A Day in the Life

Day in the life of an average Senior

6:15-6:30 am : Usually I roll over, blink stupidly at the phone and thank heaven that I don't have the ear-grating-old beep...beep...beep alarm clock that I had as a kid. Instead, it's wind chimes or a fluted pipe. Significantly better. I don't like getting up early. I give myself 15 minutes to leave. My coffee is already made, another perk of technology, and my clothes are laid out, thanks to my wife. Most of the time, I brush my teeth...just kidding. I'll be at the hospital by 7am.

6:30-7:00 am: Detroit traffic and potholes. Dodge the blast craters, if I'm lucky. Tires are the first casualties of winter in the motor city.

7:00-8:30 am: Hit the floor. It could be one of many; cardiology, general internal medicine, nephrology, infectious disease. Floors are by specialty here, but they're mostly the same: two teams of senior residents and interns staffed by an attending physician covering somewhere between 14-20 patients per team. Coffee is finished, protein bar is in process. I'm mostly awake. I pass nurses, MAs, techs, the halls are busy, shift change and hustle. The air smells like disinfectant, among other things. Meet the team in the work room, they're usually working, chart review, answering calls, and seeing patients. I have 3 interns and 1-2 medical students. I usually ask if anyone is sick or needs to be seen; if the answer is, "no" then I find my co-senior who was on nights and get a quick sign out of my team. Then I'll sit down and run through all the charts, talk with my interns, set up a plan for all of our patients before rounds. If there's a code blue, when I'm on call, I'm on the code team so I'm running. I hate running.

8:30-11:00 am: Rounds. It's the same everywhere. See patients, talk with the attending, let the interns or medical students present patients and try not to say anything. I'm a senior now, let the interns learn. Some attending physicians want me to make the plan. Luckily, I almost always agree with the intern (which makes them look brilliant) because we've already made the plan an hour before. That's one of the tricks. Don't expect any more, I can't give them all away.

11:00-11:45 am: Progressive rounds. The two senior residents on the floor sit down with the nurse manager, the case manager, the pharmacist, and all of the floor nurses and discuss the patients overall plans and disposition. We talk about social issues, barriers to discharge, and how best to keep our patients out of the hospital. Interdisciplinary care is the way of the future.

11:45-Noon: Go back to the team, share the important bits. Get things done like make sure all of the new consults are called (the earlier the better) so we can go to lunch.

12:00-1:00 pm: Food! The best part--provided by the program (so free). There's also a lunch lecture, M&M, journal club or an evaluation meeting every day. The lectures are usually senior faculty from all of the medicine specialties and sometimes from outside specialties like neurology, dermatology, or surgery. Lunch is protected time so there is always education and the phone should only be called for emergency issues.

1:00-4:00 pm: Time to make sure all of the plans we talked about earlier in the day get implemented. We make sure all of the consults are followed up on, patients are discharged, and when we're on call, new patients are admitted. If I'm not on call, I'm signing out to the senior on call and out of the hospital by 4:30. If I'm on call, then I take sign out and admit until around 7:30 and sign out at 8pm to the night float who is coming on shift. I admit with my interns, usually just overseeing, making sure no errors in diagnosis or treatment are made. If there's time, I'll sit down and teach a topic or discuss a differential diagnosis. Sometimes, I have a 4th year medical student or sub-intern and then we admit together.

Evening: I get home, try to exercise, read, or make dinner (my wife doesn't cook...). I usually have time to get dinner with friends and still be in bed at a decent time. Around 10:30pm, I walk over to the coffee machine and set the timer. I set my alarm on my phone and... Whew... turn the alarm off. That was close...I have the day off tomorrow. Yeah, you'll get those too.

Jeremy Gentile, D.O.

One Step Closer to Completing Residency – Second Year Resident

Second year is the awkward middle child of your Internal Medicine residency. You have the knowledge of the inner workings of the hospital to be more comfortable, yet your medical knowledge is still being polished. It is during this year, though, where you start to really make the transition into a competent physician.

Your second year is heavy in critical care at Henry Ford Hospital. 3 months of medical ICU, 1 month of cardiac ICU and 1 month of emergency room serve as the foundation of your year. This helps you when you are by yourself on night float and able to manage acute issues.

On your typical ICU month, the flow is similar to the general medical floor. You arrive between 6:30-7, depending on how adept you are at pre-rounding on your patients. Lecture is at 8:00 and given by one of the ICU staff. Rounds start at 8:30 and start with overnight admissions. During this time, one resident calls consults, the on-call resident listens to the plans and another resident places orders. You are accompanied by a critical care fellow and the ICU staff to help guide your plan, but you provide the framework for the treatment. These are your patients, after all. This is a little different than intern year, where your senior still serves as the link between you and your attending staff. Once rounds are completed, the rest of day is spent admitting patients, performing procedures, or assisting with your team’s patients. One of the differences between the general medical floors and the ICU is the shared responsibility of the team’s patients. Based on the call structure, you are constantly picking up each other’s patients and presenting them the next day. If you are on the 28 hour call every 4 days, you will stay overnight and manage your team’s patients. Otherwise, if you are in a night float pod, the night resident takes over admissions and care at 8:00 PM.

