Thursday, January 7, 2016

day in the life: internal medicine

5:35: alarm. snooze.
5:48: whoops. time to get up! I kick the cat out of bed, go brush my teeth and wash my face. I just started using a serum from First Aid, but besides that, my morning routine is the same as always. A light foundation, blush, eyeliner, eyebrow powder, and mascara.  

6:05: All done!

6:15: Time for breakfast. I have the same thing every day - two scrambled eggs with sausage and avocado or black beans. 
6:20: I collect my snacks (eggs I cooked the night before and a zone perfect bar) and my new shiny water bottle, and quietly shuffle out of the house. CR doesn't have to get up for another hour so I try to be as quiet as possible.
6:30: I'm running fairly on time, and I see that the line at the Dunken Donuts is short, so I stop for a toasted almond iced coffee. I don't even care that it's like 15 degrees outside, iced coffee > hot coffee.
7:00: We have morning report, where one of our family medicine residents presents a case on psoriasis inversus. Interestingly, I actually saw a patient with this exact problem the next day!

7:30: Once rounds are complete, I log onto the computer and print off all of my papers for the day. I have one set that is a synapsis of all of the patients on the IM service, and then another more detailed set about "my" patients. As a bit of background, I am at a small community hospital with no IM residency, which means that I spent the day with just the attending. I usually have about three patients who are "my" patients, which means I see them in the morning before the doctor does. Then I write a progress note on them, and present them at rounds. Two of my three patients today have been with us for over a week, so I know just about everything about them, but one is new. 

7:45: I check in with my attending, and then go and see my patients. I always feel bad waking up the patients, even though 7:45 is kind compared to the 5 AM wake-up the surgery patients get! I ask them how they are doing, about certain symptoms, how they are eating and sleeping. Then I do a physical exam and take a few notes on my paper so I don't forget anything for my notes later. I try to spend a few extra minutes with each patient to make sure they understand what is going on, and to answer any questions they have because I know that sometimes all the things we are doing and saying may not make sense. 

8:15: Once I've seen my patients, I start writing my progress notes. This includes detailing why they are there, what has changed in the last 24 hours, and what my assessment + plan is for them. No one really looks at these notes, but my attending has challenged me to really try to work out a plan for each patient. For me that takes the longest time, because it involves making sure we are doing the best we can to keep their labs and vitals stable, as well as treating the cause of their hospitalization. 
8:55: With rounds about to start, I quickly go have a hardboiled egg, chase it with mints and water, and quickly go to the bathroom.

9:00: We start rounds at 9 every morning. Rounds involves the attending, the case manager, the nurse, and me to go to each patient and see how they are doing. It is my responsibility to present my patients, what has changed for them, what any reports show, and what I think our next steps should be. The case manager is someone who knows a lot about their home life, and what their plans are for when they leave the hospital - they are the ones who set up any rehab or skilled nursing our patients need after leaving. And the nurse is obviously the member of the team who spends the most time with the patient, and knows anything that has happened in the last 24 hours. The attending listens to all this information, and makes the decision on what the next step is - is the patient ready to go home? Do we need to change their current medications? Have reports shown new evidence, so now we need to look for a new cause of their infection? Sometimes we see a patient for five minutes, and sometimes we see them for 45 minutes - it depends on their situation!

11:45: We finish rounds, and quickly go grab some lunch. Today I have meatloaf, vegetables, and soup. Not exactly the most exciting lunch of all time :/

12:15: I go down to radiology to watch one of my patient's receive a paracentesis. I have never seen one, so I was interested in watching! 

12:30: As I'm watching the fluid drain, my attending calls me and asks me to come to the ICU - one of our patients was deteriorating and needed a central line placed. Once I got up there, we got everything ready - I did the placement of the sterile field, he put in the central line, and I sutured on the attachments. I'm still so shaky whenever I suture. I'm just always so nervous - definitely something I want/need more practice with!

1:30: As soon as we finish the central line, another one of our patients goes into SVT, which is a very fast heart rate. We eventually are able to treat him properly, and his heart rate stabilizes. Between consulting our cardiologist, treating and reassuring the patient, and writing up the report, the whole event takes about two hours. 

3:30: My attending and I go and finish our notes from rounds. I only recently moved from writing paper progress notes to using our EMR, so it all takes me a bit longer. 

4:15: We got a consult from the ER, so we go down and do a complete history and physical. Then we admit them to the floor and put in all of their orders. 
5:00: Time to go home! I even catch a few minutes of sunlight on my drive :)
5:45: Once I get home, I snuggle all my boys, and then change into my gym clothes. I'm basically head to toe Old Navy - my new mesh work-out bottoms, tank top, and light jacket. Our gym is about 15 minutes away from home, but it's so nice to go with CR because we motivate each other to actually go, and the drive is always a good time for to catch up without distractions.

6:30: I'v finish my 100 floors on the stair master. I do 2.5 minutes at moderate speed (setting?) and then 30 seconds of high intensity, and just switched back and forth for about 25 minutes. Then I do a 5 minute walking cool down on a treadmill, and then do either an arm, leg, or ab work-out. Today was arms. We have been going to the gym consistently for two months now, and while I don't notice a difference body/weight wise (which honestly is a bit disappointing since I've been pretty good with my food too), it feels good just to move and get a good sweat in. 
7:15: We get home, shower, and I put on a layer of my Glam Glow mask. Cute, right?
7:30: CR has the less time-intensive rotation this month, so he makes more of the dinners. He made this roasted veggies and roast and it was soooo good. We split a Christmas Ale too :) After we eat, we watch 20 minutes of Making a Murderer - we are so close to being done!

8:30: My attending told me that we were going to "talk about antibiotics!" tomorrow, so I prepare my little presentation on the wide range of antibiotics. Luckily, CR is on an infectious disease IM-subspeciality, and has a copy of a lecture his ID attending gave the week before on antibiotics. I use it as a guide and supplement with UpToDate articles. I have a google drive document I keep all my notes from these assignments and lectures on, so that I have it all in one place and easily accessible on my phone. 

10:40: I can't really think about antibiotics anymore, so I kiss CR goodnight and climb into an empty (but warm!) bed by myself. He's a night owl, and I have to get up early, so this is one of those rotations where our sleep schedule is off. It sucks, but the good thing is that we are both understanding of the situation, plus it changes every four weeks, so it's not that bad. Plus I'd be lying if I said I didn't mind having the bed to myself for just a little bit ;)

Day in Review
hours slept: 6.75
hours exercised: 1
meals cooked: 1
hours studied: 2
steps walked: 4,573*
patients seen on my own: 3

* I feel this is slightly misleading because my fitbit didn't track my steps on the stair master, and I actually was standing almost the entire day! So not that many steps, but definitely more active than in certain other months!