A Day in the Life

Day in the Life of a PGY-1 Resident at Henry Ford Hospital
Bella Khatib-Shahidi

• 5:30 am: Beep… Beep… Beep… Time to wake up and start the day, bright (or should I say dark) and early! I get ready, grab a quick bite, and pour my first coffee of the day. I should mention, it is the first of many.
• 6:20 am: To the floors! I like to get to the hospital a little early to pre-chart on my patients. I review overnight vitals, new notes, lab results, and any events from the night. Before long, the overnight resident arrives to sign out the patients under our care.
• 7:00 - 8:00 am: Pre-rounds: time to see my patients. After reviewing each chart, I stop by every room, perform focused exams, and gather important updates. With any extra time left, I’ll head back to the workroom to build on my notes.
• 8:00 - 8:30 am: Drop everything, it’s Morning Report! Twice a week (Tuesdays and Fridays), residents from the floor teams and specialty services come together. We work through an interesting case and discuss the final diagnosis. It’s usually resident-led, making it one of the most meaningful peer-to-peer learning sessions of the week.
• 8:30 - 11:00 am: Back to the floors! I chug my coffee before beginning rounds with the teaching attending. We discuss each patient outside the room, then head inside together to examine them and finalize the plan for the day.
• 11:00 am - 12:00 pm: Orders. Updates. RTL. Repeat. While the senior and attending multidisciplinary rounds, for us PGY-1s, it’s go-time. This is when we update care plans, place orders, follow up on consults, prioritize discharge, finish notes, and “run the list” (RTL) to make sure nothing has slipped through.
• 12:15 - 1:00 pm: Lunch… and learn! Noon conference is hosted by our faculty and chief residents. Food is provided, and I get to see my co-intern friends. As we chow down on some of Detroit’s popular cuisines (Thai and shawarma days are undefeated), we learn about practical topics that make us better physicians.
• 1:00 pm: Coffee, round two. I run to PJs (Papa Joes) with a friend and grab my second coffee of the day. If I'm on call, I might recruit a Celsius for backup. Then back to the floors.
• 1:15 - 4:00 pm: Back to work! This is the time to complete any remaining work for the day. This can include managing the floor, coordinating discharges, collaborating with case management, admitting new patients, and making sure everything is ready for the evening.
• 4:00 pm: Call vs. Not on Call: If all is sorted out and I'm not on call, then I sign out my patients to the evening team and head home. If I am on call, I receive sign-out from the day teams and begin covering the entire floor.
• 4:30 pm: "ATTENTION: CODE BLUE!" Nothing gets your heart rate up faster. My senior takes off, and I’m right behind as we rush to the code. (And yes… if you're on call, this can happen at any time during your shift!).
• 4:50 pm: Once the code is over, it’s back to the workroom. The rest of the evening might include admissions, rapid responses, cross-cover pages, floor management, or finishing up anything that still needs attention.
• 8:00 pm: If all is squared away, I sign out to the overnight resident and head home.
• Evening: Recharge! After work, I like to unwind by catching up with friends, getting in a workout, or decompressing with a show. If I get home early enough, I usually have a couple of hours to relax before doing it all again tomorrow.

Day in the Life of a PGY-2 Resident in the Medical ICU at Henry Ford Hospital
Sadie Knill

• 6:30 am: Arrive to the MICU for sign out from the night resident, split the list with your team, and look over your assigned patients for the day (usually between 3-5 patients). The team consists of a few residents and 1-2 APPs who help the day run smoothly! The team changes on a daily basis depending on who's off/on nights.\
• 6:45 - 7:30 am: Chart review your patients and start their notes. It takes some time, but once you find a good method for pre-rounding, you can turn your brain on auto-pilot and go through the data/make adjustments.
• 7:30 - 8 am: Go around and examine your patients at the bedside. It's important to do a thorough physical exam but to also note all of their access sites, lines, drips (and their rates), and ventilator (checking their pressures and vent settings but being sure never to adjust them without the fellow/RT present). I always make it a point to touch base with the patient's nurse to see if there's any urgent orders needed and RT to discuss the respiratory plan for the patient that day.
• 8 - 8:30 am: Weekdays include a morning lecture in the conference room by attendings or other important MICU staff members and are pertinent to everyday things we encounter in the unit.
• 8:30 - 11:30 am: Bedside rounds start. We always start with the overnight admissions from the night resident and then complete the remainder of the pod. On rounds we always have our attending, fellow, someone putting in orders, the patient's respective nurse, and a pharmacist present to offer another important perspective. We discuss patients from head to toe and look at their ventilators together. Attendings also like to incorporate teaching points into rounds based on the cases that we discuss.
• After rounds: Reach out to consultants and finish progress notes and find some food for lunch! We are encouraged to stay for the IM resident noon conference for additional teaching and catered lunch.
• 2 - 3 pm: Attendings return around this time to run the list in the afternoon and tie up any loose ends and supervise any outstanding procedures. Depending on the attending you are rounding with they have their own special areas of interest whether it be POCUS, procedures, or certain pathology.
• 3 - 4 pm: Update families and double check all appropriate orders are in place for the evening. Update the hand off tool for our colleagues who will be staying later that day/the resident who will be caring for the patient overnight. Planning ahead can make a busy night a little bit easier.
• 4 pm: If all work is done, this is the time we sign out to the resident staying on call. We provide a brief overview and discuss outstanding tests and things to follow up on in addition to contingency planning. You can then head home to rest, relax, and try to maintain some balance on a busy rotation! The MICU can be intimidating, but you have lots of support and those around you are extremely knowledgeable. You grow really close to your team over the span of a month and will enjoy the chaos!
• APPs usually sign out later in the afternoon, and the night resident comes in at 8pm. The "on call" resident(s) is in charge of admissions until 8pm (day time residents who are not on call try to help each other out by taking earlier admissions). You always staff the admission with the fellow on call and the attending who is covering at that time.

