A Day in the Life
Tuan T. Tran, CA-3
My day usually starts at 8am. I wake up and make my kids breakfast. I drop my kids off for the day and I make it into the hospital by 11am. I check in with the OR coordinator to see if they need any morning assistance. I pick up the PACU phone and I walk through the PACU check on the patients and see if the nursing staff needs anything. I meet up with the Acute Pain Service team to pick up the airway pager for the day. As the PACU resident I am responsible for adult PACU problems and airway calls. Occasionally, I am an extra resident if there is an emergent OR case and there are no other providers available. If things are slow when I get into the hospital then I get a nice cup of coffee at Finger Lakes Coffee Roasters. Some days are busier than others, but there is ample variety of clinical duties. The Acute Pain Service team signs out their service and pager at approximately 4pm. Most of the day is comprised of responding to calls from the PACU, hospital airways, and Acute Pain Service. Lunch happens when there is downtime. There is ample time during the day for reading and to meet other educational goals. I try to meet my educational goals while I am in the hospital so that when I go home my focus is family time. Obviously, this is fluid.
The typical day is from 11am to 7pm. At 7pm, I sign out the airway and Acute Pain Service pager to the OB late resident. I sign out the PACU patients to the night Attending. I leave the hospital and make it home to have dinner with my wife and kids. My wife and I put the kids to bed and take time to catch up for the day. Sleep happens at 11pm to then repeat it all over the next day.
Ming-Yun Tang CA-2
Generally I wake up around 5:30am with the aim of being at the hospital by 6:30. It only takes me 5 minutes to drive to the hospital and another 10 minutes to get to the locker room to change into scrubs, so I have some time to slowly adjust to being awake. Once I get up to the labor deck, I take sign-out from the overnight resident and commiserate for a few minutes about how busy it was. Next, I check over the running epidurals and laboring patients on Epic, then round to make sure our patients have appropriate analgesic levels. Everyday is different up in ob land, so the rest of the morning is a mix of doing elective C-sections, managing epidural catheters, and waiting for the bells to ring. (Hold on.....Phew, not an ob stat!)
Once there's a break in the afternoon, I'll grab lunch and (hopefully) our workload will have slowed down. As long as there's time, the attending will give a lecture on the day's topic (there's assigned reading out of Chestnut's each day of the rotation for us to read and discuss). These are great times to talk about the basics of obstetric anesthesia as well as to answer questions, discuss the literature behind our everyday practices, and to explore new developments in the field. The rest of the day is spent prepping the patients for the next day, and at 4pm we sign out to the obstetric lates resident, who will in turn sign out to the night resident around midnight. (Although some days you'll get a late afternoon emergency c-section or epidural request!) Generally I'll try to do some reading once I get home, but otherwise my wife and I spend our time together watching our 5 month old son smile at us and drool!
Day in the Life of a CBY in EM
Mike Caponigro and Steve Tsang
“A Tale of Two”
“One of the unique things about being a CBY here is how much exposure to anesthesia we get in our PGY1 year here. Like most other institutions we'll rotate through surgery, medicine, MICU (I did SICU as well), and EM. However, unlike most other places we get 4 months in the OR and another month on perioperative and chronic pain. Currently, I'm rotating through the ED with one of my co-interns Mike. In the ED we cover 1 of 3 shifts: 700 - 1600, 1430-2330, or 2200-700. We work around 5 shifts a week. Today I have a 1430-2330 shift. I woke up at 8, and had some breakfast. After that I did a block of U-world, and reviewed it from about 9-11. I then went to the gym, showered, ate lunch, and prepped my food for my shift and left for the hospital at 1400. During my shift I'll see, write notes on, places orders for, and disposition 6-8 patients depending on how busy it is. We sign-out at 2300, and then I'll stay after sign-out to finish my notes/dispositions for the patients I saw that shift. Usually I get home by midnight, then go right to bed.
