Monday
- Monday Morning: Good morning! This month I am on the geriatric psychiatry rotation at BUMC-South (we also do a one-month rotation on geri psych at the Southern Arizona VA which is next month for me). This is my first day on geri psych rotation. Today starts at 8 a.m. and we are responsible for our patients until 5 p.m. when we sign out to our colleagues on the consult team for overnight coverage. I arrived a little early this morning (around 7:30 a.m.) to get myself settled in and was met by the delightful Senior Care social worker when I walked into the work area, and she got me oriented to where the attending’s office was and where the resident and students sit. This week we have a Sub-I and third-year med student on the team. When the attending arrives, we run the list so I have some context and then the Sub-I takes the lead on rounds while I observe and get to know our patients. At 10 a.m. we have treatment team meeting with nursing, social work, and the nurse practitioner who we collaborate with regarding medical concerns on the unit. I appreciate this interdisciplinary approach and with some of the complexities of geri psych placements, the expertise of each team member is crucial. We do have one discharge today, so after rounds and treatment team meeting, we staff that patient and go back to see him again to follow up on some discharge planning that I had initially missed, then I’m ready to complete his depart process and order his discharge. Once orders are placed, we have some time for teaching and the attending provides an introduction to some of the nuances of senior care and the logistical complexities of connecting patients with appropriate resources for long term care when indicated. We also discuss the emotional difficulty of caring for folks with neurocognitive disorders and have an important conversation about systems of care. The medical student astutely suggests the rotation should be renamed “Geri psych and society and large” and she’s spot on!
- Monday Afternoon: We break for lunch and head down to the cafeteria. After lunch we wrap up our notes for the morning and the Sub-I does some more teaching with the MS3 before they head out for the day. Around 4 p.m. I sign out to my colleague on the consult team and head out myself, and while I keep my phone on to field any calls until 5 p.m., I don’t get any.
- Monday Evening: By the time 5 p.m. rolls around I am at the gym ready to jump into the pool. I swim at the University of Arizona recreation center where they have a beautiful outdoor pool and it’s a great way for me to reset at the end of the day. After my swim I pick my dog up at doggy daycare and head home for my evening routine which usually involves dinner, TV, sometimes knitting and/or reading, and going to bed earlier than I care to admit :)
Tuesday
- Tuesday Morning: Today is day two on Geri-Psych and I’m ready to hit the ground running. I arrive around 7:45 a.m. and print patient lists for the team. We have a new patient today, so I also spend a few minutes reviewing his chart. When the Sub-I and MS3 arrive, we spend a few minutes catching up and then head to the unit to round. One of our patients is Spanish speaking only, so the in-person interpreter meets us on the unit. When we arrive to her room, we find that she has abdominal pain and has been vomiting. While we are a psychiatry unit, our patients’ general wellbeing is of the utmost concern for us, so we initiate a workup in collaboration with the nurse practitioner that also works on the unit, and also consult medicine for further support. The patient is diagnosed with cholecystitis and is transferred to the med/surg floors and undergoes a cholecystectomy the next day. Meanwhile, we round on the rest of our patients who are fortunately all stable. We arrive to interview the new patient and his wife and daughter are at bedside. We spend some time getting to know the patient who is unable to provide a full history due to his altered mental status, so we invite the family to join us in the conference room and gather a full history from them as well as coming up with a plan together.
- Tuesday Afternoon: After an eventful morning, we grab lunch then work on notes in the afternoon and spend time debriefing the family meeting with the attending and discussing the main teaching points from each case.
Tuesday Evening: In the afternoon, I head out a little early to go to the dentist. After my appointment I log on remotely to chart review and be sure nothing has come with our patients that I need to address, then sign out to the consult team for overnight coverage. A quiet evening for me, I finally unpack from my vacation last week, wind down, and get ready to do it again tomorrow!
Wednesday
- Wednesday Morning: This morning I got up early and squeezed a workout in before work. I got a new Pilates bar that I’m learning to use effectively and it was part fun, part frustrating, and totally worth it! After that today started much the same, arriving at the Senior Care unit a little before 8 a.m. Wednesdays, however, we have the afternoons protected for didactics so this morning we saw our patients, met with the team, and wrote notes and around 11:30 a.m., I headed out. Because the afternoons are protected, the attendings cover whatever we didn’t finish in the morning and take care of any calls or needs for the patients the remainder of the day.
