5 years of you know, infancy and such, 4 years elementary school in MN, 2 years elementary school in OR, 3 years junior high, 3 years high school, 4 years college, 1 year receptionist, 1 year AmeriCorps VISTA, 4 years medical school, 3 years residency, and 6 years here!
SIX YEARS. That is ...math... 2,191 days, 315,384 hours, and so forth (more math). Granted, I have missed a full year with my two maternity leaves, but I'm just gonna ignore that for now.
In honor of my sixth anniversary, I figured I'd fill you in on A Day in the Life of a Pediatric Hospitalist. Thrilling, no?
6:30 - Wake up. Sometimes this is earlier. Sometimes it is in the middle of the night. Especially when Marian decides that her imaginary friend needs the pink smiley face light turned on in a specific way to make the colors go through a specific rotation. One time, I got up early and worked out. Then Marian started waking up in the middle of the night to force us to cater to the whims of her imaginary friends, and I decided working out at 5 am was WAY overrated. But, 6:30 is the goal. It used to be 5:30 when I got up to pump for the boys. It used to be 5:15 when we lived in Sacramento and I had to commute 1 hour and 45 minutes to work. But, again. 6:30 is awesome. Or 6:35. But no later than that.
I leave for work around 7:15. Isn't that a nice, civilized time? I can't tell you how much I like leaving for work after the sun has risen. I still need lots of coffee, though.
8:00 - Meet with the pediatrician going off service to get 'sign out.' This is when they tell me who the patients are and what is going on with them. I also get the pager from the person going off service. Pager. Remember those? Doctors used to use them, and drug dealers, I guess, and then for about, what? 2 years in the 90s, everyone had pagers. Now it's pretty much just doctors again.
After sign out, I usually head to the opposite side of the hospital to the doctor's lounge to get a second cup of coffee. And maybe a slice of bacon. One of the perks of being an attending is the doctor's lounge. There is a coffee machine, and they serve us breakfast and lunch Monday through Friday. It's pretty much just cafeteria food. Correction: it IS just cafeteria food. But it's free, and even though I have been out of med school and residency for almost as long as I was in, I'm a sucker for a free meal. I think most doctors are. I think that's why pharmaceutical reps have such a hold over some doctors. Not me. I haven't seen a pharm rep since... medical school? Not many medications to push to inpatient pediatricians!
Today, after coffee #2, I went to the scheduled morning c-section. At a c-section, I scrub in, get all gowned and sterile-d up, and then stand there while the OB and the midwife get the baby out. Sometimes I suction things. Sometimes I adjust the overhead light. A lot of the time I wonder why I am scrubbed in at a scheduled c-section. Most of the time, the babies come out kicking and screaming, and I just carry the baby over to the warmer, where I meet the nurse, and we dry and assess the baby. Occasionally, the baby needs a little extra support. If the baby pooped before birth, there is a risk of them breathing the meconium into their lungs, so I'll place an endotracheal tube to suck out their trachea. If the baby doesn't want to breathe, we'll stimulate the baby, and may use a mask and bag to give the baby a few breaths. If the baby's heart rate drops too low, we'll do chest compressions. In my six years here, I've intubated probably 20-30 babies, I've used bag-mask ventilation for too many to count, and I've done chest compressions on maybe 5 or 6. Babies are awesome. They come out with such a strong will to live, we usually don't have to do anything!
After this morning's c section, I rounded on the other healthy newborns. During my rounds, I look at the patient's information on the computer - their vital signs, lab results, notes from the nurses, and their ins and outs (how much they ate, and how much they peed and pooped) Then I go into the rooms, and examine the babies, and chat with the parents. I enjoy this part most of the time. Most parents are sleep deprived, but happy. Most of the babies are just fine. Some get jaundice, some have murmurs, some get broken collar bones, a lot have feeding issues and some have other issues that they were born with. But most babies, again, do just fine.
