A day in the life of a PGY-3 – Yana Zemkova, MD

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.

Spring 2021
Inpatient VA

Despite the countless days that have turned into months of similar schedules, waking up early still has not gotten any easier. Regardless, I slide out of bed and stagger through my morning routine. Since the conclusion of intern year, I have invested in multiple pairs of Figs in various colors, and my morning centers on this important decision. Although the cost is exorbitant, it’s worth it for those 24 hour shifts and call days, so they basically pay for themselves! At least, that’s what I will keep telling myself after veering away from the traditional green scrubs.

After my wonderfully short drive to work (think: 1.5 miles), I pull into the VA parking lot, but not before being stopped by the security guard to verify that I have privileges to park in the ramp. Some things never change, and despite it being my 3rd year, I still arrive at the hospital by 6:30am. The desire to read about patients calmly and slowly set up my workspace remains just as strong as ever (coffee #1, stethoscope, pager, pens, patient notecards). If I’m lucky, the VA coffee shop downstairs in the lobby will have been open for me to snag a cup of my usual Starbucks Blonde Roast to start the day just right.

When the time for sign-out rolls around, my intern and I collect the code pagers from the overnight team since we are on call today. I still mentally cross my fingers in hopes that there were no major issues overnight, and a slight twinge of guilt sets in if any unanticipated events occurred. But now we can get started with our day! Pre rounds, COLLECT ALL THE DATA, examine the patients, develop a plan. This time around, my interns run their plans by me for confirmation – which still feels a bit wild to be in that role already. Honestly though, my interns are rock stars and ready to be R2s by now, so I’m trying my best not to be a helicopter senior. The VA boasts an open ICU system, so we have to split our morning between floor and critical patients. It’s great for those of us interested in critical care, but adds just another level of complexity to time-management skills.

Just as rounds are ramping up, a piercing sound interrupts our discussion and stops our hearts–is it a code or a rapid response? The overhead page answers our question: “RRT Main Entrance, RRT Main Entrance.” Down to the main entrance with a quick hello to the security guard from this morning; it turns out a patient tripped over the curb when walking away but has successfully navigated to their vehicle without issue. Crisis averted, back to the grind.

Our census tends to be lighter than at the U, so we see our patients more easily in a timely manner and geographic distribution. We converse with our patients, do more extensive bedside physical exam teaching with those allowing, discuss breakfast choices with one of our long-term patients, and conclude our work for the morning. Noon conference is expected of us at the VA as well, and lunch is provided on certain days–again a protected time for education. Early afternoon allows an opportunity for us to do some Chalk Talks with the medical students, review and provide feedback on notes. A call day cannot be complete without morale rounds and having the team get snacks together from the Patriot Store. I’ll let you in on a little secret: one of the VA’s hidden gems from the Patriot Store is an energy drink called UPTIME (it looks like a can of hairspray). Now don’t ask me why, but it will change your life!

Now that we are caffeinated and stocked with snacks, we can tackle the rest of the day. As an intern, I underestimated the skills necessary for a successful triage call and remembering to elicit relevant details and clarifications–-that is an ongoing skill I’m working on when fielding triage calls from the nursing supervisor. The rest of the work day is filled with admissions, orders, seeing new patients, and staffing. The overnight intern arrives at 4pm to take cross cover from the other teams and by 6pm, the night senior has arrived for us to successfully hand off the code pagers and admitting duties. My interns are ready to be independent, but I remain as neurotic as before by checking orders, medications, and handoffs. I personally cannot navigate the VA EMR as efficiently as the University EMR, which causes inefficiencies and extra stress for me, but I certainly feel more proficient at it than at the start of my residency career.

It seems like just yesterday that I was feeling like intern year was about to be a memory glimpsed in the rearview mirror. Now, as I am screeching into the last few months of my training, I can similarly say that soon the entirety of residency is going to be a memory to glimpse as we speed away into practice or fellowship. Where has the time gone?? Am I ready? Did I learn enough?? I certainly hope so, but what I do have confidence in now is that the call day for me is over, and it’s time to rest. We can save pondering and contemplation for another day!

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