Sleep is Good

My grandmother suggested I tell you all about what my daily life is like, so I thought about many options available to me and I selected the "day in the life" approach. I have to start off by telling you that my children and wife are occasionally able to share a free on call weekend meal with me in the hospital, and so if you were to ask them what I do I am sure their answer would include "Doctor, surgeon, sick people, hot dogs, cutting on people, grape fanta, giving people medicine so they feel better, and french fries." The hot dogs might actually be higher up on their list, you are welcome to call and ask them yourself and I am sure they could tell you.

I am just picking a regular day, not an on call day since the on call day is not something I usually like to re-visit. Typically, I wake up around 5:20 and am out the door to drive it to the hospital around 5:35. I arrive and print off my patient lists from the computer so I know who it it I need to see that morning. I then check on the laboratory values of the patients I am going to see, and then any recent radiographic tests as well, and if the patient has a chest x-ray already back by 6am I will look at that real quick as well. I try to start "rounding" on my patients by 6:10, which involves seeing anyone who just had surgery or is new on our service before the others who are either ready to go home soon or are "rocks," and will likely be there for some time to come.

I usually start with gravity rounds, where I start on the highest floor first and work my way down to the lower floors. This is only the case if I don't have patients in the ICU or other "units" to see, and then they are seen first because they are more urgent. Going to the patient room, I take the chart from the pull-down and quickly look at any new orders (tells me what is really going on), overnight vital signs (this includes pulse, blood pressure, oxygen saturation of the blood, respiratory rate, urine output, intake and other output if the patient has drains or tubes or is vomiting or eliminating). Armed with this information, I look at the other doctor's notes if they are decipherable, and then charge into the patient's room where I spend usually less than 2-3 minutes asking incredibly pointed questions that are never to be repeated outside of the correct context. The conversation goes something like this, "Hi Mrs. Smith, sorry to wake you up again, any troubles overnight? Were you able to walk around at all yesterday? Are you eating anything, any nausea? Passing and gas or stool? How well is your pain controlled? Is there anything you need? Okay, I will see you later on, send you home, or explain the plan, etc..."
I then quickly scribble out a note that includes how long since they have been in the hospital, or how far out from their surgery or trauma they are, any other major issues being treated for and then pending tests or evaluation or upcoming studies or surgeries and other plans, or even when I think they will go home or back to the nursing care center, or whatever. I sandwich this information around a very detailed exam where I mention they were breathing, had a pulse, and their belly exam or wound inspection and status, and the character of any fluids draining out of anywhere.
This is repeated on the 7-15 patients I see every morning until around 7 or so we usually have some sort of educational meeting, where we also meet with the other members of the team and discuss all of the patients with each other and then go from there to the Operating Room where we first meet the patients if we haven't already, or else go straight to the OR suite and announce our presence to the scrub team and pull our gloves and gown so they have all of that. As we are scrubbing in with the attending, we fill him in on all of their patients and see what they want to do for each one and what the plan will be. After the cases we some times will physically "round" with the attending physician or we will go do other duties that may include but not be limited to pulling out drains, draining an abscess, pulling our or placing a chest tube, ordering special studies or reviewing studies with the radiologist and attending, seeing any new patients that have come to our service and getting them checked in to the hospital, and if we are lucky catching a quick lunch.
If we are on call, we get paged at any time for questions up on the floors, new traumas that have come in, or other questions that are inappropriately asked of us. If there is time remaining after the cases in the afternoon, we will quickly go over the list of patients with our team of residents (oh, each team has at least a chief or senior resident and an intern.... often a mid-level resident as well, and then 3-6 attending physicians, whose patients we are responsible for)and then make sure everything is tied down for the next day and tell the on call staff about anything that needs to be taken care of, results that the attending needs to be called about, drains or lines that need to be removed, changed, or placed. Hopefully it is only 5pm and we can go home, at the most it is 7pm by the time we get out and sometimes it is 4.
On call, means we do all of that and then at 5pm we are responsible for all of the surgical patients, any new surgical patient that comes into the ER, or that is already in the hospital but has become a surgical patient. This is typically very busy and means answering pages from all over the hospital for most of the night. Things seems to calm down normally around 11:30pm, which is typically the calm just before the shooting or drunken trauma comes in. You would be amazed by how many innocent people are shot by folks, especially when they always say they were just minding their own business (at 3am). Just a lot of crazy people out there, you know.
The on-call day ends at 7am, when you get to ditch the pager to the next on call resident. Hopefully you have been able to round on some patients before 7, but at times this is very difficult, especially if any traumas come in after 4am. In order to go home after being on call, you must have rounded on your patients, checked out with your team, possibly helped with 1-3 surgeries and then checked out again. We are required to be out of the hospital for 8 hours following being in the hospital for 30 hours continuously, but we never have to come back in before 6 the next morning, which is nice, since at times we may be on call again. Typically, I get four week-end days off a month, which is when I get to help Kristi out a little bit and hopefully sleep in some too.

That is about it... I think I will have to discuss some interesting cases and interactions if I get a chance next time I comment about work.

Yesterday, the weather was so perfect, and I was stalled in my research so I took the day off after the 7am education meeting and we went to the Cleveland Zoo, raked leaves in the afternoon, and played with the children. Tomorrow I start the neurosurgery service, so that will be interesting for me. I will be the only resident on the service, which will be no fun, but fun because I get to do whatever case I want to in the operating room, as there will be no competition. Just means I will have more paperwork and dictating to do... Oh, I forgot to mention that in the course of a normal day we are required to keep up with our dictations and paperwork, try to go to office hours, read topics for upcoming educational conferences, etc...

Have a great week
Dr. Meat

October 2006