A Day in the Life of Our Residents

COVID-Era Anesthesia

Marie Mayer, MD, CA2- Class of 2022

I wake up around 5am, am out of the house by 6am, and am at the hospital by 6:15am.  Usually my 7yo son wakes up before I leave, gives me a little sleepy hug, and then tries to scam some extra TV time out of me. When I get to the hospital, I change in the locker room and select my N95 and goggles for the day.  Sometimes, I've sent my old N95 out for cleaning, and sometimes I have an extra, already cleaned.  All of my patients should be COVID negative for their elective cases, and I double-check that before I start.  

I'm in my OR for the day by 6:30am, and sign into the morning didactic conference via zoom while setting up.  Greeting my patient at 7am, my attending and I talk over the plan if anything is different in the patient's history, and the case usually starts by 7:30am.  Sometimes, I check the white board on our website to see when I'll have a lunch break. I go to the resident lounge or cafeteria for lunch, depending on what I'm in the mood for, and then it's back to my OR.  If finish up my cases for the day early, I usually go to the lounge and play video games (ahem... I mean study), until 3:30pm.  

If I have a COVID positive or COVID unknown patient, I prepare my gown, N95 mask, and goggles.  I double-glove to intubate the patient- one set of gloves comes off to handle the ventilator.  Ten minutes have to go by after intubation before the doors of the OR can be opened or closed to allow for enough air exchange to clear out any possible viral particles.  These patients are always in a negative- pressure operating room.  I can choose to stay gowned or I can doff it without contaminating myself until the end of the case.  It’s hard to remember not to touch the outside of my N95 to adjust it, or to change gloves and alcohol-gel my hands after I do, but somehow I remember.  We had great training, and did enough practice beforehand that it is habit now.  I repeat everything for extubation, including the ten minutes of wait-time.  

At the end of my day, if I'm not on call, I'll check in with Dr. Sabnis in the main ORs at 3:30 to see if she needs help to finish out the day.  Either she won't need anything, or I'll quickly set up a trauma room for her.  If on call, I'll check the white board to see which cases to take over.  Call usually lasts anywhere from 5pm to 7pm depending on the number of emergent cases that come into the hospital during the day.  When I drop off my last patient in PACU, I send my N95 for cleaning.  I change before I go home to my family.  

PACU

Maura Crisafulli, DO, Chief Resident- Class of 2021

Welcome to a day in the Post-Anesthesia Care Unit (PACU), or less formally referred to as the recovery room. After surgery, most patients go to the PACU where they are eased into the first stages of post-operative care.  The nurses, surgical team, and I will treat pain, nausea, manage hemodynamics and fluid status, as well as any acute events that may occur in the immediate post-operative phase.

A day as the PACU resident starts at 11am which means I get to enjoy some extra sleep- which is wonderful! The late start also means I am lucky enough to catch some rays of sunshine on my way into the hospital (yes, the sun does shine sometimes in Rochester!)  Coming in around 10:45am, I change into scrubs and finish my coffee as I pickup the PACU phone and airway pager from the pain service. Throughout the day, I field calls from nurses in PACU about patient management and respond to urgent/emergent airways on the floor and in the ICU.

The red airway bag and glidescope live in the PACU and are readily available; they are the first thing I check in the morning! The airway bag has all of the equipment needed during a routine induction and intubation. In the evening, I pick up one more pager from the Acute Pain Service, and retrieve sign out information about the patients we will be taking care of. Around 7pm, I check in with the night attending, and based on how busy it is, I sign out the Airway and Pain pagers to the night time.

On Thursdays, the day starts a little earlier at 10am, as I come in to present a case at Chair rounds. During Chair rounds, I meet with the Chair or Vice-Chair of the Department, and some of my available co-residents to present and discuss an interesting patient taken care of in PACU earlier in the week. In the PACU, I have diagnosed and treated everything! Ranging from the dreaded corneal abrasion to acute MI's, venous air emboli, post-operative hemorrhage, respiratory failure, ordering Tylenol/ Zofran, you really get to see the whole spectrum during the week!  As I enter my final year of residency, I've come to really value chair rounds and this rotation. The PACU rotation gives you the chance to care for patients outside of the OR, as you would when you graduate to the attending level, as well as the ability to learn from the valued members of the department in a different context, gaining perspective on how they care for patients through the entire peri-operative course.

