A Day of a Senior Resident
Yu-Ting Chen (2015-2018)
Today is Thursday. You wake up at 6 a.m. You quickly brush your teeth, fix a sandwich, and get ready for a new day. 6:40 a.m., you park your car at Parking 2. You always park at the same spot so you can easily find your car when you go home. You walk into the hospital and pass by the cafeteria towards the new hospital elevator. You run into a MICU nurse in the hall way whom you worked with on your night float last year. The elevator is slow, and you finally arrive at H8.
You enter the resident work room, it’s 6:45 a.m. and there are four residents working in front of computers. One of them is the night float resident who is sending a checkout email to everyone. The other three residents are updating their general team, stroke/Neurocritical care team, and consult team list. After the night float resident sent the email, she gives oral checkout to other residents. It was a good night as only three new patients were admitted. After the checkout, the residents print out their patient lists and start seeing patients. You briefly review the lists and decide to go to ICU to make sure one of the stroke patients is stable.
It is 7:30 a.m., you start walking towards the spine building. You go to Lucy Library and download the PowerPoint file you made last night for the upcoming chairman round. It is 8:00 am, Dr. Archer, the department chair, is sitting in the first row. The room is full of residents and medical students, and you start the presentation. The case is about foot drop, and you have a very interesting discussion with the residents and students.
It is 9:30 a.m., you already came back to H8. You decide to round with general inpatient team today because they have more patients and some of them have interesting symptoms and neurological exam findings. When a student is presenting a patient who likely has Guillain-Barre syndrome, a nurse rushes into the room and tells you that a patient in the epilepsy monitoring unit just had a seizure. The patient is admitted for ictal-SPECT test, and the nuclear medicine student successfully injected the isotope in the beginning of the seizure. You assess the patient, who is post-ictal but stable. You call the on-call epileptologist, order the anti-epilepsy medication, and sent the patient for the SPECT scan.
It is 10:45 a.m., when you are about to go back to join the round with general team, the stroke pager beeps. The stroke patient is at the emergency department room 2. You immediately go down to the emergency room and the consult resident is already there evaluating the patient. It is not a straight forward case, but finally you decide that the patient is a candidate for tPA. You order the tPA and report to the stroke attending.
Now it is around noon, and you are back to Lucy Library for the noon lecture. You don’t need to waste your time because the department provides free lunch. Today’s topic is movement disorder phenomenology given by your program director, Dr. Lotia. The lecture ends at 1 pm. You feel you learned a lot and enjoyed a delicious meal.
You have resident continuity clinic in the afternoon, so you take the elevator to the second floor of the spine build and walk to the neurology clinic. On the television screen, it shows your first patient is in the exam room. You quickly review the chart and go see your patient. The patient presents with a first unprovoked seizure one month ago. You get a detailed history, perform thorough neurological exam on the patient, and leave the room to discuss the case with your attending. You and your attending go back to the exam room to discuss the management plan with the patient. You have six patients scheduled today, and five of them show up.
It is 4:30 p.m., and you just saw your last patient. You walk back to H8 work room. Residents have checked out to the short call resident at 4pm, but they are still in the room working on notes. You make sure everything has been taken care of, and then go home.
No, the day is not over yet. Tonight, you will finish writing your clinic notes, read on some diseases you saw today, and start preparing for your lecture next week. You will wake up tomorrow and may find yourself rounding with a stroke team followed by a quick session for the medical students and then reading up a review article on a newly approved MS drug. While there is some structure to the day, the unpredictability in the day brings the excitement for the day.
The Life of a Neurology Resident at UAMS
Eugene Achi (2011-2014)
Should one ask any of the neurology graduates of this institution what they loved about their program, the unanimous answer is sure to be, the unity of its members. I am a fourth year neurology resident on my way to a fellowship year elsewhere. Today, I look back at my four years with a sense of belonging, and a new set of eyes through which I now see clearly the true value of this program. Without further ado, allow me to tell you what I loved most about my neurology residency.
You might find yourself in the EMG lab for an elective your second or third year of neurology. Even though your first day is overwhelming, you are approached by your attending who benevolently volunteers herself for a nerve conduction study. As you ponder that thought, your amygdala is bathing in the delight of this amicable offer, but your frontal lobe is nagging worriedly about the fact that…you’re about to shock your own attending! It is your attending after all, and you do have a few more months you may have to endure as a resident. Au contraire. Such is the attitude our attendings carry with their residents, a friendly approach with a genuine interest in teaching. Indeed, while on EMG, you will perform nerve conduction studies, and eventually needle EMGs under their guidance, discuss each individual case, and practice critical thinking. Such an experience with EMG/NCS is rare for a resident, and is often limited to fellowship in other places.
