My First 30-Hour Day

I bet you all thought there were only 24 hours in a day. Not in residency! In fact, the weeks are longer in residency too.

I just started my adult medicine rotation, and it is definitely the most challenging rotation I've had yet. The patients are very sick, and there is never enough time to truly understand what is going on with them. As a first-year resident, I am responible for six patients on any given day. Usually at least two of them are in the intensive care unit. We start rounds at 6 AM each day and try to see six patients in three hours before meeting with our attending at 9 AM. That's only half an hour for each patient, which is never enough, especially when I'm picking up new patients in the morning who are really complicated. Of course, most of the time I have no idea what I'm supposed to do with the patients - what meds to give and how much. So I have to look stuff up, which takes even more time. After meeting with our attending frmo 9 to 10 AM, we have 30 minutes to finish stuff up - writing orders, discharging patients, calling consultants. Then we have to rush over to our sister hospital to be on time for "morning report," a teaching conference for all of the adult medicine teams. Three days a week we also have a noon conference. The afternoons are spent either in clinic or at the hospital. That's the only time I really have to read up on patients, talk to them about their rest results, and figure out what the next steps are.

One or two days a week, I'm on call. Day call goes from 6 AM to 5 PM. Night call is from 5 PM to 6 AM. However, after night call, I still have to round on my patients the next day. Hence the 30-hour work day. I had my first one this week. Actually, it was more than 30 hours. I was up at 4:30 AM, got to the hospital at 5:30 AM and started getting organized to round on my patients (looking up labs and vital signs). Morning went pretty much as above, and the afternoon was spent catching up on clinic and hospital paperwork. Then I started call at 5 PM. I had a patient to admit almost immediately. Each admit takes at least an hour, sometimes more. I have to see the patient, look up their medical history and any diagnostic studies that have been done. Then I have to write the admitting orders, which means deciding what further work-up and treatment they need. This usually involves doing some research and reading if I have time to figure out what to do and how to do it. Then I go over everything with the attending. Once that's done, I dictate the history and physical exam by phone. Then it starts all over with the next patient. In the meantime, I get to answer calls on my own patients, hopefully not too many. Some calls are relatively quiet. But my first long call this week, I admitted 5 patients. Doesn't sound like that many, but three of them were admitted to intensive care, so they were pretty sick. Anyway, I didn't get any sleep that night, so I was pretty sleepy by the time morning report rolled around. But I made it! I guess I'm still young after all!

Besides being incredibly physically and mentally challenging, this rotation has its rewards. I have gotten to know several of my patients and feel like they really appreciate it when I take the time to go back by their room and talk to them later in the day. Often, they have questions that no one has answered. Or they just want reassurance that someone cares for them. There are always so many people coming into their rooms and examining them and asking the same questions - different specialists, residents, attendings, students. I'm sure they wonder who's calling the shots and if everyone is talking to each other. My job as a primary care doctor is to try to integrate what everyone's doing and communicate with the patient. I also have to think about whole picture while specialists may only focus on one organ system. And I have to think about what's going to happen when the patient goes home. Can they care for themselves? Will they follow up? Take their medications? Do they understand their illness and what causes it? Do they know how to prevent a recurrence? I wish I had more time to be able to sit and talk with my patients to make sure they understand.

Some days I feel like I'm learning by leaps and bounds. Other days I feel like I will never have a handle on how to take care of patients. But I have found that I am more confident in responding to pages - things like patient's blood pressure too high or too low, patient agitated or confused, patient spiking a fever. Now I can often spout out orders that sound pretty good.

Well, time for bed - I have to get up in 7 hours and start a 24-hour day! More on some of my interesting patients later...

Bike Trip!

My residency program sponsors an annual trip to Colorado for first and second year residents, to promote team bonding, learning and comraderie. It's called "Bike Trip" because there is always a challenging bike ride up Vail Pass (15 miles uphill) and back. Of course, those who are less athletic can opt to do the downhill portion only - definitely a good choice.

Bike Trip 2010

I had a wonderful drive with two of the second-year gals, convoying with another group of first-years. The first morning was spent in team building activities (silly games - like making a team mascot from medical supplies - see photo) and continuing medical education lectures. Then we took a "short" hike to get acclimated. Basically, we hiked straight up for an hour, huffing and puffing, and had lunch on the top of some mountain. I got talked into hiking up even farther with some of my first-year buddies. It was, literally, breathtaking. The aspens were all turning yellow and orange and the weather was perfect with clear blue skies. So the scenery was a feast for the eyes and refreshing to the soul.

Day two was the bike outing. I got talked into doing the downhill portion of Vail Pass, imagining hurtling downhill at breakneck speeds on a rough mountain trail. Actually, the path was all asphalt and the slope gentler than I expected. So the ride was thoroughly enjoyable. After the 15-mile downhill ride, which was quite invigorating, I rode around Dillon Lake, about 10 miles. This was a somewhat more challenging ride, actually - although shorter, there were a lot of uphill sections. The crystal blue lake surrounded by pockets of golden Aspens was well worth the ride. On the third day, I kayaked around the lake. That's the first time I've ever kayaked. It was great, except when the wind kicked up. Dillon is at about 9,000 feet of altitude, so I feel pretty proud of myself for being up to several hours of rigorous activity in low oxygen conditions.

In addition to all the outdoor frolics, we had lots of social activities - games, pizza, medical pictionary (harder than you'd think - try drawing benign prostatic hypertrphy!), and even dancing. On the last night, we had a line dance with a real "caller" who led us through several line and square dances. It was loads of fun - good exercise and easy for those of us with two left feet.

I came back from the trip refreshed and ready to start my adult medicine rotation, which I just started on October 1st. It's going to be a very challenging month - but more on that later.

Sorry it's been so long between posts. I miss you all!