Day in the Life of a PGY-2 Resident on Night Float at Henry Ford Hospital
Dennis Boynton

• 5:30 - 8 pm: Time to wake up! I try to get up a little earlier than most on nights because it’s the time I get to spend with my partner and our dog, Iggy! I have a light “breakfast” and then head out to work! The drive to the hospital is quite nice on nights because there is hardly any traffic.
• 8 - 8:30 pm: Time for sign-out from the day team. I print my list off and take notes as the day team tells me about what transpired through the day and who I might need to look out for through the night. I also start my check list on things I need to do/check in on for the day team. Sign-out concludes, the day team heads home to get some sleep, and now I’m here to hold down the fort through the night.
• 8:30 - 10pm: I use this time to make my rounds on the floor, introduce myself to all of the nurses working tonight and we work together to troubleshoot/anticipate any problems that may come up throughout the night. I find that it’s helpful to do this because it sets a positive tone for the night with the whole team!
• 10 pm - 12 am: Usually this is when the first admissions of the night will start to roll in. I put in orders, talk with patients and start a foundation for my H&P. Usually I’m being pulled in a few directions toward the start of my night, so I find that it’s helpful to have a page about which admissions are coming and a to-do list for each one. Having a standardized list about things you need to do ensures that nothing falls by the wayside.
• 12 - 2 am: This is a great time to review your patient’s night labs. Usually this is when we will order electrolyte replacement on patients who are not on our electrolyte protocol. I’ll head down to H1, which is one of our communal resident lounges, where many of the internal medicine residents will hang out at night. It’s so great to get to spend time with your co-residents. You can bounce ideas off of each other about complicated cases and usually make snack runs to the gas station (it’s a little convenience store right in the hospital that’s open pretty much 24/7)!
• 2 - 6:30 am: Depending on how busy your night is, you will continue to get admissions through 6:30AM. On slower nights, this is a great time to work on your notes and dive deeper into complex cases. If you’ve got time, some residents will use down time to get ahead on research projects or do practice questions.
• 6:30 - 10 am: The sun is rising and the day team is here, which means it’s the end of your shift! You give sign out to the day team and provide updates that happened throughout the night. After sign out, you have two hours before rounds start to polish up your notes or spend time with your co-residents. Oftentimes, we’ll meet up in the cafeteria and eat breakfast together; it’s a great time often accentuated with lots of laughs! Once 8:30 rolls around, the staff are great about night float presenting their patients first and getting you home! I also like to use time on rounds to discuss any issues that popped up throughout the night that I’d like the attending’s input on. After you’re done with rounds, it’s time to head out, get some sleep and rest up for another night

Day in the Life of a PGY-3 Resident at Henry Ford Hospital
Rohan Patel

• 5:30 am: Roll out of bed and take my dog out on a short walk. She’s an Australian Shephard so she needs her exercise!
• 5:45 - 6:30 am: Grab a quick shower and get ready for my day. I’ll usually also try to get some calories in me, whether that be a protein shake, a granola bar, or whatever else I have that’s easy. Then I head over to the hospital, I live close, so my commute is only 10 minutes, which is nice.
• 6:30 - 8 am: Get report from night float about overnight events, then turn on some music. Everyone on the team gets to pick the music one of the days per week, so we get a nice variety. Then we split up the list and start pre-charting. Before rounds we run the list, go over any patients the interns are confused about, and make sure all their plans are rock solid.
• 8 - 8:30 am: Head over to morning report if it's a Tuesday or Friday. While one of our illustrious colleagues presents a case, I get to enjoy a bagel and cup of fresh coffee to help me think through my differentials. This is one of the most fun parts of the week, and I love the opportunity to discuss difficult cases with my friends and get their takes.
• 8:30 - 11 am: Time for rounds! First night float will present their overnight patients so we can get them out of here as soon as possible. Then the interns will formally present their patients to the staff (and I guess me too!). We typically have pretty big teams consisting of a staff, senior, 3 interns, 1 sub I, and 2-3 M3s. Sometimes we also have a pharmacy student join us. This leads to lots of great discussion and super fun because I get to teach if there is something pertinent on a patient. During rounds I will also put in orders and send any urgent messages to consultants that are needed.
• 11 - 11:30 am: Head over to collaborative rounds. Both the floor seniors will sit down with the case manager and the nursing staff and will discuss disposition and patient needs. Nursing concerns are also addressed.
• 11:30am - 12 pm: Come back from collabs and give my team any updates from what was discussed. We will also run the list again to make sure everyone is on the same page and discuss any updated consultant recommendations. We can also start getting any patients ready for discharge teed up.
• 12 - 1 pm: Time to go to lecture! We get food catered every weekday for lunch which is amazing. It’s a different meal every day so it doesn't get boring. Lecture could be on literally any topic so it keeps it interesting. Lectures are typically given by one of our senior staff members from any of the numerous specialties we have in the hospital from hepatology to transplant infectious disease.
• 1 - 1:45 pm: Run the list again, make sure everything we need to get ready for our discharges is done. If it’s a Tuesday (my clinic day) then I will sign out to my floor co senior about any things that need following up on and head up to clinic!
• 1:45 - 4:45 pm: Afternoon clinic! My preceptor is Dr. Moore (one of my favorite people in the hospital), and I get to work with him almost every week through continuity clinic. As a third year, our staff really try to build our independent clinical decision making. This means a lot of autonomy in our plans and follow ups for patients which is nice.
• 5:00 pm: Time to head home and take my dog for another walk!