A Day as an Intern
A Day in the Life as an Anesthesia Intern
2016 Intern update provided by Susan Walters, CA-0
0520: I show up to the 4West work room to pre-round on our patients with the NPs on today. It’s great to have the NPs on the service with you every day to help answer questions and assist with procedures since there we there aren’t other providers on the floor during the day.
0600: We meet up with the 3 TCV fellows to quickly sit-round before the fellows head down to the OR. Decisions are made quickly about diuresis dosage, chest tube management, and discharge planning. After developing plans for the day, the NPs and I pair up with the fellows to go see patients. The fellows check incisions and discuss plans with the patients. I’ll come back later in the morning to do a more thorough exam since we have a lot of patients to see.
0640: The fellows head down to the OR. If we need to reach them, we tend to text them between cases or call down to the ORs if there is an emergency. I have 5 chest tubes to remove and 2 sets of pacing wires to pull, so I start with chest tubes. By the end of the month, pulling chest tubes is almost as easy as writing notes. Patients tell me that it doesn’t really hurt, but that having a foot long tube pulled out of your mediastinum just feels (and looks) weird. Since the tubes are a big source of pain for these post-op patients, it’s satisfying to take them out and see them feel relief quickly.
0745: All of my tubes are out but my two patients with wires to pull are eating breakfast so I sit down to start my notes for the day. Fortunately, it’s a surgery service so the notes are typically pretty straightforward as long as the patients are recovering as expected.
0900: I finish my notes and set out to pull pacing wires. While it’s not a difficult or painful procedure, if done too quickly can cause a major bleed or tamponade and send someone back to the OR. Fortunately that’s rare and both of my wire pulls are uneventful.
1100: Twice a week, one of the cardiothoracic surgery attendings, Dr. Tribble, comes to do one-on-one teaching. He loves teaching so it’s a great time to just sit down a talk about a patient or cardiac surgery topic with someone who has seen and fixed it ALL. Today we’re talking about post-op afib, which is timely since one of my patients went into afib yesterday. He emails me an article about management of POAF after our meeting and a book chapter he wrote about managing arrhthymias in an ICU.
1230: I start tying up loose ends and following up on afternoon labs. It’s the slowest part of the day if all of the patients are doing well. We pick up 2 new patients being transferred out of the TCVPO and tee them up for step-down. One of the patients is only postop day 1 and his main complaint is pain now that he is no longer receiving IV pushes of fentanyl and only on PO oxycodone, so I start a PCA for him to get him through the night. Some afternoons can be busier than others, but today is pretty quiet.
1700: Of course at the end of the day, one of my patients goes into afib with RVR. He’s otherwise stable so we manage him appropriately and at least get his rate under control. Since he’s feeling better and there is a good chance he converts back to normal sinus on his own, I won’t try to load him with IV amiodarone right now, but I’ll let the night intern know to do so if he stays in afib.
1815: I sign out to the night intern and let him know my plans for the patient in afib. Then I head home to sleep before my alarm goes off at 4:30am again tomorrow.