By Dave DeFusco
During one of Anthony Pagan鈥檚 clinical rounds at St. John鈥檚 Episcopal Hospital in his last semester in the Katz School's M.S. in Physician Assistant Studies, he was summoned by the attending physician to perform an ultrasound-guided intravenous procedure on an older man with a life-threatening bowel obstruction.
After an exchange of pleasantries with the patient, Pagan explained the steps that he鈥檇 be taking during the procedure but, first, he鈥檇 have to palpate an inaccessible vein before inserting a needle, assuring him that it wouldn鈥檛 be too painful. The patient nodded and then asked Pagan a question that he gets often given his age: Had he ever performed the procedure?
鈥淚 told him that I鈥檇 seen quite a few, but I couldn鈥檛 lie,鈥 said Pagan. 鈥淚 told him that it鈥檇 be my first one but that we were going to have a doctor present in the room guiding me through the entire procedure to make sure I was doing everything just right. He took that pretty well."
Pagan gathered the necessary equipment, including the ultrasound machine, ultrasound probe, a sterile IV catheter kit and IV tubing. When he identified a suitable vein, he applied a tourniquet and sterilized the area, holding the ultrasound probe in one hand to keep an eye on the vein while using the other hand to insert the IV catheter.
鈥淚 was a bundle of excitement and nerves,鈥 said Pagan. 鈥淚 was, like, 鈥楢lright, alright, I can do this.鈥欌
He inserted the catheter needle into the vein at a shallow angle while focusing on the needle tip on the snowy ultrasound screen, gently pushing the needle forward but not too quickly so as not to accidentally poke through the other side of the vein. When he correctly positioned the needle, blood started to flow back through the needle and into the IV catheter hub, which is the small plastic tube that goes into the vein to deliver fluids or medication. He moved the catheter further into the vein and removed the needle, connected the IV tubing to the catheter hub and secured it with adhesive tape.
鈥淭he ultrasound probe looked like an icicle in the darkness,鈥 said Pagan. 鈥淵ou鈥檙e not looking at your hands, you鈥檙e looking at the screen while you鈥檙e doing it. It鈥檚 very intuitive. I was able to learn it kind of easily because it reminded me of a video game.鈥
Pagan credits the PA program and Professor Abraham Oxilas particularly for instilling 鈥渃onfidence, grit and tenacity鈥 into his approach to patient care. After practicing in other specialties, he prefers emergency medicine because 鈥渋t鈥檚 controlled chaos.鈥
鈥淵ou never really know what you鈥檙e getting into,鈥 he said. 鈥淚 enjoy doing things that I can鈥檛 easily predict, because you don鈥檛 necessarily have to go in with a plan. You just have to assess the situation in the moment and use what you鈥檝e learned and experienced for the benefit of the patient.鈥
At the end of his clinical rotation, Pagan was asked by the chief attending physician at St. John鈥檚 Episcopal Hospital what he wanted to do after graduation. When he said emergency medicine, he was offered a job on the spot. He started in June.
