A Day in the Life

A Day in the Life of an OB-GYN PGY1

5:20 am: I usually get up a few minutes before my 5:30 alarm. Henry Ford Macomb is in a great central location, not too far from a major city, but far enough away that you don’t have to deal with the typical morning rush hour, depending on where you live. I’m out my door by 5:35, caffeine in hand, and with my drive only being about 8 minutes I know I can make it to the hospital with plenty of time to change into my scrubs and get ready for morning rounds.

5:50 am: Scrubs on and phone ready to go. I find my upper level resident whose been on nights and will usually be assigned 1-3 post-partum patients that need to be seen this morning. I make my way to each room making sure mom, but also baby, did well overnight. With all my rounding information collected, I can make my way back to the residents lounge and start my morning rounding notes in Epic. I take a few minutes after my rounding notes to lookup some info on our laboring patients on the floor. By 6:30 the rest of the L&D team has arrived and we are all ready for morning sign out!

6:30 am – 8:00 am: Morning sign out is efficient and quick, I jot down notes on our laboring patients and try to keep mental notes of the urgent matters that need to be taken care of after sign out. When sign out finishes I hit the floor with both my upper level and senior resident. We go up front to our nurses’ station and check our log of inductions and scheduled c-sections to see what is coming in for the day.

8:00 am – 12:00 am: With our morning responsibilities divided up I go about seeing the patients coming in that morning for scheduled procedures. Today there is a patient coming in for a scheduled primary c-section. I wheel our bedside ultrasound to our patient’s room to assess for fetal position, weight, and fluid volume. We go over a quick history, get consent forms signed, and go over any last-minute questions or concerns. The patient is wheeled back to one of our section rooms. Baby is out, a vigorous crier, overhead a familiar chime rings as another happy and healthy baby is delivered. Something I truly appreciate about our program is the responsibility and autonomy given to you even in the first month on Labor and Delivery. As an intern you will get to do all the primary c-sections that come in. The days of only ever getting to retract and cut suture are finally over!

1:00 pm – 4:30 pm: The afternoon is a time to make sure all the things on the floor are running smoothly. Patients here in labor need to be checked, they may need to have their water broken, an IUPC or scalp lead may need to be placed to help us monitor babies more closely. Notes and orders are put in and depending on the day a ton of babies are born!
If it’s a Monday this is the day we have protected time for education every week. Usually three to four of the residents have assigned readings or questions which are presented to the group. Our program director Dr. Ludwig is with us every Monday to keep our didactics running smoothly. His continued involvement is one of the reasons I chose to come here for residency.

5:00 pm – 6:00 pm: 5 PM is here, our night team has arrived to take over for the day team. GYN team signs out first and then OB. As the intern I’ve done my best to keep organized notes throughout the day so I can make sign out as smooth as possible. After sign out we all get out of our scrubs and walk down together to the parking lot. Another day on labor and delivery has come to an end. Even though it’s been a busy day I know I made the right specialty and program choice.

6:20 pm – 10: pm: It takes me a little bit longer to get home in the evenings, but I make it back relatively quickly. The first thing I do is get my bag off and take my puppy out! We have someone come during the day to let him out but he’s still so excited to have someone back home again. We run outside until he burns off some of that energy. The rest of the night is filled with cooking dinner with my girlfriend and relaxing, usually with the latest Netflix show or movie. By 9:30 or 10:00 the whole crew is wiped out for the day and usually when I’ll try to get some sleep. I want to be well rested for another day on L&D!

A Day in the Life of an OB-GYN PGY2

3:30 pm: Alarm goes off, time for another night of solo nights! Sign out from the day team happens at 5pm and this is enough time for me to be sure to have one more snooze, take a shower and pack my lunch before heading into the hospital.

4:40pm: arrive to the hospital, COVID screen with temperature taken, good to go

5:00pm: GYN team is ready to sign out the postoperative patients from the day, and any patients that were admitted to the hospital from a consult

5:20 pm: OB team signs out all of the postpartum, active laboring or induction of labor and triage patients to me

6:00 pm: Assess the current laboring patients. Check the patient’s cervix to see her progress and monitor her pain. Always need to keep an eye on the fetal heart tones

6:48 pm: Get called to a laboring patient room since she is feeling lots of pressure! vaginal delivery! Happy birthday!

7:00 pm: Shift change for nurses

7:13 pm: Another vaginal delivery, pushed through 2 contractions and baby is here!

8:00 pm: At this time there is typically an induction of labor patients that comes in. Typically patients coming in for an overnight induction have an unfavorable cervix, I get to discuss a plan with the attending on how to go about labor induction.