You may find yourself on call, or on night float, overwhelmed by your work and running behind. Help is only a phone call away. You can be certain that the back-up resident will be by your side, no questions asked, and their last question before returning home will be, “is there anything else I could do to help?” You may then find your thoughts challenged by doubts and in search for guidance late in the night. Fortunately, your attending is also a phone call away. Never will your call be met with anything but kindness and advice, that is once they have exited the deep sleep stage…
Down the road, you may finally find yourself the senior resident on service. The end of the residency track appears like the flickering light of a distant train at the end of a tunnel. You lead your fellow residents by example; you help with discharge summaries, challenging spinal taps, reexamine difficult patients, and teach the medical students. Suddenly, when it is time to round, your attending kindly offers you to lead rounds! As you hesitantly lead the team from room to room, slowly but surely, the culmination of your hard work begins to take shape, and you realize your accomplishments.
Such is the neurology residency at UAMS.
I guarantee you it will not be easy, but I also assure you that you will never find yourself wanting, in help, in guidance, or in kindness. The group you work with will soon become your best friends, and your family, and the hard work will quickly turn into an enjoyable and memorable experience.
A Day in the Life of a Neurology Resident
Nabeel M (2013-2016)
5:00 a.m.: The alarm on my cell phone goes off, I hit the snooze button a couple of times and then I get up. I get ready and try to look as sharp as I can.
6: 10 a.m.: Arrive at work, grab a coffee and set myself up on a computer in the resident workroom on the 8th floor of the hospital which is the Neurology/Neurosurgery floor. Depending on the service I’m on, general inpatient or stroke or consults, I look under the shared lists in the EMR to see how many new patients have been admitted overnight. As I am on the stroke team I will go over the patients’ information and also follow up on the vitals, labs and imaging of the prior admissions. There is a new patient admitted after tPA from OSH in the ICU, so I review his chart and get ready to go down there to perform a follow up NIHSS on him and to pre-round on my other patients. The new post tPA patient has a left MCA stroke and is stable. At 6:45 AM I meet up with the chief on service (a PGY4 resident), the residents from the general and the consult team and the night call resident to discuss the new admissions and the major events from last night. The chief on service will then usually go over the plan for the new patients and the things that need to be followed up. They, he or she will decide to assist the resident who had the most admissions overnight. Afterwards I continue with my pre-rounding.
8:00 a.m.: I meet up with the attending in the Neuroradiology Reading Room so that we can go over any new images that were done for the patients. Afterwards we start rounding, checking NIHSS, doing thorough neurological exams and going over every minute detail of the patient’s stroke risk factor management as many of these patients are sick. We are done with the rounds around 11:30 AM and then it is time to head to the Spine Center for the daily didactics from 12-1 PM. Lunch is provided in the conference. On Wednesday we have Chairman’s Rounds from 8-8:30 AM where we discuss any interesting case that is on service or was seen recently and all the residents are encouraged to ask questions about the history and exam. Also to provide localization, differential diagnosis and suggest appropriate tests and, if time permits. then a general discussion is done about the case. On Friday there are Grand Rounds from 8-9 AM where a speaker will give a detailed talk on any particular topic e.g. Advances in Multiple Sclerosis Treatment.
1:15 p.m.: We meet back in the resident room on H8 and go over the orders or consults that need to be placed for the day (urgent orders are placed during rounds using a computer on wheels). Then the chief on service will go over the plan for every patient with the specific team. Later, it is time to sit down and start typing up the notes for the patients for the day and follow up on the results as they keep popping up.
Around 3 p.m.: I get a call from the ICU that the new stroke patient’s exam has worsened. I rush to the ICU to see and examine him and his exam is worse than before. A CT head is repeated and showed a small bleed consistent with a hemorrhagic transformation, so after discussion with the attending I started him on aggressive blood pressure control.
Now it is 4:00 p.m.: Getting close to that time of the day where I wind up my notes, recheck on the consult and labs results and place orders accordingly, I start working on my checkout list and update it and print it out. At that same time one more time we go over with the chief on service about the plans of the different patients. At 4:45 PM the short call resident is here and we give check out and then head out at 5:00 PM. I call my wife and ask her what she wants for dinner. Most days I can get in an hour of exercise in the gym or go running with my buddy from ER medicine down near the beautiful Big Dam Bridge before dinner. Some days whenever I can I try to get in some sessions on jamming on my guitar.
At home after dinner we watch some TV and then I read about the different cases that I saw today or have seen in the week. I hit the bed around 10:00 p.m. and will see y’all tomorrow.