A day in the life of a Kaweah Delta Anesthesiology resident
Intern Year:
Intern year is great! We typically rotate through Medicine, ICU, General/Trauma
Surgery, Vascular Surgery, Neurosurgery, Emergency medicine, Neurology,
and Ultrasound. Days usually start between 6-7am, and the hourly schedule
varies greatly between rotations. Mornings may be spent rounding, admitting
patients, seeing consults, and any other activity of interest. Attendings
for our off-service rotations are welcoming and truly tailor our rotations
to Anesthesiology. Additionally, we feel supported and protected by our
Anesthesia residency leadership. For example, clinic time was removed
from off-service rotations for Anesthesiology residents. Residents from
all programs work well together in a collegial manner, eat lunch together,
and socialize after work. Senior Surgery, EM, and Family Medicine residents
are supportive in our goals for each rotation. Our work environment gives
a feeling of togetherness rather than hierarchy. Our days usually finish
by 5pm, and we do not take call internship year. There is plenty of time
for learning, procedures, studying, and wellness outside of work. We finish
off intern year with an "Anesthesiology Bootcamp" that includes working
one-on-one with attendings and a robust lecture schedule to prepare us
for joining our Anesthesiology family as a CA-1 (PGY-2).
CA-1 Year:
A day in the life of a CA-1 varies considerably, depending on the rotation,
and on the day. One month it will be caring for a handful of very sick
patients in the ICU, another managing all of the patients in the PACU.
We also complete rotations in the pre-op clinic, obstetric and vascular
anesthesia, and ultrasound with emphasis on TEE. Most of our time, however,
is spent in the main OR, where we may be seeing cases from general surgery,
orthopedic surgery, hand surgery, ophthalmology, urology, gynecology,
neurosurgery, podiatry, trauma, or any combination of the above.
My day typically begins around 4:00AM, when I wake to the sound of my phone’s
alarm and frantically grope the top of my dresser in the dark to find
said alarm and make it stop. After catching up on the news of the past
day and responding to any new messages, I get dressed and spend a few
minutes with my cats. In my mind, I am a responsible doctor who understands
the importance of good nutrition... but usually a certain amount of gratuitous
laziness gets the better of me and I grab something more convenient than
healthy for breakfast on my way to work or at the hospital...
Most of the time, I try to arrive at the hospital by 5:30AM, change into
OR scrubs, and stuff the pockets of my jacket with essentials like clear
tape and alcohol swabs. I then go to my room, run diagnostics on my anesthesia
machine, gather my checklist of equipment, and prepare drugs for the first
case. Next, I introduce myself to my first patient, perform a focused
history and physical exam, and write a pre-op note. By now, it will be
almost 6:30AM, time for the morning conference. One of my colleagues or
I will present for half an hour on a drug or keyword with one or more
attendings present to add further insight to the discussion. We then go
to the morning huddle for brief departmental updates before starting the
day’s cases at 7:30AM.
Depending on the types of cases we are doing, we generally see three to
eight patients per day, with the last case wrapping up by 6:00PM. If we
are on call, once we finish our last scheduled case, we will start relieving
our colleagues to get them home, prioritizing the person who is on call
the following day. Once finished with these cases, we will eat, sleep,
and study whenever we can until morning, while responding to any critical
traumas that arrive in the ED and running any emergency cases that need
to go to the OR before morning.
If we are not on call, once we finish our day’s cases and are dismissed
home, we look up our cases for the following day, communicating our plans
and any concerns for each case with the attending with whom we will be
paired. After this, dinner, studying, exercise, and/or “me/family
time.” And then... bedtime and reset!
CA-2 Year:
The days of PGY-3 (CA-2) anesthesia residents are extremely diverse and
are rotation-dependent. Living beyond your comfort zone is a large requisite
of this year, as you will be asked to competently perform in many different
arenas. Adaptability and flexibility are characteristics that will be
highlighted this year and they also will cushion you from the natural
whiplash that accompanies transitioning between OB, acute pain, Difficult
airway, cardiac, chronic pain, CVICU, neuro, peds and the main OR. Most
rotations will be starting earlier than you are used to with Main OR.
Generally speaking, I set my alarm for 5:00 knowing that I will likely
snooze 2-3 times. Luckily, the hospital is only ten minutes from where
I live, as is generally the case all over this fine town, but we try to
arrive about ten minutes to 6:00. If you do this, you can start setting
up your rooms at 6:00AM and have time to interview your patients before
daily conference at 6:30. As you can tell the mornings are busy: you need
to set-up your case, interview your patient, go to conference from 6:30
to 7:00AM and submit a pre-op note before your patient goes back at 7:25
for a 7:30 case. There is little time to waste when you arrive. If we’re
on cardiac, or CVICU, push your whole schedule back an hour as you need
a good hour or longer to set up or pre-round, respectively. We can have
call up to 3 times per week with a post-call day per call shift. We’re
busy, there is no doubt about it. We can be asked to stay as late as 19:00
some days. We have the very accommodating option of signing up for “Late
Duty” when you’re in the main OR, which facilitates shorter
days for people who are not on-call. There’s a nice prize if you
accumulate three “Late Duties”, which is highly incentivizing
and representative of our faculty’s focus on our wellness. If you
are “pre-call”, it is our prerogative to get you out early,
so you can be well-rested for your call day. You’ll be expected
to call your attendings the night before when the cases are sent out.
Depending on the rotation, you may finish your clinical duties earlier,
but you are always expected to check in with the main OR at the end of
the day. Whether it is squeezing in epidurals between C-section cases,
or squeezing in a nerve block pre-operatively with everything else going
on in the morning, you are constantly moving.
From an academic standpoint, studying is done on your own time. The staff
have provided us with bound chapters from one textbook in order to be
able to study without the appearance of being distracted on a cell phone
or the computer, which once again is very thoughtful. We have daily conferences
every morning, and oral board prep every week for two hours with SIM lab
in the mix.
At some point you will be doing a 2-month pediatric rotation and a 1-month
chronic pain rotation in Fresno. We have housing that is 15 minutes from
Valley Children’s Hospital. The apartment is gated and spacious
even if two people are there together. There is a cleaning service available,
but they do clean prior to new people coming.
Prioritizing your physical fitness and mental wellness will be difficult,
but necessary and you have to find a convenient way to squeeze these things
in for yourselves. I have a nice running loop by my house, the gym is
less than five minutes away. I limit all workouts to 30 minutes and I
listen to Headspace before I go to sleep. These four years are hard on
your body and mind and you need to be constantly finding ways to expand
your mental bandwidth, so little things do not seem harder than they need
to be. If you have a family, you may need to alternate the days where
you do physical fitness and dedicated family time. If you have a hobby,
it may need to wait for the weekends, or post-call days. As far as food
goes, we have a stipend during the day and my life got way easier when
I invested in a prepared food service like Sun Basket or Blue Apron. The
fresh food of the Central Valley is very accessible at many of your local
grocery stores, and of course there is always delivery if you’re
short on time to cook. The CA-2 year is an increase in responsibility,
variety and requires precise time management. If you got in to Anesthesia
to work hard, you will not be disappointed. If you did not, this year
will surely push you.