Day in the Life of an Emergency Medicine Resident

Written by Puja Singh, MD

5:45 am- DING DING!!! Time to go!

5:45-6:00 am- snooze until… DING DING, now it’s time to go!

45 minutes to eat, get ready and get downstairs to the jitney (the shuttle that our program has to take residents from our housing to the hospital)

But first coffee!

6:45 am- on the jitney- time for some pump-up music!

7:00 am- Morning report. A small topic/case was reviewed by a PGY3 for about 15 minutes. Time to sit, wake up, enjoy some (more) coffee and learn.

7:15 am-12:00pm - Up and at 'em! I put on my scrub cap, Patagonia, stethoscope and holder, my N95 and surgical masks, and my eye protection goggles. I get out a pen, a pulse ox, my EMRA notebook, shears, and a water bottle and we are ready to doctor!

(the rest of this schedule is made up and variable for each shift since patients in the ED are undifferentiated, unscheduled, and traumas and resuscitations patients come in at any given time and take priority. At my program, the PGY1 is in charge of attaining IV/IO access for every trauma, PGY2 is airway, PGY3 is leading.)

You enter the organized chaos of the emergency department. Patients in the hallways, monitors beeping, consultants consulting. Some patients are happy, others disappointed, frustrated, anxious. Scared.

I log onto EPIC, our EMR, and look at the board. I receive any signouts to relieve the person coming off shift and make sure they catch the jitney on time to go back home. Next, I sign-up for a new patient and get ready to meet some people! First, I go meet the patients that were signed out to me to introduce myself and update them with any news.

For the next 3 hours, I see patient after patient- some COVID/URI, some chest pain, shortness of breath, abdominal pain, vaginal bleeding, and headache, among many others.

I present to my PGY3 senior, tell them my plan, put in my orders, and move on to the next one. Between each new patient, I quickly run my list of patients in my head- checking for any new labs or data that might have resulted and thinking of any change in plan or next steps for my patients.

Somewhere in between I briefly look at how many patients are in the ED.

For many of my patients, I am COVID swabbing them, starting their IVs, drawing all their labs and blood cultures, and walking or pushing them to XRAY/CT scan. I discuss with the nurses to communicate and update them.

12 pm- I hear “Red team resus, repeat, red team resus”. I drop whatever I am doing and run to the resuscitation bay. I put on a blue gown, an added layer of PPE, and start to collect all the tools I need to attain IV access for this new patient- the IVs, the tubes, the blood cultures tubes, the tubing, IV starter kit, and some flushes. Pockets and hands filled, I rush to the bedside and start examining the patient’s arms for any clear and obvious access sites. Simultaneously, EMS is rolling the patient onto the bed, giving the story to everyone in the room, the PGY2 is behind the patient’s head on airway, and the PGY3 at the head of the bed preparing to take over.

“Small poke okay”- I explain to the patient who is barely awake with her eyes closed.

IV inserted. Labs drawn.

I roll over the ultrasound since the patient is here for undifferentiated hypotension and altered mental status. I do a quick RUSH exam and find that there is some fluid in her right upper quadrant and quickly tell the room. All of a sudden I hear “traumatic cardiac arrest arrival time 2 minutes”. Half the people in the first resus room leave and go to the second room, including myself.

Everyone sets up the room with airway tools, AED, epinephrine, amiodarone, CPR backboard, labs and tubes for IV access, central line kit, and ultrasound. EMS rolls in the patient while simultaneously explaining the story and doing CPR. PGY3 takes over and we do a brief pulse check and start running the code. I step in for compressions while every other person in the room has a vital and defined role.

Fast forward, after coding the patient for 45 minutes, drenched in sweat and tears we were unable to revive him. Multiple rounds of CPR, epinephrine, amiodarone, calcium, using the ultrasound to check for cardiac activity, intubating, and inserting a crash femoral central line, were not able to restart his heart.

A moment of silence. My eyes well up with tears. I swallow them and take a deep breath. I pop over to the next resus room to check on the previous patient and they are gone- up to the OR with the remaining blood and plastic on the floor. A scene straight out of a Grey’s Anatomy episode.

Time to get back to work.

3 pm- I go check up on my patients, discharge/admit people, look at labs/imaging and update my attending and PGY3.

3:30 pm- break time. At my program, every PGY1 gets a 45-minute break during every 12-hour shift. I go to the breakroom, eat, digest what just happened and try to decompress.

4:15 pm- back at it! I sign-up for another patient. They are here for alcohol intoxication. I see them, examine them, speak to them, and get them some food and water.

5:30 pm- a nurse tells me the intoxicated patient fell on the floor while trying to walk to the bathroom. I ask a person to help me and run over to examine him. At first glance, he seems fine so we see if he can get up and back into the bed.

6 pm- I sign up for 1-2 more patients before I start trying to tie up any loose ends before I sign out at 7 pm. I go over return precautions with patients I discharge. I educate patients on various resources they can use. I explain what medications to take and how. I give patients their discharge paperwork and see them off. Then I sign-out a few patients to the medical team, as they were being admitted.

7 pm- time to sign out and catch the jitney!

On the jitney home, I listen to a podcast about one thing I learned today and then listen to some music the rest of the way with my eyes closed. I am tired. It was a long day.

It was sad, emotional, exciting, an adrenaline rush, heartbreaking, and gratifying. So many emotions and thoughts. So much to learn.

But before I step into my apartment, I remind myself, I GOT to be a doctor today! I GOT to help some people! I smile to myself and turn my keys to open the door.