“As Steve was on evening shifts this week, I mainly had day shifts as it changes throughout the month. I try to get up around 530-545 so I can have breakfast and get ready to head in. Once I change into scrubs I walk over to the ED in the Acute area for 7am sign-out. After that I head off to see my first patient of the day, get an H&P, head directly to the Attending, and present the patient. We get to discuss the case and decide on the best way to manage these patients from labs to imaging to consults. After discussing the patient I quickly put the orders in, write a note, and then pick up any new patients. This constant flow is great as it allows you to multitask while seeing a variety of medical presentations. People can be discharged home, admitted to the hospital, or go for immediate surgery. Having the ability to see this complexity definitely keeps you on your toes the whole day and makes the day fly by. At a blink of an eye its 230 and I see my fellow co-intern Steve walking in. We briefly chat and then there is sign-out at 3pm. All the staff members gather around and we do sign-out again. After that I finish my notes and head out the door around 4pm. Once I get home I have dinner then look over the various medical conditions I saw today. Before you know it, it’s time for bed and I get ready to do it all over again tomorrow.
MICU, Sun Mei Liu - PGY-1
My alarm goes off at 5:20 but I'll hit snooze as many times as I can afford without being late, 2...maybe 3 times. When I finally get out of bed, I'll make my way to the hospital for sign out from the overnight team at 6:30, keeping my fingers crossed that nothing too crazy happened overnight! The crazy always comes out at night. After sign out, I'll pre-round on my 3-4 assigned patients for the day; usually one of them is a new patient. Each patient gets a thorough chart review and focused physical exam. We begin rounding at 9:00AM sharp. The team usually consists of 3 interns, a senior resident, a fellow, and an NP/PA, in addition to the attending, a well-oiled machine I tell you! During rounds, orders are changed, consults are made, and new tests are ordered, depending on how the patient's night went. Changes happen quite rapidly in the MICU, so hour-to-hour adjustments are customary. The nurses are a huge help with that too! On days when rounding ends by 12pm, we make our way over to noon conference (and a free lunch). The lecture topic varies widely, so they're helpful Step 3 refreshers. In the early afternoon, we follow-up on the morning changes made (I.e. tests, scans, consults, etc.) and finalize our notes for the day. Around 3 pm, we meet with the attending for critical care-focused teaching. They are small,
discussion based, group sessions. We generally hold quick evening rounds at 5 pm in time to prepare for 6:30 pm sign out over to the night team. While the days can be hectic, they are never boring! In the evenings, I do my best to meet up with my anesthesia co-interns for dinner or drinks after a long day. We try our best to find outdoor seating, gotta enjoy the good weather while it lasts!!
I usually try to get up around 6:30 AM…although after hitting snooze several times, it’s closer to 7:00 AM. After getting ready and drinking my coffee, I’m out of the door by 7:30 AM and at the hospital by 7:50 AM. Most mornings, there’s something going on from 8-9:00 AM (medicine grand rounds, TB conference, chest conference, etc.). After that, I start pre-rounding on my patients (about 4-5 patients for me, but depends on the census), and see any new consults (usually 1 consult daily). After lunch, around 1 pm, the pulmonary team (for me, it consisted of the attending, pulmonary & critical care fellow, third year medicine resident, medical student and me) would meet in the conference room and go over X-Rays and CT Scans from that day and then round on our patients. Depending on the day, rounds would last between 1-3 hours. Some days, there are afternoon teaching sessions, and most of the days, I would be done by 5:00 PM. I was planning on taking my USMLE Step 3 a few weeks after my rotation, so I used most of my free time to study…although, I did make sure to take some breaks to enjoy the beautiful Rochester summer!
General Anesthesia, Derek Mitchell
I set my alarm to go off sometime around 5:43 AM on a typical weekday morning. I shower, then head out the door by 5:53 AM. I have a very quick commute to campus and most mornings I see some form of wildlife (raccoon, squirrels, rabbits, skunk, deer, wild turkey, etc.) that provides a glimpse of entertainment before starting the workday. I park in the farthest lot from the hospital that demands a brisk power-walk to get to the entrance, but the walk in gives me time to review the day’s cases in my head and get “dialed in”. I change into scrubs, grab the biggest flower cap I can find, and head to my scheduled OR. I perform the anesthesia machine check and get all the equipment and drugs ready for the day. Depending on the complexity of the cause, it takes anywhere from 20-40 mins to set up the room. Once my room is ready, and after morning lecture from 6:30-7:00 AM, I meet my patient in the pre-anesthesia area where I review their history, medications, and allergies, and discuss the anesthetic plan. When the patient gets the ready-to-go green sign, I go all Mad-Max through the hallways to get the patient in the OR by 7:30 AM sharp. On most days, my attending will get me out for a 15 min morning break and a lunch in the afternoon. Cases usually end between 3:30-5:00 PM, however, many days an on-call resident will relieve me from before 5:00 PM. When my room finishes, I check the next day’s schedule and pre-op those patients and complete their chart. This generally takes 30-45 minutes, again depending on the complexity of the patient and how frequently they eat an infamous Rochester garbage plate. When I have reviewed their chart, I call my attending and discuss the patient and anesthetic plan. Often, some great teaching occurs during the pre-op session with the attending. All-in-all, most days I’m walking out the hospital doors around 4:00 PM. I power-walk back to the furthest parking lot and use my remote key thingy to set off my car alarm so I can find my car. I drive back home in time to make dinner with my wife and kid. I do feel very fortunate to have enough free time in the evening that I can spend quality time with my family, study for an hour(ish) and usually get enough sleep for the next day.
