06:45-07:00 - Arrive early to check on your patients.
07:00-08:00 - Morning "sign-out": Listen in as the night residents give their patients to the day residents and then continue checking on your patients.
08:00-08:45 - Morning conference: Gather with the all the residents in pediatrics to go over some practice board-style questions and then work through the stories of 1-2 current interesting patients as a group to see where we've gone right and wrong with their treatment thus far.
08:45-09:15 - Try to finish up any research you need to do on your patients before rounds begin.
09:15-12:00 - Morning rounds: The entire team (usually one attending, one senior resident, one second year resident, two interns, one sub-intern, three medical students) goes from room to room around the hospital to see each of our patients. The treating nurse, parent and patient are all invited to participate. The least senior team member following the patient presents the case to the attending. Depending on the attending, this can be a pleasant learning experience of a humiliating pimp-session. This is, by far, the most nerve-wracking thing we do on a day-to-day basis.
12:00-13:00 - Noon conference: We each lunch with all the pediatric residents and med students while listening to a lecture on some topic.
13:00-16:00 - Write progress and/or discharge notes on our patients. We can't sign the notes (electronically) until the resident supervising us reads through the note and writes an addendum documenting their approval.
16:00-17:00 (or later!) - Wait around until you've finished your notes and been given permission to leave.
At the moment, I'm on the subspecialty team as opposed to the general pediatrics team. This means that we get interesting patients, but our day is a little more chaotic because instead of having one general pediatric attending physician to travel around with during rounds, we have half a dozen depending on which specialties are responsible for our patients. The big ones seem to be pulmonology, neurology, GI and adolescent med. So each day we need to coordinate with all of these specialists to see when they will be ready to lead our herd of doctor-y people around the hospital.
Day one was pretty nerve wracking but, by day two, I feel like I've got a handle on what is expected of me. Pretty fun, if a bit tiring.
MondayIL: Chronic right middle lobe atelectasis (aka right middle lobe syndrome) is the damage or partial collapse of only the middle lobe of the right lung. This lobe is particularly prone to collapse because of its relatively narrow branch point and because it is surrounded by lymph nodes. Mucous, inflammation, cancer, or lymphadenopathy can all restrict that narrow opening. Or, even without touching the opening, the encompassing lymph nodes can all become inflamed and collapse the lung on their own.
TIL: Always have a replacement tracheotomy tube (a tube that passes through a hole in the throat allowing air into the lungs, usually to bypass some blockage of the airway in the mouth or upper throat) at the bedside in case of emergencies.
Also, a common problem with asthmatic young children is getting them to sit still long enough to get a nebulizer treatment. Sometimes they get upset and start crying and parents/nurses/doctors will say, "At least we know that they're getting the medication every time the breathe in while crying!" This is not true. The breathing you do while violently crying is very different from the kind you do while calm. The turbulent airflow causes most of the aerosolized medication to get stuck on the patient's tongue or throat rather than getting into the lungs where they actually work.
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