All in a Day's Work
The alarm goes off. . . beep. . . beep . . . beep. It is 4:30 AM. I have Internal Medicine this month and getting up this early ensures time for a shower, a trip to Star Bucks, since they open at 5:00 AM, and then to the hospital to round on patients. I am thankful not to be on call today and to also have time for some bold coffee. After my shower, I kiss my wife and son on the head, careful not to wake them and head on my way.
Now at the hospital, I look at my list from yesterday and determine who to see first. Usually, it is someone in the ICU and head in that direction. Now, sitting at a computer, I print off our team's list and run through the names and consider my eventual path of pre-rounding once I leave the ICU to ensure that I am not backtracking or wasting any time. The ERS service (patients with no physician) and AFM (patients of attendings) and FMC (patients of residents) are seen first and private physician patients are usually seen after rounds. The patient that I admitted to the ICU yesterday had not been looking too good and was on a ventilator and pressors. I run through the chart to look at the patient's vitals to see if she had been stable overnight, and then run through her labs to determine any source for sepsis. I then run through the consultant’s notes to get their impression and recommendations. I call the nurse to discuss what alterations or improvements were made overnight. She tells me that the patient remained stable on the ventilator and has been able to be weaned some from the pressors and fluids are still running at the same rate. She did think the patient's lungs had become more wet and urine output had not been much. This information is now permeating my neurosynapses and I head to the patient's room to examine her. After my examination, I enter orders, write my note and head to the next patient.
Once my pre-rounding is finished, I head down to the first floor to the resident conference room, where the medicine team meets at 7:00 AM every morning. This month rounds are tableside and we usually discuss the old patients first and then the new ones that the on call resident picked up over night. When it is my turn, I present my patients as concise as possible and then wait for any questions from the attendings. Usually, there are several teaching points during rounds that are discussed as well. Once all of the patients have been discussed, my attention is now turned to the chief resident who usually has a learning topic to present such as how to workup anemia. . . etc. This usually lasts about 15 minutes and then off I am again to place any additional orders on patients that evolved through rounding discussion and make discharge preparations for any patients going home.
My non-call, post-rounding day on medicine typically starts with entering additional orders and diagnostic tests and consulting other physicians. There are also private physician patients also to be seen. This usually takes me into lunchtime, at which point I head to the cafeteria where often there will be fellow residents enjoying their meals and conversation. Post-lunch, I am back to checking in on patients, dictating discharge summaries, and making any consultations that I was not lucky enough to secure earlier. Once, my work is done, usually around 4-5PM, I call the on call resident to sign out and let them know which patients need closer follow up.
Once, out of the hospital, I make a point to man my pager until 5PM, since any new admissions of my own patients will come to my attention before this time and to the on-call medicine resident after this time. Usually, I will head back to the Star Bucks at this time for some educational/leisure reading for a few hours. Before, heading back home, I call my wife to see if there is anything to pick up before heading that direction. Once, home the garage door opens and closes, triggering the attention of my family. My family is usually waiting by the upstairs gate excited to see me home from work.
I am happy to be home. All in a day's work.
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