Neuroanesthesia (on call), Jennifer Chiem
My alarm clock starts to beep at 4:30 AM, and after 2-3 snooze buttons, I get dressed and make myself a smoothie and coffee for the car ride to work, which lasts 7-8 minutes. The walk from the parking lot to the locker room probably takes longer than my actual commute from my apartment to the hospital. I change into scrubs and go to my assigned OR for the day; since I’m on a neuro rotation, I could expect to do a neuro-interventional case in our IR suite, an ortho-spine case, or even the occasional craniotomy (both asleep and awake). I start my machine check, draw up my drugs, and make a pit stop to the Anesthesia stock room to "shop" for extra materials I may need for the day. Once everything is set up to my liking (since Anesthesia allows me to utilize my obsessive-compulsive habits to its fullest potential), I head over to morning lecture and then to the Pre-An area to meet my first patient. I usually try to call my patients the night before to discuss their medical history and the tentative plan for anesthesia; this way, in the morning, I’m able to complete my preop by asking just a few additional questions and performing a physical exam. After all the paperwork is done, I'll wheel the patient to the OR for a 7:30 AM on-time start. Depending on how stable the patient is and how many cases there are that day (usually 2-3 neuro cases), I try to draw up drugs and prepare my airway materials for the next case. I also try to study, utilizing the question bank application on my phone. During the day, I'll get a 30 minute lunch break and a 10-15 minute morning or afternoon break. Since I’m on call, when I finish my assigned cases I’ll check-in with the clinical coordinator as to which cases I'll be taking over. Being on call typically means I'll be in the ORs until approximately 7:00 PM, when the Night Float team arrives. At the end of the day, I'll pre-op my patients for the next day and call my attending to discuss my anesthetic plan. When I get home (roughly 8:00 PM when on call), I may complete the evening with a dinner outing; since I moved to Rochester, I have organize weekly dinners with my co-residents to try a new restaurant each week. I also take Aerial Silk classes once a week (think of Cirque De Soleil and the performers doing tricks on silk sheets hanging from the ceiling). If there isn't a dinner or class to attend, I'll end my evening being nerdy, watching episodes of Big Bang Theory or New Girl with my boyfriend (after studying, of course!). My life in residency has been an amazing learning experience, and I couldn't be happier that I can balance family and friends, work and fun times over these past couple of years.
Regional Anesthesia at Sawgrass, Joseph Poli
I typically get up around 5-5:30 AM to the sound of my alarm clock. I enjoy my early morning routine at home consisting of my first cup of coffee and a light breakfast. After a short commute to Sawgrass (door-to-door in less than 6 minutes) and a quick change in the locker room I’m ready to see my first patient by 6:30 AM for a 7:30 AM case start. The morning is very hectic with often multiple first case starts requiring some form of regional intervention. Many of the patients at SG are relatively healthy and most of the procedures are orthopedic in nature, affording an ample opportunity for a multitude of peripheral nerve blocks, including brachial plexus blocks (interscalene, supraclavicular, axillary) and sciatic nerve blocks via the popliteal approach. I try to grab a quick lunch on the fly and then finish up the last few blocks as the day winds down. It is not uncommon for me to personally perform between 8-14 blocks/day. Throughout my residency, I’ve done close to 150 blocks (not including neuraxial blocks), and I still have a couple weeks of regional anesthesia scheduled before I graduate. Once done, I will log my cases, make follow up phone calls for the patients seen the day prior and print out and go over the next day’s cases with my attending. I’m out the door and home well before 4-4:30 PM most days with plenty of time to read and relax. I usually grab dinner around 6-7:00 PM, digest and hit the gym around 8:00 PM, shower and read until bed around 11:00 PM.