My friend the Vet called me up yesterday to find out if I wanted to go see a movie, to which I immediately responded "Oooooh. Yes! The (insert name of tiny independent theatre here) is showing The Waiting Room. It's a documentary about 24 hours in the life of an emergency room waiting room. I really want to see it!" My enthusiasm was met with silence from my friend, who had been anticipating something more along the lines of the Hobbit, but being a good friend, she indulged me and my nerdy interests yet again and agreed to tag along.
Watching the movie, it was as if my workplace had been captured on film and projected on screen. The patient demographics were different, but otherwise everything else was the same - the noise, the fear, the shuffling of patients between beds, the scrambling to find follow up for patients. The moment when a code comes to an end and a death is pronounced. All of it was a reflection of what I've been doing almost every day for the past four and a half years, and it was a reminder of how much I love my work, even though the day to day is often hard.
What struck me most, though, was the Vet's reaction. During the film, I heard her suck in her breath from shock and caught her flinching at the things she was seeing, and I was struck by the fact that what was so commonplace to me was completely foreign to her. This world of medicine, which has become so ordinary and everyday to me, is so unfamiliar to others. And it left me wanting to share a bit of what my days are like with the "outside world", so as to help other people understand what it means to be a resident. If this is of interest to people, I may do it again in the future, as my days vary tremendously from one to the next depending on what's happening at the hospital.
For the next two and a half months, I'm a senior on the internal medicine consult service. The consult service sees all of the internal medicine patients in the emergency room (usually for admission, but sometimes just for advice/follow up), sees consults on other wards (e.g. surgery, obstetrics, psychiatry), and performs a lot of the procedures on the internal medicine wards (e.g. line insertions, paracenteses, thoracenteses). Some days are incredibly busy, and others are so slow as to be boring. Here, for illustration, is a breakdown of last Friday, which was definitely a slower day:
6:00 - Alarm goes off, but am already awake thanks to a cat poking me in the eye in the hope of getting fed. Feed cats, clean litter boxes, shower, eat, and review my physical exam of the ulnar nerve for my morning teaching session.
7:00 - Leave for work.
7:30 - Arrive at hospital. Lead the first half of the morning teaching session (attended by all of the ward residents and members of the consult service), in which we collectively examine a patient with an ulnar nerve palsy.
8:30 - Consult team disperses to see consults in the emergency room and follow ups on the wards. It's a slower day, so there isn't anything for me to do. Pull out my physical examination book and practice peripheral nerve exams with a fellow resident.
10:00 - Review of consults and teaching session with my Program Director. After discussing patients for about half an hour, the Program Director picks on us randomly to demonstrate physical exam skills and describe our management of mock cases. I get to demonstrate the radial nerve exam, which makes me happy as I had been practicing it just minutes earlier. For the first time in the four and a half years that I've been working with him, my Program Director uses the word "excellent" in reference to something I've done. (Gold Star day!)
11:45 - Run to cafeteria to buy lunch.
12:00 - Attend senior rounds, which is a presentation by a senior resident about the scientific evidence behind something that we commonly do in our clinical practice.
13:00 - Meet with the consult team for a status report on the consults that are in progress. Meet with the bed coordinator to figure out which wards have open beds.
13:30 - Speak with a young patient who is about to have dialysis for the first time and get consent to place a vas cath (large iv line for performing dialysis). Run around hospital getting equipment and ultrasound for line insertion.
14:00 - Supervise junior resident inserting the vas cath. Watching her, am reminded of just how far I've come in the past year.
15:00 - Review consult with medical student and do impromptu teaching on gastrointestinal bleeding, altered level of consciousness, and fatigue.
16:00 - Get sent home early because things are quiet and one of the other seniors is staying for the evening. Become horribly entangled in the Friday evening traffic.
16:45 - Arrive home. Pull out Harrison's Principles of Internal Medicine for some quick studying before calling it a day.
17:45 - Head out to dinner with my Mom at my favourite restaurant. Pork tenderloin, red wine demi glace, and herbed mashed potatoes. Mmmm. Great end to another week.
19:30 - Return home. Empty the dishwasher, tidy the apartment, and prep for my photography lesson the next day.
21:00 - Veg.
23:30 - Sleep. Another week behind me.
While this gives an idea of what my days are like, it was definitely a slower day. Usually there isn't time for studying (or for leaving early), and I'm reviewing far more consults with the team and seeing a consult or two myself. Also, most nights are not spent dining out, but rather are spent at home trying to fit in two to three hours of study time. The days are often long, but for the most part they're good. I wouldn't change what I'm doing for anything.
9 comments:
I was a third year IM resident when my mom asked me "So like when do you go into the OR?"
WTF?
This might be an idiot question, but what are you studying for--a test? To be a better doctor? Have I revealed my first year medical student-ness?
Red - That's awesome! My mom is similarly clueless about my life in residency. Every time I do overnight call, she asks me "So, do you get tomorrow (i.e. the day after my post-call day) off?". And she'll frequently send me text messages during the day asking me if I'm at work. Umm...yes?
Elena - It's a bit of both. In Canada, all specialty residents (i.e. everyone except for family medicine) have to do a Royal College exam at the end of their training, which usually consists of a written and an oral component. Mine is 15 months away, but I'm starting to ramp up my studying in preparation for it. It isn't an exam that one can cram for!
Sounds like an excellent day! And, I need your study motivation. I think my boards (in nov) will be the little fear factor I need to get my butt in gear :)
Um, you DO know that veterinarians are medically trained, don't you? We don't see human patients, it's true, but I guarantee if you saw a day of your friend's life, especially HER rotations in a veterinary ER, you'd suck in your breath from shock and probably flinch more than a few times. Did you even ask your friend what she found disturbing? It probably wasn't what you think, though I, like many veterinarians, certainly find human medicine plenty disturbing. My most frequent thought is, for quality of diagnostic and treatment process, as well as dignity and compassion, I'd rather be treated by a veterinarian, in a veterinary hospital.
Sarah - My motivation comes and goes, but I'm trying to be more consistent with it. The next five months are intended to be a major learning period for residents (lots of teaching and a reasonable amount of time to study), so I'm trying to take advantage of them as much as possible.
Anonymous - I'm not sure why you took such offense to this post. I'm not an idiot; of course I realize that veterinarians are medically trained. My friend ("the Vet") and I talk often about training and work, so we both have a reasonable idea of what the other person's career is like. We also talked about her reaction to the documentary, and the things she found disturbing were what I described here. As for being treated by a veterinarian vs a doctor, it's very dependent on the individual providing the treatment - there are bad and good practitioners of both human and veterinary medicine.
I saw The Waiting Room when it came to my local theatre a few weeks back. I really liked it - made me very glad that I live in Canada.
~Rach
Rach - Indeed, I can't imagine not having access to medical care. Canada is a good country.
All kidding aside, I'm absolutely impressed and astounded and humbled by people in the medical profession. I tip my Tilly Hat to you.
Okay, slight kidding: this post would best be read with the "ER" soundtrack playing in the background. :)
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