A Day in the Life

Internal Medicine PGY-1

5:30 am: Time to wake up and start the day, bright and early. I get ready, eat some overnight oats for breakfast and head to work. I live across the street which is very convenient (especially for days when I'm running late!)

6:00 am: Arriving at the hospital, my workday commences. I take sign out from the nighttime. My patient had 2 units of hemoglobin drip overnight. The night team had already ordered a unit of blood.

6:45 am: I finish chart reviewing and head out to see my patients and make sure that I make that patient my priority. I enquire about any bleeding the patient may have experienced overnight.

8:00 am: I am done chart reviewing and pre-rounding on my patients. I grab a protein shake from the cafeteria to refuel and then it is off to the lounge to discuss the list and learning point with my senior. I am given a new patient and I head straight to see them.

9:15 am: We meet with our attending for rounds.

10:50 am: We are done rounding on the patients and have devised a plan. Now it is time to attend a lecture. Today's topic; AKI and anemia.

1:00 pm: Following the lecture, I start working on discharges and orders. After following up on all of the patients, I start working on my notes.

1:45 pm: I get another patient. I head over to see them and discuss the plan with my senior.

3:00 pm: I finish my notes. The medical students on the team were assigned to read up on Multiple Myeloma. We head over to one of the work rooms to discuss the topic.

4:30 pm: I’m ready for sign out and head to the gym to conclude my day in a healthy way.

Internal Medicine PGY-1 (On Call)

5:35 am: Time to start the day! I’m on call today. First stop is coffee. I’ve been treating myself to a Starbucks vanilla iced coffee most mornings as I drive to work. I only live 8 minutes away, so I chug it by the time I reach the hospital parking lot.

6:00 am: I quickly put on my white coat and make sure my multi-colored pen is in my pocket. I print my team list and clean my computer station to use for the day. I ask my night team colleagues if anything happened overnight. It turns out that one of my patients went to the ICU for increased breathing requirements.

6:15 am: I sit down at the computer and review my patients’ charts, checking for any updates overnight or from consultants. I jot down their morning labs, and for those who don’t have them, I give the nurse a quick, appreciative call to request a lab draw. This is the time to replace some low potassium. Sometimes, if I have patients that I know can be discharged today, I send the case manager a message to ask for any disposition updates.

6:45 am: I grab my stethoscope and head downstairs, power-walking to all of the floors my patients are located to see how they’re doing this morning.

7:30 am: I sit down and scan a few patient charts for more information. There’s a patient who may have gout, so I ask the lab if I can take a look at the synovial fluid under a microscope (no crystals, phew!)

7:45 am: If I have a quick minute, I sneak away to the cafeteria and quickly scarf down a bowl of Cheerios and a bottle of water.

9:00- 11:00 am: Rounds.

11:00 am- 1:00 pm: We attend Morning Report and lectures.

12:00 – 7:00 pm: I grab lunch and iced tea from the cafeteria and make my way back to the resident lounge. There are some families to call and consultants to ask about medication adjustments and pending procedures. We receive some new admissions. We also receive sign-out from the other teams. Sometimes, our patients have serious issues to attend to during this time, like hypoxia or low blood pressure, so we run up to the floor to stabilize them. I’m still a little lost navigating the floor units by number but plenty of nice staff direct me the correct way.

7:00 pm: Code Blue called overhead. I find the patient surrounded by nurses, doctors, and respiratory therapist with my senior resident running the code. I get in line to do chest compressions. I observe the sequence of events: chest compressions, pulse check, Epi, etc, trying to retain it all in hopes that I can be that senior resident someday. I spend two minutes doing chest compressions, which feels like ten minutes with my weak arms. The patient eventually achieves ROSC! I consider working out in the near future.

8:00 – 8:15 pm: Time to sign out to the night float team. I make sure all my sign-out communications are updated, and progress notes and H&Ps are done for the day. It’s been a crazy day!

8:30 pm: I’m home - time to shower and eat a lot. I do 10 UWorld questions and message my co-interns in our UWorld group chat, since we’re trying to keep each other accountable right now. Sometimes I fall asleep on my recliner watching Netflix. Time to snooze! Nothing feels better than a good night’s rest after a long call day.

