You can never predict what will happen during the course of the day as a family medicine resident. This particular month is my NICU/Newborn rotation, which includes home-call for the Pediatric floor. My day truly started yesterday evening when I started my peds on-call shift. I answered multiple questions from patients that called our after hours emergency line. The calls ranged from simple medication refills to a patient with chest pain that had to be evaluated in the emergency room. Then between those calls and sleeping comfortably in my own bed, I had to come into the hospital twice in order to do a pediatric admission. The patients included a 10 month old with history of gastroschisis that presented with a small bowel obstruction and an 11-year-old boy with a cystic fibrosis exacerbation.

After I had completed those admissions and staffed with the attendings, it was back to bed in the call room for one last hour before I would have to start morning rounds. It was my responsibility to see 2 babies in the nursery that belonged to our clinic and also follow a 34-week premature boy in the NICU that was being treated for possible sepsis. Everyone was doing well overnight and I was able to send one of the well-babies home with her parents. It is always rewarding to see new parents excited about bringing their child home for the first time. By this point in the morning, I had just enough time to get some breakfast with some fellow residents and drive over to clinic.

This morning was my scheduled weekly continuity clinic and I had a full schedule of patients to be seen. As I looked at the schedule, I noticed I would be seeing a wide range of patients with problems including chronic diabetes management to prenatal care to acute sick appointments. My first patient was a pleasant elderly lady that I have really gotten to know over this past year. After catching up with how things had been going over the past few months, I looked at her glucose reading logs and a few recent labs. We decided on increasing her insulin, and I was able to refill some of her medications electronically through the EMR as we discussed the timing of her next follow-up. That morning I also diagnosed a femoral hernia and sent her to go see a surgeon, had one kid with acute otitis media, had 3 pregnant continuity patients seen for prenatal visits, and one gentlemen was seen for follow-up on his congestive heart failure. It was definitely a busy morning, but I appreciated the great variety of patients and the learning opportunities that came with coordinating their care. I was still able to finish clinic by noon and now it was back to the hospital for lunch and to check up on the pediatric floor.

During my nice relaxing lunch in the cafeteria my pager went off. I looked down and it was a number that I didn't recognize, but I could see it was from another resident. When I called the number back I found out that it was the on-call OB resident. He was informing me that one of my pregnant clinic patients (not one that I had just seen a few hours ago) had come to the labor and delivery triage and was in active labor. Her due date was actually a few days ago and if she hadn't gone into labor soon, then she was planning on coming in for labor induction in a few days. The other resident told me that her water had broke 1-2 hours ago, her contractions were every 3 to 4 minutes and was now 4-5 cm dilated. I made my way up to the labor and delivery floor in order to get her admitted and make sure she knew I would be in the hospital all afternoon managing her labor. She was in good spirits despite the painful contraction, and we joked with each other that hopefully her baby would come soon so she could order dinner before the cafeteria closed at 6:30pm.

Her labor was thankfully uneventful and she continued progress throughout the afternoon. By 5:00pm she was fully dilated and ready to start pushing. Then half an hour later there was a new little baby girl that had entered this world. Everything was fine with the mom and the baby and she was cleaned up in plenty of time to order her dinner. I am always so thankful be able to help deliver a baby and see the joy on the parents' faces as they meet them for the first time. After completing all the post-partum orders for mom and baby and doing the initial history and physical on the baby, my work was finally done for the day. As I drove home to have dinner with my wife and 7-month-old daughter, I remember thinking about the tremendous variety of medicine I was able to practice over the past 24 hours. A day like this certainly leaves you tired, but the rewarding feeling of accomplishment you experience and the lives you have impacted definitely makes it all worthwhile.

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