6:00 am – Out of bed, to the shower
6:35 am – Wake up 11 yo son, remind him to take ADD medicine this morning
6:40 am – Feed 3 hungry cats, out the door to work
7:00 am – Sign and update day’s surgical H&P’s, type an overdue office note into EMR so procedure can be precert’d for Friday
7:10 am – Breakfast, grits and poppyseed muffin, with premed student who’s shadowing this month
7:30 am – See first surgical patient in preop, sign chart, dress in scrubs
7:45 am – Call medical records to assure them I did the overdue discharge summaries last night and I’m back on staff
8:00 am – Do first case, small outpatient procedure
8:40 am – Talk with first pt’s family, see next patient in preop holding, write postop orders, handwrite prescriptions since EMR printer not working AGAIN
9:00 am – Start next case, 2-hour outpatient procedure. Get page about emergency cerebellar stroke pt en route to ICU from sister hospital, need to consult
9:30 am – Review films of stroke pt during short pause in surgery, obviously needs emergent craniectomy. Book case, give anesthesia instructions while operating.
10:30 am – Still operating on pt #2; get paged about another consult, not emergent but needs to be seen today.
11:10 am – Finish case, stroke pt not here yet. Speak with family, write postop orders, decide to proceed with next case (1 hour inpt surgery) while waiting for stroke pt
11:40 am – Start case #3 after difficult awake fiberoptic intubation. Play Christmas music to improve mood. Get paged about consult #3 – brain mass. Start getting irritable, since this was supposed to be a short day (get home at 6:30, actually see family and get dinner made, start decorating tree we brought home ). There goes any chance of getting home before 9:30 AGAIN, on a day I’m not on night call.
12:45 pm – Finish case #3, talk to pt family, write postop orders. Run upstairs to see stroke pt. Awake but with ominous “pressure” headache. Discover the internist started him on blood thinners 2 days ago (including Plavix), and he had a dose this am. Delay emergency OR so platelets can be transfused.
1:15 pm - Cancel last 2 scheduled elective cases to accommodate emergency. There goes ’s light schedule. Soothe angry patients who have to be fixed before their deductible starts over Jan 1.
1:30 pm – Field call from our other hospital’s trauma committee chief, chewing me out for taking too long to see a trauma patient in their ER two weekends ago on call. Explain that when I got their call, I was operating on the day’s second emergency case in the other town and couldn’t leave that patient on the table. Called partner for help, who wouldn’t come in. After finishing case, drove straight to ER 30 min away at after operating since 8:00 am. Got stopped by police for speeding. Took pt straight to OR, operated until 4:00 am. Pt survived and had great outcome. “Oh, okay, I guess the circumstances were understandable.”
1:45 pm – Drop by doctor’s lounge for a cup of soup while platelets are being prepared. Watch news about health care reform. Wonder how many hospitals will have to close with Medicare cuts, and how many physicians will be able to stay out of hospital employment situations. Realize there’s nothing I can do about it.
2:30 pm – Pt rolls into OR.
3:00 pm – Begin emergency surgery. More Christmas music, reminding me I haven’t done any shopping or even thought about what to get for which people.
4:58 pm – Still operating. Get paged about consult #4. On call partner takes over at 5:00 pm. Hospital called him first, but he told them to call me.
6:00 pm – Finish emergency. Speak with family, write postop orders. Review films on postop pt in rehab with new leg pain. Can’t tell if his graft has migrated. Order CT scan.
6:15 pm – Change out of scrubs, see patient with brain mass. Order additional testing, type consult note.
vegetarian exchange student who lives with us during the week. Remind him to make sure son takes anxiety meds tonight. Husband texts back that son only got sent out of one class today for disruptive behavior. Progress. – Answer text from husband to tell him I won’t be home for dinner AGAIN. Attach sad emoticon. Advise him to use olive oil to make couscous for the
back pain. MRI films aren’t here, instruct pt’s family to bring tomorrow so we can make decisions. Type consult note. – See consult #3, pt with
– Field question from floor nurses about a postop patient, preventing the need to disturb the on call partner.
– See consult #4, pt with back pain. Explain to family why I didn’t get here earlier. Discuss treatment plan, not surgical. Enter orders and type consult note.
– Check on craniectomy pt in ICU. BP is 210/130. Start Cardene drip. Otherwise doing well. Hug family member.
– Stop by office to check messages. Ignore inbox on my desk (known to my staff as “ Mount Surgeon .”) Review To Do list, realize I can’t mark off a single item. (There are 18.)
Christmas (Thurs-Mon) and on backup for New Year’s. – Glance at call schedule accidentally, reminding myself that I’m on call
– Rest for 5 minutes to read this blog, am inspired to write this guest post.
– Start wiping away tears as I think about what I’ve just written. I used to love my career, but I am realizing how sick and tired I am of this workload - of not seeing my family, not being ready for holidays, using weekends to catch up on charts… of being dumped on by partners and pushed around by insurance companies. I can’t remember what I used to do for fun, and I can’t figure out why I’m still getting out of bed for this, day after day. Why would anybody want to have a day like this, or worse, 5+ days a week? I know, it’s supposed to be hard, and the culture of is to suck it up and avoid asking for help, because that’s a sign of weakness. Maybe my fellow residents were right after all, and I’m just lazy. Maybe I just need to finally reconsider my options and decide whether this has devoured enough of my life.