Transplant Anesthesia

Brett Normandin, MD, CA2- Class of 2022

Typically, the resident on their transplant rotation is assigned to any liver transplants, kidney transplants, or liver resections throughout the week. On a day with a living donor liver transplant, my day starts at 630am with a meeting to discuss the case. Included in the meeting are both surgeons (one for the recipient and one for the donor), the operating room staff for both ORs, and the anesthesia providers for both operating rooms. After the meeting, the anesthesia team for the donor takes the patient to the OR at 730am to begin the case. This allows me time to set up the OR for the recipient, discuss the case with the patient and their family, and take care of any last-minute details before I bring the recipient to the operating room. Once the surgical team from the donor’s room tells us to proceed, usually around 9am, I bring the recipient to the OR. Induction of anesthesia, intubation, and placement of two central lines, two arterial lines, and a rapid infusion catheter usually takes 45 minutes.

Throughout the case, I manage any issues that arise such as hemodynamic changes, coagulopathies, and anemia. During liver transplants, residents work one-on-one with an attending which allows for plenty of opportunities to discuss relevant topics. After the case is finished, we transport the patient to the ICU where the ICU team will continue to monitor the patient. Depending on how the case went, my day is usually finished around 830pm which allows me time to go home and relax with my girlfriend and husky.

Obstetric Anesthesia

Ming-Yun Tang, MD, Graduate- Class of 2019

Generally I wake up around 5:30am with the aim of being at the hospital by 6:30. It only takes me 5 minutes to drive to the hospital and another 10 minutes to get to the locker room to change into scrubs, so I have some time to slowly adjust to being awake. Once I get up to the labor deck, I take sign-out from the overnight resident and commiserate for a few minutes about how busy it was. Next, I check over the running epidurals and laboring patients on Epic, then round to make sure our patients have appropriate analgesic levels. Everyday is different up in ob land, so the rest of the morning is a mix of doing elective C-sections, managing epidural catheters, and waiting for the bells to ring. (Hold on.....Phew, not an ob stat!)

Once there's a break in the afternoon, I'll grab lunch and (hopefully) our workload will have slowed down. As long as there's time, the attending will give a lecture on the day's topic (there's assigned reading out of Chestnut's each day of the rotation for us to read and discuss). These are great times to talk about the basics of obstetric anesthesia as well as to answer questions, discuss the literature behind our everyday practices, and to explore new developments in the field. The rest of the day is spent prepping the patients for the next day, and at 4pm we sign out to the obstetric lates resident, who will in turn sign out to the night resident around midnight. (Although some days you'll get a late afternoon emergency c-section or epidural request!) Generally I'll try to do some reading once I get home, but otherwise my wife and I spend our time together watching our 5 month old son smile at us and drool!

Advanced Resident Spot

Rashad Sirafi, MD, CA2- Class of 2022

My experience as an advanced resident has been a truly positive one. Prior to coming to URMC, I spent a preliminary year in another program. My transition here was a relatively smooth one, made all the more easy by welcoming co-residents and attendings. I began my anesthesia orientation in July (traditionally along side an OMFS resident) which was organized by an attending and several senior residents. I received lectures from residents in all years and was able to work with them in the ORs in the early part of the orientation. Everyone was extremely welcoming and helpful; understanding that I was new many residents took a vested interest in helping me get quickly comfortable in the ORs and "catching-up" to speed with my co-residents who've had at least 3-4 months of experience in the ORs. My CA-1 co-residents were of great value because they could advise me on some of the common errors we make early on that soon become second-nature and we may not always remember to pass on to new orientees. After orientation and working in the ORs for a few weeks, I soon began taking call. And, soon after that, I began taking some subspecialty rotations within anesthesiology. A seemingly steep learning curve didn't necessarily always feel that way due to the continuous support of my colleagues, both residents and attendings. After 6-months, the gap between my CA-1 co-residents and I was much narrower, and by the end of the year it felt like I was at the same pace as my co-residents as we all got ready to embrace the new challenges of being CA-2 residents. 

Chronic Pain Clinic

Monica Brown-Ramos, MD, CBY- Class of 2024

I wake up at around 6:30 am and arrive to the Chronic Pain Clinic by 7:20 am. First, I check in with the attendings working that day to find out whether I am most needed on the clinic team or procedure team. Today, I’ll be on the clinic side in the morning and the procedure side in the afternoon- the best of both worlds! At 7:30 am we have chronic pain lectures, taught by either an attending, fellow, or resident. The excellent 30-minute presentation today was about neuropathic pain management. 

In the clinic, which opens at 8:00am, we see both new and established patients. We take detailed history on their pain and any treatments or diagnostic tests they’ve completed, perform a comprehensive physical exam, and then present to the attending. The attending reviews images with us and discusses important pharmacologic considerations for our treatment plans before going into the patient’s room and finishing the visit. Between visits, we put in orders and complete notes.

