Saturday, July 07, 2007

a weekday in the life

5:00: wake up to jaunty cell phone tune. savor the precious 30 minutes of relaxation time that comes with eating breakfast and drinking a vat of black coffee while it's still dark out.

5:30: shower, brush teeth, and take about 4 seconds to put my hair up on top of my head. put on ill-fitting (very ill-fitting) baggy blue scrubs.

5:50: pack bag with clipboard, stethoscope, pens, and lunch (if i've had time/resources to make one).

5:57: remember the one essential item that i forgot (varies from day to day between pager, calculator, and the like) and rush upstairs to find it

6:03: out the door.

6:09: walk into special care nursery (yes, it's quite the commute).

6:12: print out list o'babies, and walk around collecting vitals (respiratory rate, pulse oximetry readings, heart rate, feeding details down to the millileter and temperature) on all of them. sometimes have territorial squabbles with the nurses over the charts (not really, actually they are almost all incredibly nice). talk to nurses to find out if anything significant (ie, stops in breathing, heart rate dips, etc) went down overnight. all of this essential info goes onto sheets which i have pre-made the night before for each baby and which will later serve as their daily notes.

7:00: the hospitalist covering overnight staggers sleepily out of the call room to tell me if anything significant happened (which i've usually already heard from the nurses). my senior resident arrives and gets an update.

7:10: i do a 2 minute 'scrub' (not a real scrub like surgeons do, just a prolonged handwash) and see all of the babies. i do a quick exam (heart still beating? check!) on each of them and look more closely only if a baby is sick or has something physically unusual going on (a suspicious lookng former iv site, for example).

8:30: time to start checking any labs that were ordered that morning and doing other random tasks like scheduling appointments and filling out discharge paperwork for any babies slated to go home that day or in the near future. i am a phone call making machine.

8:40: but then -- the C-section pager goes off and we rush to the delivery room! baby comes out crying, we catch her, stimulate/dry/suction/show her off to mom and then whisk her away to the nursery. i get to declare apgars -- "8 at 1 minute and 9 at 5" -- almost always one point off for color, we never give 10s. i write a very boring note that i wish i had a preprinted form for.

9:10: head back to the special care nursery. snarf some kind of cereal bar because by then i'm starving again.

9:15: attending rounds. i report all of the data on each patient and talk about any new patients if we have one. the senior resident gets the charts out while we do this and write orders depending on the attending's whims. once in a while, i will suggest something to do ("um, could we go up on her feeds? d/c the reglan? send her home in the next couple of days?") that is actually agreed upon, but let's face it, i'm a week-old intern with zero newborn experience. it's a small victory any time something i say makes it onto the chart. but it's already happening more than it did on day one.

11:30: time flies during attending rounds! i've been here 5 and a half hours already? time to start getting things done -- making calls to follow-up pediatricians and parents, finshing notes, etc.

12:30: another c-section. this one is covered in meconium (a euphamism -- because saying 'swimming in its own feces' sounds so much less pleasant). the senior has to intubate and suck out the mec (YUCK) before we stimulate the baby to breathe. they won't let me practice intubations on these newborns becuase it's such a critical, pivotal moment. sort of disappointing, but i agree it is a sound decision.

1:30: the attending decides it's time to teach us about something (formula? apnea? retinopathy of prematurity?) and i try to forget that i'm so hungry that the formulas she is discussing actually sound tasty. mmm, Neocate!

2:05: snarf lunch in the little room we are allowed to eat in.

2:15: a fellow calls us to let us know we have a new admission coming from the NICU-next-door. a former 24-weeker now at 32 weeks coming to feed & grow (now a whopping 2 lbs, which is more than double the birthweigth, but not nearly big enough to go home). these are the babies we like at our institution, and we accept. i start an H&P (history & physical) from the summary provided by the NICU-next-door and work with my senior on some orders.

3:00: baby arrives! we ooh and ahh over its cuteness (this is a must to do with any new baby that comes in from the outside) and i do a quick exam so that i can finish the "P" part of the H&P. this word document then goes into the chart.

3:30: i prep my notes for the next day. annoyingly, all of the sheets have to have name ID stickers placed on them, and this is apparently MY job. unless there's a med student there! usually he or she helps me with this and i write all of the info i can on them for the next day (day of life, adjusted gestational age, meds, formula type & amount) to make my vitals collection/note writing easier for the next morning. i also update word documents that we keep on each baby summarizing the course of their stays. these are used to create a handy historical document that can be used for transfer notes or discharge summaries. i actually really like this system -- it's 10 times easier to update them every day with new milestones ("on 7/7/07, baby xyz was transitioned from Neosure to Enfacare and tolerated this well") than to try to figure out all of those details after the fact from the chart.

4:45: follow up any labs & newborn screens pending, sign any discharge orders for babies that get to go, and work on any necessary discharge summaries. we have to do these the day that the baby leaves so that they can be dictated stat and ready for their provider. unlike an adult discharge, these newborn babies see a pediatrician within 48 hours of their stay, so it is important for the information to be readily available.

5:30: the evening coverage hospitalist arrives to take over! the senior and i sign out to him, letting him know anything he needs to do overnight or any baby to watch out for. i usually finish up one last discharge summary or pending annoying-little-task and leave at around 6:00

6:07: arrive at home! change into gym clothes, eat a snack that won't cause severe gastric distress on the treadmill, and drive to the gym for a run. time to learn about the important goings-on in hollywood via us weekly and release the tensions of the day!! (along with a lot of sweat.)

7:35: cook something supereasy (usually from cooking light, especially their superfast section), or heat up leftovers. and if i'm lucky, josh will arrive home!

8:10: dinner. mmm! and a half-hearted cleanup.

8:50: either read something NICU-related for 20-30 minutes or fall immediately onto couch in a heap to watch the next food network star! or worse.

9:45: fall into deep sleep and hope that josh's home call pager doesn't go off (or that i can sleep through it if it does). the end!


running42k said...Best Blogger Tips[Reply to comment]Best Blogger Templates

A full day!

Amy said...Best Blogger Tips[Reply to comment]Best Blogger Templates

I found your blog through your past listing on the CRN group. Wow, what a day! I am not in the medical field, so it was interesting to see. Hope you reach your running goals with all the other great stuff you have in your life.

Susan - Nurse on the Run said...Best Blogger Tips[Reply to comment]Best Blogger Templates

I'm always shocked when people tell me they don't have to be at work until 9. I get to work around 7:15 (shift starts at 7:30!), and the residents get in at 6am. (Yikes!) I think 9am would be like sleeping in...or allow for running before work.

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