of Pittsburgh Medical Center (UPMC) system, we perform all major thoracic surgeries from lung resections to esophagectomies and everything in between at our facility. I spend my day in all aspects of patient care: first office visits, OR, hospital stay, postop, and follow up visits. I wouldn't have it any other way.
■ 7:00 AM
I arrive at the hospital and stop at my office to print the list of today's inpatients. After grabbing a cup of coffee from the OR lounge, I go to preop and check in our first cases of the day. Thursdays are called "thoracic Thursdays" because we have two doctors operating all day, and clinic runs for most of the day. Our first cases are a thoracoscopic lung resection and a laparoscopic fundoplication. I check with the nurse anesthetist or the anesthesiologist to be sure we are all on the same page. For the lung resection case, we will use a single lumen endotracheal tube for the bronchoscopy; then the anesthesia team will change it to a double lumen endotracheal tube to achieve isolation on the operative side. This patient will also have an arterial line placed prior to the operation for intra- and postoperative monitoring. I check the charts to verify that the consents and other paperwork are in order and then meet with the patient and family to go over any last minute questions or concerns. The lung resection patient's family asks about the hospital course, and I discuss details such as postop chest tube management and expectations for discharge.
■ 7:30 AM
I accompany one of the patients to the OR and help set up the patient. The hospital is a teaching facility; therefore, plenty of residents and/or medical students are available to assist the surgeons. I supervise during the Foley catheter insertion and help position the lung resection patient in lateral decubitus position. After the patient is ready and the team scrubs in, I help the circulating nurse get the equipment into place; I then head out to the inpatient floor. Many of our patients participate in clinical investigations, which mainly entails tissue collection for genetic or proteomic research. I verify which studies the patients are involved in with the tissue collector as well as the circulation nurse to ensure that the appropriate sample is collected.
■ 8:15 AM
The intern and I meet on the surgical floor and run through the inpatient list. Most of our patients are doing well after their operations in the beginning of the week, and the majority of our work consists of discharge planning. We put some orders in through the computerized medical record. Then I attend the "bed huddle" with the case managers, charge nurse, and social worker to discuss patient dispositions. An elderly gentleman who underwent an esophagectomy a week ago is doing well but will need some home nursing as well as physical therapy when he is discharged. Also, he will need tube feeding supplies delivered to his house. Next, I take out a lung resection patient's chest tube and adjust her pain medicine from a patient-controlled analgesic to oral narcotics. She is happy to hear that she will most likely go home today if her pain is controlled on the oral narcotics and her chest x-ray this afternoon is satisfactory.
■ 10:00 AM
One attending physician is finished with his first case, and I meet him on the floor to do rounds. We review the day's x-rays and check for any pathology reports for patients. In the ICU, we meet briefly with the critical care attending to discuss issues on our patients there. We also brief the intensivist on the case coming in from the OR. We go to the surgical floor and meet with the lung resection patient whose chest tube I took out earlier. We inform her that she had a 2.7-cm adenocarcinoma in the left lower lobe. Fortunately, no mediastinal lymph nodes were involved, and the tumor did not invade the visceral pleural. She is staged as a T1b N0 MX non-small cell lung cancer, in other words, stage Ia. The patient is relieved by the news and ecstatic that she will not require any further treatment at this point. We explain the follow-up schedule to check for recurrent cancer and give her a card for her postoperative appointment. We finish seeing our patients on the surgical floor, and I put in any new orders from rounds and discharge the esophagectomy patient after he was seen by his surgeon.