When you are not in the ICU, you are able to rotate through electives which help guide your interest into possible fellowships. You have more seniority and have preference in choosing the rotations. There are wide variety of electives to choose from, and the program is flexible if you want to pursue something that is not immediately offered. These electives also strengthen your overall medical knowledge, and they help to take some of the pressure off from the demanding ICU months.

After each day is finished, you are one step closer to completing your residency. This year can be more rewarding than intern year as you gain the confidence and often make an immediate impact on patients’ lives. It is a difficult year, though, as the days in the intensive care unit can take its toll on you. Each day, I try to take time to completely remove myself from my work, spend time with those closest to me, and enjoy the precious free time. Once the year is finished, you have the confidence to be the senior resident on the team, guiding the interns.

Brendan Sullivan, D.O.

A Day in the Life of a Second year MICU Rotations

6:30AM: I get to the unit, settle in grab some coffee and water. I relieve the overnight resident of phone duties and receive sign out. Then I review labs, pre-round on my patients, and touch base with their nurses.

8:00AM: There are daily lectures in the unit where we discuss important topics related to critical care.

8:30AM: We round on the overnight resident’s patients first after which they go home and then the rest of team continues to round.

11:00AM-4PM: After rounds, I call in consults early in the day. When I get a free moment I grab some lunch. Through the afternoon I follow up on recommendations from consult services, labs, update families, and perform procedures. Typically admissions early in the day are done by other team members that are not on call to help out the on-call resident.

4pm: If all my work is done, I sign out to the on-call resident.

On Call:

Hospitalist Schedule: On the hospitalist schedule, you take new admissions until 7:30pm and sign out to the incoming night resident between 8-8:30pm. As the overnight resident you take new admissions from 8:30PM-6:30AM and present first on rounds and then go home.

30 hour call q4 days schedule: You arrive no earlier than 7am. Around 1pm, team members will help manage your patients while you get some rest to prepare for the rest of call. Team signs out around 4pm and then you take new admissions until 6:30am and present first at 8:30am.

All our ICU rotations are done in second year. Our patients in the ICU require high acuity care and have complex pathology, which may seem daunting but you have the support of the co-residents on your team, an ICU fellow, your attending, ICU nurses and support staff. It is definitely an intense but rewarding experience that provides you the opportunity to learn how to care for critically ill patients.

Kathleen Estrada, M.D.

Day in the Life of an Intern

Starting medical school, we all dreamed of that day we would go out in the real world and start making a difference. We saw that faint light at the end of the tunnel while studying long hours and having sleepless nights. As an M3 and M4, we were one step closer to our goal by being in the hospital and taking care of patients. Then one day, with the blink of an eye, it was time to graduate. We were handed that glorious medical degree and assumed the role of a resident, awaiting the success and challenges that would mold us into an excellent physician. Not only is this moment exciting but it can also be overwhelming. Keep in mind that you are not alone! You will find an excellent support system as you transition from a medical student to a resident. You will be welcomed by attendings, co-interns, senior residents, administration that want to see you succeed and will help guide you as a new leader in this program. This may not always be easy, this may not always be what you imagined—but stay motivated. Keep on challenging yourself so you can be the best. We have the privilege to learn and take care of patients who are at their most vulnerable. Remain compassionate and embrace this opportunity. As Ralph Morston once said, excellence is not a skill, it is an attitude.

First day every month is a new and exciting experience. A typical day as a new intern on the general internal medicine floors starts at approximately 6:30am. I would aim to arrive at the hospital around 6:15am so that gave me enough time to park, grab coffee, and settle down in my workspace. First order of business is usually touching base with the night float (commonly comprised of a senior resident and an intern) about events overnight with patients. If significant issues were present, discussions should take place so as to offer learning experiences, educating the team in guiding future decisions and interventions. Admissions overnight will be divided amongst the two teams on the floor. Each intern will usually pick-up a few patients who then become a part of your team for which you will be providing direct care.

You will then start to go over your assigned patients. Tasks will include reviewing vital signs, labs, imaging studies, consult recommendations. After updating assessment and plans, it is time to go see your 5-7 patients. Pre-rounding can result in changes in management. You might need to call additional consults or place more orders. Make sure to review your patient list and plans with your senior prior to rounding (with full team and attending) so everyone is on the same page!

Rounds with your team and attending start at 8:30am. You may be assigned a medical student who will be your partner in crime, helping present patients and learning from your vast knowledge. Teams usually consist of an attending, senior, co-interns, medical students, and often a pharmacist. This multidisciplinary team ensures efficiency, appropriate and safe health care, and an interactive learning experience.

If you are on call, the senior carries the admission phone and will notify you of any new admission(s) coming from the ER, outside hospitals, or transfers from within the hospital such as ICU or specialty floors such as Cardiology. Admissions will allow you to take the lead on placing admission orders, identifying key problems, diagnoses, and formulating assessment and plans. These new cases will be presented on rounds the following day.

As you finish up your call, you will sign out patients to the night float, providing them accurate and quality updates to keep patients alive. It is then time to go home, eat a delicious meal, rest, and pat yourself on the back because a job well done today is the best preparation for tomorrow (Shiv Khera).

--Lindsey Aurora
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