A day in the life of a PGY-2 – Jason Cascio, MD

We asked residents in each class to provide an account of what a typical day looks like. Below is an entry from second-year resident Dr. Jason Cascio. We are grateful to all the residents who have participated in this series.

Inpatient shifts begin at 7am, and I live close enough to the hospital that I could roll out of bed at 6:30, throw on a pair of green scrubs, and bike to work with time to spare. Instead, my alarm goes off at 5:30. I creep into the kitchen, bleary-eyed, in search of a coffee cup, and inevitably I hear the familiar pitter-patter of footsteps behind me. “Morning, buddy,” I say. Coffee will have to wait. To a four-year-old, timely administration of morning cereal is a HUGE deal. “Dad, I’m hungry.” I’m pretty sure my son stands at his bedroom door each morning, waiting for me to walk out of my bedroom, ready to pounce.

I change course and head towards the pantry. At this point in residency, I could probably serve cereal in my sleep. The sound of Cheerios hitting the bowl sounds like a thunderous roar when it’s 5:30 am, and maybe it is, because this always seems to trigger stage two of the morning . . . my two-year-old daughter comes sprinting into the kitchen. “Me too, daddy!” she says. Two bowls of Cheerios coming right up!

I spend the next 45 minutes slowly waking up while drinking coffee on the couch and watching the kids devour their breakfast. Soon they both make their way to the couch to join me, usually with books in tow. “Dad, read this one.”

One of the great things about our program is the 7am start time, which you don’t find in most places. A one-hour difference sounds trivial, but if we started at 6 am this time with my kids would not exist.

Around 6:20, I start the process of disentangling myself from my kids in order to head toward the shower, and by 6:30 they finally relent (though sometimes they don’t, at which point I wake up the wife for backup). I’m out the door by 6:50 on my bike and locking it up to the bike rack by 6:57. I arrive to my team’s workroom at 7:00.

By the time I arrive, my interns have already received sign-out from the overnight team. I print out our team’s list and start my morning chart review, coffee #2 in hand. As the senior on the team, I don’t have to see everybody before rounds; that would be impossible anyway. But I do make it a point to pay our sickest patients a visit before the attending arrives, usually between 8:30 and 9:00.

Rounds usually finish by 11, which allows plenty of time to place orders, call consults, and get patients discharged before our noon conference. While my interns do all this work, my pager goes off with an admission in the ED. I quickly scan this new patient’s chart and pick up the phone to get the triage from the ED physician. Most times the admission seems appropriate, but sometimes there are reasons the patient should not come to our medicine service. It’s my job to ask the right questions and recognize when a patient would be better served somewhere else, like an ICU.

At noon we head to our department’s aptly named “noon conference,” which is held every day and includes free lunch. Afterwards, there will probably be a few more admissions, and in between I’ll help lead some case discussions, med student teaching, and a usually much needed mid-day adventure to the coffee shop (coffee #3).

At 6pm the night residents arrive, and a cacophony of resident babble fills the room as the day teams sign out their patients. While my interns are busy finishing up notes and signing out, I’m giving each of our patients one final look over. Did everything we meant to happen today actually happen today? Any abnormal labs or vitals we missed? Any last minute consultant notes that completely change the plan? Yes, no, and phew, no.  I pack up my stuff, walk out of the hospital, and bike home.

8 minutes later, I’m greeted at my door by an overexcited dog. At the top of the stairs my two kids wait, jumping up and down and screaming “yay Daddy, yay Daddy, yay Daddy!” My wife is also happy to see me though she only occasionally joins the jumping. Next, as if no time had passed from the morning to now, I’m handed a book by my two year old. “Daddy, read this one now”.

After dinner, it’s time for more books and then bed by 7:30 with any luck. We set the coffee for the next morning and then my wife and I have a bit of an evening to relax and enjoy the quiet. And herein lies the final perk of that 7am start time. If we started at 6am, I wouldn’t be able to stay up much longer than my kids. But that 1 hour difference allows me just enough time to myself at the end of the day to get ready for the next one.

 

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