8:00 pm -12:00 am: during this time you are managing laboring patients, induction of labor patients, and all triage. Hopefully during this time you get to deliver a laboring patient's baby. There seems to always be someone each night who suspects their water broke during these hours as well. Also there will be a nauseous post-op patient who requests zofran

8:00 pm: 25 wk patient sent to the L&D for rule out rupture of membranes. After a speculum exam checking for pooling, nitrazine test and ferning, she is found to not be ruptured!

9:30 pm: Check up on a postoperative patient and make sure she is recovering well

10:30 pm: ER calls to consult for hyperemesis gravidarum, go down and evaluate and admit patient.

11:30 pm: Grab some snacks!

12:00 am: Catch up on notes piling up including progress notes from checks, h&p’s from triage patients, delivery notes from the deliveries and consult notes from ED consults. Documentation is very important in all aspects of medicine. If you didn’t document it, it didn’t happen.

1:00 am: Round on all postpartum mothers on our floor and those who have also migrated to unit 28, our women and children’s unit. For post op c-section patients take off their bandage and assess the incision. Good thing the babies are keeping mom up late so you don’t have to wake them up to round!

1:30 am: Note writing with a warm blanket

2:50 am: ED consult for retained products of conception.

3:15 am: Evaluate ED consult with pelvic exam

4:30 am: Manage OB triage, likely a patient with complaints of contractions who thinks she is in labor

5:00 am: Artificial rupture of membranes for an induction of labor

5:15 am: Tidy up charts, get things ready for sign out. Review patient vital signs

6:00 am: The intern on OB days arrives to round on two postpartum patients

6:30 am: Sign out to GYN team, then sign out to OB team

A Day in the Life of an OB-GYN PGY3

The other Obstetric and Gynecology resident bio’s will take you through a day in the life of our typical services. So I will take you through the adventure that is (cue dramatic music) - the 24-hr shift. As a third year, we still cover 24-hours shifts, though during this year we transition to a training roll for our interns.

On the day of my shift, I wake up awash in the glow of a Saturday morning; I get ready and grab an iced coffee on my way to the hospital (even during the Michigan winter, because why not). I arrive at the hospital at 8 am for morning sign-out from the night-shift residents who are eager to start their weekend. On weekends, the incoming 24-hour resident covers both the labor and delivery floor as well as the gynecology service and thus gets sign-out on both. I am handed the service phone and the shift has officially begun.

The incoming attending is present for sign-out as well and discusses the patients and the plan for the morning. This usually consists of discharging patients, introducing myself to and updating the laboring patients, and the circumcisions. And I know what you’re thinking, “Yes! A procedure right off the bat!” You would be correct; you will get so many circumcisions your first year you will be an expert, and as a third year you get to use your expertise to train the new interns.

24-hour shifts have an aura about them. Just like any other service, there is a significant amount of superstition about discussing how “quiet” or “busy” it is; that this behavior could somehow bring in more patients. These shifts can be a good time to catch up on educational work and reading, or they can be what I refer to as, “extreme learning opportunities”. Labor and delivery is like that sometimes (who am I kidding - most times!) - but that’s why we love it! You never know what is coming in - a patient who is crowning in the ambulance as she rolls up to the hospital; vertex/vertex twins and you are the only one around so the delivery is yours; a breech extraction with a weathered attending who is game to go for it; an emergent c-section where the patient is looking to you for comfort and reassurance. The 24-hour shift gives you the opportunity to test your knowledge, test your skills, and stretch your time management abilities. The gynecology service can be just as exciting, ranging from simple consults that allow excellent opportunities to counsel patients to emergent surgeries which lead to excitement in the OR for ruptured ectopic pregnancies and ovarian torsions.

Eventually evening falls and the nurses begin one of my favorite past times on the floor - discussing from where we are going to order dinner. There are many good eateries nearby, and the nurses are kind to include us. Nighttime also brings with it the desire to do what most OB/Gyn residents only dream of (or not - because we don’t really close our eyes) - sleep. I find that there are times when I can rest; but this often invites that familiar female voice from our paging system saying, “Halo- secure message” - another gynecology consult, another opportunity to test my skills and knowledge. The evening might also include the arrival of scheduled labor inductions which allow us to counsel patients as well as practice our ultrasound skills (as we get an ultrasound on every patient who comes through the L&D doors for an EFW and AFI).

Sooner or later, the sun begins rise on another beautiful Michigan morning. I finish rounding on my patients, I finish typing my notes from the consultations and triages from overnight, and I prepare for sign-out to the oncoming teams. The medical students and interns arrive first and we discuss the shift and interesting patients and events. The other residents arrive soon after; I sign out the services. No matter how many I do, there is always a strong sense of accomplishment after a 24-hr shift. A feeling of going 90 miles an hour, then suddenly you hand off the service phone - and you’re done. You survived, you learned something new, and you gained new skills. I drive home to enjoy my post-call day of napping and another iced coffee (or two).

