We asked a number of our residents to describe what a typical day looks like. We are grateful to share their stories in this series of diaries.
I’ve chosen to outline a dayshift as a senior resident in our Medical Intensive Care Unit (MICU), my favorite rotation at University of Iowa Health Care.
6:15 am – I push the limit on sleeping in, but thankfully, I’m a single-alarm, no-snooze kind of person. As soon as it rings, I’m up and in the shower. I grab one of my 10 pairs of scrubs, brew some coffee, toast a bagel, and am out the door for my five-minute walk to the hospital.
7:00 am – I get sign-out from the overnight intern, which usually includes one of my six patients having a rather acute issue. If they sound unstable, I will immediately go to the bedside. This speaks to one my favorite things about the ICU, the high level of acuity. My day has just started, and I am already required to make a high-level medical decision that requires a sound understanding of pathophysiology. After devising a plan with the nurse, which may include starting a vasopressor, changing ventilator settings, or ordering stat labs, I return to my work room to chart review.
7:20 am – As one of the four residents in our MICU, we usually carry 5-7 patients. This allows us to really dive deep into assessing every detail of their charts: I/O’s, rates of various drips, hour by hour trends of blood pressures and heart rates, etc. After spending roughly 10 minutes reviewing each patient, I replete electrolytes, put in any other diagnostics I want before rounds, and then head out to the floor.
8:00 am – Again, since we carry fewer patients, I can spend more time at the bedside compared to when I am on a general ward. I will first go to the ventilator if they are intubated and assess various parameters (plateau pressures, P0.1, tidal volumes). I then check any lines/tubes, what is hanging on the IV poles, and then focus on a thorough physical exam. This also includes an ultrasound evaluation of the patient’s cardiac function, pleural spaces, and/or assessment of volume status via IVC diameter or JVD distention. If warranted, I have the freedom and autonomy to make changes individually on prerounds which I can then reassess during formal rounds.
9:00 am – Rounds start, which includes a huge team (staff, fellow, two residents, respiratory therapy, pharmacy, nurse, and usually 2-3 students). While some may view this as a pressure-packed situation to present a medically complex patient, all my experiences have demonstrated that we truly are a large team, with the unified goal of treating a very sick patient. There is great interdisciplinary input from every member, but at the end of the day, as the resident, you oversee the management of your patients. All the staff and fellows are phenomenal teachers; every patient has a learning opportunity that they will address at bedside via ultrasound, on the ventilator, or with physical exam.
11:00 am – Rounds conclude. Each MICU team has 10-12 patients; we rarely round for longer then 2-3 hours. I put in orders based on our plans devised on rounds and begin to work on my notes. I usually can get all my ‘clerical work’ completed prior to noon conference.
1:00 pm – This is my favorite time period in the MICU. Patients are either improving or they are declining. Afternoons include calling family members with explanations of treatment plans that have kept their loved-one alive with a good prognosis, as well as phone calls with bad news and discussions regarding goals of care. While there are certainly highs and lows, there is always a well-devised plan with a clear end-goal. Those plans may be to attempt a then-successful extubation or transition a patient to comfort measures to ease their suffering.
In addition to updating family, I may have to place a central line, dialysis catheter, perform a paracentesis/thoracentesis, or notify the fellow of an impending need to intubate a patient. Afternoons are also spent getting stable patients out of the unit and the adrenaline rush of figuring out a new admission that is rapidly decompensating.
3:00 pm – I will normally find the senior who is working the 28-hour shift (we do these every fourth shift) and offer to cover their pager so they can escape to their call room for a few hours. This is the culture throughout our residency program, we always look out for one another. I will also begin to work on my sign-out and checking in on my patients to make sure they are as stable as possible prior to signing out to the night team.
5:00 pm – I sign out to the night team, which consists of an intern, the senior resident on their 28-hour shift, and the overnight fellow. I walk home, usually with sunlight, and will try to get in a twilight session on the driving range at Finkbine if the weather allows. In the winter I’ll spend my evenings having dinner with my fiancé or playing board games with my co-residents, who all live close by.