Lunch is around 12pm, and my first afternoon procedure is at 1pm. We do a number of procedures including epidural injections, radiofrequency ablations, sympathetic blocks, intraarticular and facet injections, spinal cord stimulator trials, and many more! The afternoon is spent completing the pre-procedure notes and assisting the fellow and attending during the procedure. The day flies by between the many procedures, and we are done at 4:30 pm! I check in with the clinic attendings to see if they need any more help.  Upon completion, I will get the green light to go home! 

When I get home, I catch up on reading about topics discussed during the day, and then spend the rest of the evening having dinner with my fiancé and going for a walk in our neighborhood. By the time 10pm rolls around, it’s time for bed, and I am ready for another day tomorrow!

Emergency Medicine

Eeshwar Chandrasekar, MD, MPH, CBY- class of 2024

Around 9:40pm, I’ll start walking to the hospital for the upcoming night shift in the Emergency Department (ED). I’ll be in the Acute Care 1 area by 10:00pm and will pull up eRecord to see the list of new patients. Chest pain, trauma, shortness of breath… you name it and you’ll see it in the ED. Starting residency in this setting has been very rewarding as a great way to meet residents across departments and to see diverse patient presentations. I’ll see my first patient, develop my plan, and find the attending to discuss the case together. I’ll then place the necessary orders (such as labs, medications, or imaging) and get started on the note. At 11:00pm, we’ll receive sign-out on patients from the evening team where I’ll usually hear from my co-resident, Vaughn. Soon after, I’ll check the list again to pick up a new patient and the process repeats. I’ll take up to 7 patients in a normal shift depending on the complexity of cases and the number of new patients. Along the way, I’ll make appropriate consults to specialty services, discharge patients home, or admit them to the hospital. Many times, patients will need procedures like suturing lacerations or ultrasound guided IV placement. I’ll be busy with managing patients throughout the night and before I know it, it’ll be 7:00am and the morning team will arrive. We’ll sign out patients to the new team and then I’ll wrap up my remaining notes. I’ll finally head home for the day around 8:00am to get some well-deserved rest.

Emergency Medicine

Vaughn Florian, MD, CBY- class of 2024

Over a span of 4 weeks, I’ll work a total of 17 shifts in the ED, averaging 4-5 shifts per week.  The schedule features a mix of days (7AM-4PM), evenings (2:30-11:30PM), and nights (10PM-7AM).  Of the three, evenings tend to be the busiest.  Occasionally, one of the senior residents or attendings will gather everyone to share a teaching case.  One such case focused on PE presenting with RUQ pain.  My very next shift, I encountered a patient presenting with chest pain due to symptomatic cholelithiasis, which reinforced the importance of clarifying the chief complaint and formulating a broad differential.  Sign-outs between shifts take place at 7AM, 3PM, and 11PM, and offer a great opportunity to catch up with my co-resident, Eeshwar.  We’ll talk about interesting cases we’ve seen, nerd out over anything anesthesia-related, and look back fondly on the night shift we worked together during eRecord downtime.​

Operating Room Orientation

Wenceslas Krakowiecki, MD, CA1- class of 2023

During my CBY year, a typical day during orientation for me started at 5:30 am. I woke up, had a hearty breakfast (typically corn flakes and a bagel), and then got ready for work. Leaving my apartment by 6 am, I was able to walk to work for 30mins. (I even did this in the winter!) While this was lengthy and time consuming by some standards, I found that it allowed me to wake up and get my thoughts and plans set up for the day. Upon arriving to the hospital I changed in the locker room, and then headed to my assigned OR to set up. There, I met up with my co-intern who I would be working with that week. The special part of OR Orientation is I had the opportunity to work directly with co-interns, which in anesthesia is extremely rare after orientation. Together, we did our machine checks, pulled up our drugs, and got ready for our cases. We would then saw our first patient of the day, got them ready for the OR, and met up with our attending to finalize plans. Most of the time, my co-intern and I traded who was “primary resident” every other patient so that we both had our fair share of the experience. During every case, the attending was in the room with us at all times which allowed us to deliver safe patient care and learn an incredible amount from someone with a vast wealth of knowledge. Being paired up with other interns allowed me to also from them, and them from me.

At 3:30 we were relieved from our OR to attend lectures until around 5 pm. After that, we looked at the cases assigned to the next day, prepped a battle plan, and ran it by the attending. Usually by 5:30 pm at the latest we were able to head home. For me, that involved another 30 min walk, but this one allowed me to cool down, and truly leave work behind when I returned home. After that, I had some down time and would study, hang out with friends, or play video games (my favorite!) Finally, I went to bed and did it all over again the next day!

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