Last year, we asked two interns in the Internal Medicine Residency Program to each provide an account of what a typical day looks like. Over the next couple weeks, we will post diaries from second- and third-year residents as well. We are grateful for their participation.
Intern year has been my year of sunrises. One of the great pleasures of walking to work is having the solitude to gather my thoughts while nature awakens around me. Thankfully it’s nearly light as I head out the door. One of the reasons I chose to live in University Heights was for its proximity to the hospital. By the end of my 10-minute walk, the cool winds have jolted awake my mind in time to receive handoff from the overnight intern who is at once relieved to unload her precious overnight cargo and also besieged to stay awake a few hours longer to round on her overnight admissions. Cordial smiles through bleary eyes are exchanged as all the patients are safely returned to their day teams.
Gathering numbers feels rote but they inform me how the day will shape up. The gentleman on 4 requires more diuresis, the lady on 6 has finally turned the corner on her bloodstream infection, a new fever on the post-op patient on 5. There is something meditative about data-gathering before I visit my first patient.
Seeing patients in the morning is always a delicate balance between gathering as much information from the patient as possible while providing reassurance, not an easy feat for a hospitalized patient at 7:30 am. Pre-rounding is a very gratifying experience as patients and their families are often eagerly awaiting the arrival of the primary team to provide guidance. I push aside breakfast trays and wake up the occasional sleeping patient to obtain the human half of my data: “my back is killing me,” “I’m still having trouble catching my breath,” “I was sweating all night.” After collecting all the overnight stories, I return to the workroom and prepare my thoughts for the attending’s arrival.
I enjoy staff rounds for their intellectual nature. After piecing together the data and narrative to support my plan, I discuss our daily treatment goals with the team. I appreciate the attending chiming in with recent data supporting or refuting treatment options, one of the advantages of working at an academic center. The entire exchange is a volley of ideas and perspectives, and the source of a great deal of my learning at work. Throughout rounds I’m also mentally reviewing the list of consultants I need to contact, the medication changes I need to order, and the patients that I will be revisiting in the afternoon.
Noon lecture provides a welcome respite from the hectic pace of wards, allowing us to place patient responsibilities on hold for an hour. After handing over my pager and filling a plate of lunch I relax into a seat, content to let someone else do the talking at least briefly. Lectures are clinically oriented and offer basic workups and approaches for common problems such as electrolyte abnormalities or shortness of breath. They are a reminder that we are simultaneously physicians and lifelong learners.
Afternoons are divided between note writing, teaching, discharges, and new admits. Without the time constraints of the morning, the afternoon feels significantly less hurried as I catch my breath. Charting is the most “office” part of my job but also where I can take ownership of my daily notes. I also make sure to filter out at least one digestible teaching point per patient for students, because one of the most rewarding aspects of residency is having the opportunity to educate. The senior resident’s pager signals the arrival of a new admit, putting us all back on the clock. I find it a welcome challenge to juggle discharges, admissions, consultations, teaching, and the occasional family meetings. With my new admission, I let the student lead the encounter because I remember enjoying the same autonomy when I wore a short coat.
Afternoon rounding is a phenomenon of admitting days and even more of an opportunity to demonstrate your knowledge. The careful recount of the patient’s narrative, combined with a thorough physical exam and review of the labs, coalesce into a unifying diagnosis and plan, the true yield of an intern’s yearlong training.
My day begins and ends with a sign out and the circle is complete when I entrust my panel to the overnight team, maintaining continuity of care. With another rewarding and hustling day behind me I pack my bag for the walk home, continually humbled by the work that I am privileged to perform.