A Day in the Life of an OB-GYN PGY4

5:10 am: My alarm clock sounds, but I typically allow for at least one snooze. Twenty minutes is all it takes to get myself ready and fill up my thermos with coffee. My drive in is longer than most of my co-residents, but I tend to enjoy the 35-minute commute because the roads are pretty empty. Occasionally, I’ll listen to OBGYN podcasts on the drive, “CREOGs Over Coffee” is one of my favorites.

6:15 am: I pull into the parking lot and walk into the building to the Labor and Delivery unit. Five minutes later, I find a clean pair of scrubs and get ready to start my day. I print off a list and fold my paper perfectly to make organized space for all the new patients I presume will come in.

6:30 am: Morning sign out. The night team has finished their shift and is ready to sign out to the respective OB and GYN services. If you’re on OB, you’re likely to have scheduled C-sections and inductions. If you’re on GYN, there’s typically a wide variety of cases filling up your day.

7:30 am: Scheduled C-section and induction patients are getting admitted and ready to be seen. Between ultrasounds and cervical exam checks, there’s typically quite a bit to follow up on and communicate with the daytime providers if you’re the OB resident. If you’re the GYN resident, scheduled GYN cases begin promptly at 7:30 to ensure that all of the operating rooms run on time. Being efficient with your time is vital to be a successful OBGYN resident.

8 am, 10 am, 12 pm: These time slots are classically reserved for scheduled C-sections. You will surely be well-trained among the variety of surgical techniques taught at this training program. I was well over my required number of C-sections to graduate before finishing my second year of residency. And let’s not forget about operative deliveries; our program has multiple providers that perform forceps-assisted operative deliveries. You will be very comfortable applying and using forceps, whenever necessary in your future practice. Operative deliveries are one of our strengths, in addition to the vast variety of training techniques.

8 am-12 pm: If you’re on GYN, you’re typically in the OR participating in a wide array of surgical cases. Some minors, some majors, some even with subspecialists like urogynecology and gynecologic oncology. When in between cases, this is the time to complete orders, operative notes, and maybe sneak in some food or bathroom breaks.

9:30 am: Collaborative rounds. Between the attendings and nurses, we try to reserve this time to discuss our “Board” and ensure that all loose ends are tidied up. Any concerns or high-risk patients are thoroughly discussed at this time.

1:00 pm: If you’re half day of clinic is assigned for today, you’ll walk on over to the Medical Office Pavilion, conveniently attached to the first floor of the hospital. At this clinic, we see a variety of OB and GYN patients under the guidance of our core faculty. And don’t forget about billing and coding! This is where we first start to learn about the additional aspects of medicine that medical school didn’t teach us. But don’t worry, every 6 months we have designated meetings with our own Documentation and Coding Educator to learn the tips and tricks that will help us to succeed!

4:30pm: If you’re on OB, you’re wrapping up things for the day and following up on last minute details to get ready for evening sign out. If you’re on GYN, you’re rounding on the patients you operated on earlier in the day to ensure their postoperative care is appropriate. Beware of the possible GYN consult that, without a doubt, will come in right at 4:55pm.

5:00 pm: Evening sign out. If you’re on GYN and aren’t still finishing up in the Operating Room or seeing a late afternoon consult, you’re first to sign out to the night team. Then, it’s time for OB to sign out… unless there’s a “sign out delivery” happening, babies are born when they want to be born after all. But once sign out has started, you will surely be impressed by how organized and detailed an OBGYN sign out is! Our SpectraLink phone will always tend to ring the most while trying to sign out, so don’t act surprised. Once sign out is complete, the day is done and it’s time to return to your street clothes. It sometimes may feel like a whirlwind at the end of the day, but this is a great time to reflect on the cases and deliveries you attended… and don’t forget to record them for your logs!

7:00 pm: I’m usually home by this time, thanks to the long drive and evening rush hour traffic. Thanks to my “chef” of a husband, dinner is almost ready to eat right when I walk in the door. After dinner, I try to take some personal time if I don’t have any lingering assignments before resting and repeating the next day.
The life of a resident can be tiring and grueling, but you have to find joy in at least one thing you do every day. After all, this is why we went into medicine, right? Cherish those moments, they will help you through the tough times. And never forget that you have a great group of co-residents who are right there alongside you, too. Don’t worry, your phone will remember that “home” is not the hospital one day.

 

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