My Pediatric rotation was at Premier Pediatrics in Staten Island. Professor Maida made the  clearance process was very simple, I just send an email to him and was good to go. The office itself is very big and very well organized. They have a great staff made up of MDs (3), PAs(2), Medical Assistants (5), Nurses (3), Front desk (3). The office was located within a strip mall in a very nice neighborhood. Everything about the office was very nice, but the commute to the office was not so great. Traveling from Bayside, I drove 1.5 hours to get to the Island and 2hrs to get back home on a good day. On the days there was traffic (mostly only in the evenings) it took 2.5- 3 hours to get back home, this took a good chuck of time out of my study schedule. While the commute was dreadful, I have to say the abundant parking located right in front of the office did somewhat make up for it.

One the first day I was scheduled to work with DR. Maida ( professor Maida’s son), he helped me learn my way around the office and explained the need and expectations of the patient population of that neighborhood. He explained that the patient’s parents were very protective and usually do not appreciate students examining their child. The first day I only shadowed and did not examine a single patient. By the end of the day I was very discouraged and decided to voice my concern to Dr. Gary. He then very kindly explained that he was new to the practice and it would take time for patients to trust him, which was the reason he did not allow me to examine them. He then explained I would be able to so more in the presence of Professor Maida, only because the patients trusted him more.

The next day I was with Professor Maida, and I realized it was a whole different experience. This time I would watch Professor Maida examine the child first, and then was allowed to examine them as well. After the exam I would present the findings and treatment plan. He also allowed me to swap their throats, do flu swabs, and  draw/administer vaccines to the children. After each encounter he tested my knowledge on the patient’s condition and asked about clinical signs that would manifest in those conditions. There were a few other PA student there as well, and we were all given topics which we presented during the rotation.

Professor Maida is really loved by his patients, and this was evident every time we opened a door to see a patient. The child’s face would just light up and the parents would get so excited to see him. Even after he would give a child an injection,  he was  able to get a smile out of them before leaving the room. After, watching him work throughout the day I saw how much he really cared for every one of his patients, and it made me realize why he was so adored by them. I learned from his interactions with the parents and patients that the approach to the Pediatrics population is very different from an adult population. In any other specialty you have to earn the trust of one patient at a time, but  here you have to earn the trust of the entire family ( grandma/ grandpa, mom, dad, god father/mother, babysitter, siblings). You are the provider of their precious child whom they are very protective of, and you need to really prove to them that you are good at what you do and can provide excellent care to them.

During the third week of the rotation I had a patient encounter with a child, which I will never forget. This child was diagnosed with Acute lymphocytic leukemia 5 years ago and was in for a well visit. After the visit I went through the chart to see what sign/symptoms he presented with at the time of diagnosis. Going through his chart I found the write up for the day the child came in 5 years ago, and it read on the bottom R/O Leukemia. In my head I pictured the moment Professor Maida must have realized this child may have leukemia. It must have been so difficult for him to have to advise the mother to immediately take the child to the hospital. The child was taken to the ED and diagnosed with ALL that same day. He was then put on combination therapy two days later and had many complications along the way to remission.

After I closed the chart,  I went to the bathroom to recollect myself, and at that moment I realized how important it was to be strong in such situations. When I returned to Professor Maida, we discussed how important it was to take a good history, perform a thorough physical and have broad differential. Especially in the pediatric population because they don’t always express their symptoms very clearly. This experience has helped me understand that there will be hard moments like these during our careers, and we need to well prepared to handle them. As the providers we have to be in control of our emotions and refocus our attention to the needs of our patients at the time. We are there to help them and we should understand that is our main goal and focus should be to provide them with care they need.

Overall this was a great rotation, and Professor Maida was an excellent mentor to have.

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