Internal Medicine PGY-2

5:00-6:00 am: Wake up, get ready and stop to get a coffee from Tim Horton’s.

6:30-8:00 am: Get sign-out from the night team and start pre-charting patients. We discuss the old patients with the interns and make sure any new updates in labs or overnight events are addressed.

8:00-9:30 am: Pre-round on patients and get updates from the nursing staff. Make sure no significant overnight events happened.

9:30am-11:00 am: Round on patients, discuss any teaching points at bedside with the attending.

11:00am-1:00 pm: Education, lunch between lectures

1:00-4:00 pm: Get any patients discharged, see any new patients and follow-up on consult recommendations and lab results. Staff new patients with the attending and sign-out to the next team by 4PM.

5:00-7:00 pm: Get home, go out to eat (I live in Ferndale so LOTS of restaurants). Walk my dog, and just unwind.

7:00-9:00 pm: Read up on patients or study questions for board exams.

9:00-10:00 pm: Watch a show on Netflix and get ready for bed.

Internal Medicine PGY-3

5:45 – 6:30 am: Beep…beep…beep…another day! I’ll usually grab my phone and browse through the news headlines before finally getting out of bed. Residency can sometimes be insulating, and I’ve found that it’s nice to stay up to date with the world outside of medicine. With each year of residency, I’ve found that I take a significantly shorter amount of time to get ready in the mornings. I’ll brush my teeth, shower, throw on a pair of scrubs, and get on my way to work all in about thirty minutes.

6:30 – 7:00 am: Pedal to the metal to dodge Hall Road traffic. As a native Californian, it took me a while to get used to all of the pot holes and “Michigan Left-Turns”.

7:00 – 8:00 am: Time to get to work on the floors. At HF Macomb, we are a tight-knit resident community and the resident lounge serves as the epicenter for sign outs/charting/note-typing/down-time and ultra-competitive-high-stakes Ping-pong matches. Once I get to the lounge in the mornings, I’ll touch base with my co-senior(s) who is on nights to see if there were any updates with my team’s patients overnight. After that, I’ll check in with my interns to see if they have any concerns on any of their patients. If nothing comes up, I’ll print my list, pull up a seat at one of the computers, and start chart reviewing. Then I go see patients.

8:00 – 9:00 am: Daily morning report is a chance for each of the floor teams and residents on specialties to present an interesting case from the month and lead a discussion on the final diagnosis. Morning reports are attended by our Associate Program Directors, Dr. Munasinghe or Dr. Aslam, or another teaching faculty member. This is a great learning opportunity.

9:00 – 9:30 am: Grab a coffee at Tony V’s and set up a plan with my interns for each of their patients before rounding with the attending.

9:30 – 12:30 pm: Rounding with the teaching attending begins. The entire team will discuss each patient outside of the room using our portable computers and then go inside the room to examine the patient with the attending. As the senior on my team, I’ll “drive” the portable computer and put in orders as we discuss them on rounds to make things easier and more efficient for my interns.

12:30 – 1:30 pm: Lunch time! I’ll run the list with my team after rounds to make sure we’re all on the same page and then we’ll stop by the cafeteria to pick up food.

1:30 – 3:00 pm: This is the time to make sure everything discussed during rounds is implemented, including discharges and following up on recommendations from consultants. This is also when we receive new patients, up to 3 new for each intern depending on the call schedule for that day. Apart from reviewing orders, as a senior I try my best to help my interns with social work/case management calls and discharge planning as I know they also have their notes to work on. If there are medical students on my team I’ll try to pick a different topic each day and run through it with them or take them with me to admit new patients.

4:30 pm: If the patients are all squared away and the interns are completed with their work, we sign out to the on-call team (who stays until 8PM) at 4:30 PM.

Evening: Time to go exercise, shower, and figure out what to eat for dinner. After dinner, I like to check in with my family and then spend some time reading on a topic from the day. Around 10:30, I’ll set my alarm clock for the next morning and head to bed.

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