The Day Shift.....

So after two weeks I think I have the day shift pretty much down, which definitely does not mean I am good at it. Day shift is VERY different than what I thought it would be, it's like more of hospitalist/internist medicine. As in you deal with a lot of internal medicine problems on all the trauma patients that have been admitted and are either recovering from or waiting to go to surgery. So my days look something like this...

6am - 6:15/30ish - sign out in the west wing ICU- night team gives you the run down on any problems your patients may have had over night and the scoop on any new admits on your assigned "wall" of the TRACU or upstairs (peds, ob and med surg)

6:15/30ish - 9am - sit in TRACU on a computer looking up all the morning labs, diagnostic imaging, reviewing other services consults or progress notes, seeing your patients (ie: physical exam) and writing notes on your patients. ( now this may seem like a long time, especially for me because I am only allowed to see at a max 5 patients, but trust me when the patient has a few chronic conditions on top of fractures, mental status changes, alcohol withdrawl symptoms, and electrolyte imbalances.. the time goes by waaay quicker than you think.) What is amazing to me is that in 2.5hrs these PA's can get most of their notes done on an average of 10 patients! They are AMAZING!!

9am - 12 (or sometimes 1,2 or even 3) Grand Rounds - yep, the big bad scary ground rounds of legend. Which actually turn out to not be so bad for the most part. But just like anything else it depends on the attending your rounding with. Some are slower than others, some teach as they go, some sit down with you after rounds and go over your notes with you. Presenting during rounds is still pretty rough for me, though after you've rounded with the attending once and know how they want you to present it's much easier and a little less intimidating. If I had one piece of advice it would be to WRITE down your lab values and do not be afraid of saying I DON'T KNOW. I don't know is always better than trying to bluff your way through something! I've watched it go very badly for people who try to do this and it is ALWAYS better to honestly answer any question, you will never ever be able to predict everything the attending will ask you so I try and write down as much of what I think is pertinent.

LUNCH - the PA's will usually make you go eat lunch even if rounds run over and clinic is waiting for you, on Friday's (even though that's usually your day off) there is a lecture from a couple residents that is interesting to attend if your there.

After rounds the rest of your scheudle depends on what day it is

T,W,Th - 1-5pm = Trauma clinic - it's fast paced, hectic and takes a while to get used to. ( I wasn't a fan) but one of the cool parts about doing nights first is that sometimes you get to see some of the patients you took care of when they were first admited.

S,Sn,M,F - finish up all the order changes to the patients you saw in the morning, write discharge summaries for patients that will be going home that evening or the next day. Depending on which PA your working with the rest of the day is spent learning either from quizing or lecture or it's your time and you can study, enter typhon, watch TV, take a nap, or blog :)