When I was done seeing babies, I rounded on the patients admitted to Pediatrics. On Pediatrics, we have kids any where from a few days old through 18 years old. During the winter, most of the admissions are for respiratory illnesses - mostly babies with bronchiolitis, a lot of asthma, and some pneumonia. During the summer, we have a lot of stomach flu/dehydration, appendicitis, abscesses and still more asthma. I talk to the nurses about the patients, examine them, talk to the families and make any changes to the plan of care based on how the kid is doing. Kids are great patients, too. They let you know when they are sick, and they get better. We take care of some pretty sick kids at our hospital, but we don't have any pediatric sub-specialists. If a patient needs to see a specialist in person, or if they are getting close to needing to be treated in an ICU, we transfer them down to UCSF Children's Hospital or to Children's Hospital Oakland.
Oh, and of course, I have to document all the things that I did - histories and physicals for new patients, daily notes for ones that stay and discharge summaries for the ones that go home.
I managed to round on all my patients before lunch today. Depending on the day, rounds can take anywhere from 1 hour to 10 hours. Summer months are generally lighter as we typically have only 1-3 kids. In the winter, we can have as many as 10-12 kids, plus the newborns.
Lunch in the doctor's lounge is usually pretty entertaining. We have a lot of older doctors in the hospital, though the average age is getting lower and lower then longer I've been here as more young doctors join the medical group I work for. There is one doctor in particular who sits in the lounge from about 11-2 EVERY day, and sort of holds court. He knows everyone, and is loud and opinionated. Several of my colleagues don't go to the lounge during meal time to avoid some of the craziness. I find it all amusing, though, so I go.
After lunch, I did a circumcision. There are a grand total of two procedures that I do: circumcisions and lumbar punctures. Oh, and I do frenulectomies. And intubations. And sometimes I squeeze abscess so that pus comes out. So, I guess I do a handful of procedures. I like doing procedures, though I am a bit on the fence lately about the appropriateness of doing routine circumcisions on newborn boys. I will say, I do a mean penile block, and 99% of those boys that I do circumcise sleep through the whole procedure.
The rest of the day, I tie up loose ends on the existing patients, re-assess the patients, make new plans, talk to any parents/grandparents/family friends that have questions.
I also have the pager. Ahh, the pager. The pager can and will go off at any point during the day. It is harsh and it makes my soul jump every time I hear it. I don't fear it as much as I did during the first 2 years of the job, when every patient encounter had me convinced that I was going to do something awful and destroy someone's life (I never did). But a call on the pager can be anything, including:
- A nurse with a patient update or question
- The ER with a consult on a pediatric patient
- The transfer center calling to connect me to a doctor from an outside hospital who has a patient they want to admit to us
- Call to go to a delivery for a baby they expect might need help after they're born
- One time, I got paged to a private number. It was a man looking for his wife to tell her he was on his way home from work. That was a wrong number.
- A lot of times, I get paged to three digit or five digit numbers (our extensions have 4 digits). Then it's like a mystery! Who called! I try calling all the numbers it could be until I find who it was. Or I ignore it, and wait for them to page me back. Depends on my mood.
This is where I hang out when I'm not on the Pediatrics floor, the ER, labor and delivery or post partum:
I think it used to be a closet. But, it has everything we need - desk, phone, computer, chair, bed, refrigerator, microwave and TV. No bathroom, though. Oh how I cursed that fact while I was pregnant!
I'm here for 24 hours. Sometimes I get a full night's sleep, sometimes I get 2 hours of sleep. It depends on the time of year, luck, and tidal forces, I guess. And maybe, just maybe, the particular socks that I chose to wear that day. Not that I'm superstitious...
So, that's sums up my day. Pretty glamorous, right? Hmm. Okay, so not super exciting, but I love it. Six years here, and I still am happy to come to work most of the time. I get excited with some of the crazy diagnoses we see, and I love the challenge. I have great interactions with some families. And while I respect, appreciate and like my colleagues, I don't actually see a lot of them - only at the beginning and end of each shift. I work much more closely with the nurses, who are absolutely a highlight of my job.
If you actually read all the way through this, here is your reward: pictures of the kids. They're my other job, that I do the 23 days of the month that I'm not here!