- Wednesday Afternoon: We usually have department wide Grand Rounds from 12-1pm, but the season hasn’t started yet, and will start up again weekly in September. So today, I treat myself to lunch from the nearby Salad and Go, and head over to the Behavioral Health Pavilion for the afternoon lectures. This is my first week back to didactics as a PGY-2 since we are excused during night float, and I was on vacation last week. I was so excited to see my co-residents! It’s remarkable how close we’ve become, and it was nice to catch up with everyone and hear how the other rotations are going. Our 1 p.m. session today was Journal Club. We each lead one Journal Club during second year with a faculty mentor supervising our paper selection and presentation preparation, and myself and another PGY2 are the coordinators for the schedule. Today I got us logged into the meeting and head the pleasure of introducing my colleague to the department. The 2-5 p.m. lectures are class specific. Each lecture this afternoon is part of a series so I get caught up quickly on what I had missed. 2 p.m. is advanced interviewing, 3 p.m. is developmental milestones and 4 p.m. is cultural psychiatry. The 4 p.m. lecture is taught by an Alumna of our residency program who I worked with when I was a medical student and she was a PGY-4 and while the lecture is via zoom, it’s still great to get to say hello to her and learn more about her area of expertise.
- Wednesday Evening: Didactics end at 5 p.m. and I spend a few minutes chatting with some co-residents before heading home. Nothing exciting this evening. Just wind down and get ready for another day!
Thursday
- Thursday Morning: Once again, I arrive to work a little before 8 a.m. today and get caught up on chart review and prepare for rounds. We haven’t had much turnover this week in patients, which is common for our Senior Care unit. Often the admissions are prolonged because of placement issues and collaborating with outpatient resources to ensure a safe disposition. One upside to this is we get to know our patients really well. In addition to my standard assessment, I often like to ask if there’s anything else they would like to talk about before ending our encounters each day. I’ve been amazed and humbled at some of the things on their minds, and aspects of their histories that they choose to share. Because we had the time, I spent a little longer chatting with patients this morning and had conversations ranging from hilarious to devastating. We also had more time for teaching today and our topic for the day was Lewy Body Dementia. We all read a little about it on our own and then our Sub-I gave an informal presentation. We covered specifics and how they related to one patient in particular and her treatment plan, and also spoke about major neurocognitive disorders more broadly and their impact not only on individuals and care givers, but also on society at large.
- Thursday Afternoon:
After a walk to the cafeteria with one of my co-interns, it’s back to writing notes and finalizing orders for the day. I was able to put on my headphones and really focus and finished all my notes by 3:30 p.m., so I got to leave early today! - Thursday Evening: Around 4:30 p.m. I wrap up and head home. It’s still pretty hot in the evening here, so I take my dog for a short walk and then go for an indoor bike ride. I have been toying with the idea of a Peloton this summer, but I already have an indoor trainer that I can put my road bike on to convert it to a stationary bike, so I’ll stick with that for now. I have definitely found a need to make working out indoors feasible in Arizona because of the heat and have found that riding inside can actually be really fun! After my ride, I cool down, eat dinner, and am off to bed.
Friday
TGIF!! Not much new today. Saw patients in the morning, did some teaching with the med students, finished up notes and that was it! In the evening I met up with a friend for dinner. There are so many great restaurants in Tucson, so I don’t know why I’m surprised every time I discover another great one. Tonight, we went to a fast-casual burger joint that was super low key and still had great food. 100% recommend!
Saturday
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The week is not quite over! I am on call at South campus today. “Call” is somewhat of a misnomer because it’s really a full workday covering the weekend (and holidays) instead of the regular work week. I arrived a little early and caught up with my co-resident currently on nights this month. At 8 a.m. we did the formal sign out, and she headed out for a well-deserved rest. I had a pretty big team today with an intern on her last of four training call shifts, a Sub-I here voluntarily, and an MS3 here as part of her psychiatry clerkship. We also have a social worker who helps run the show, and the attending. The attending covers both South and Main campuses but is onsite at South because as the year progresses, interns will mostly be covering day call at South and PGY-2s and PGY-3s cover main days and nights at both campuses. As PGY-2s, we always have reliable attending supervision while on call shifts, but it is often by phone, whereas interns have direct onsite supervision.
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I’m still hesitant to say this even though the day is over, but it was actually pretty slow, which is not the norm at South. That said, it did give me a chance to walk through some of the workflow details with the intern and take the whole crew on a tour of the hospital and to say good morning to nursing staff on all the psych units. Late morning, we got out first consult and all went to see him together. As the day went on, we got a little busier, but all in all it was a pretty quiet day with a nice balance of time for patient care and teaching.
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Even on a quiet day, a 12-hour shift is long, and I was happy to see my co-resident (a PGY-3) arrive for 8 p.m. sign out. We chatted for a few minutes after formal sign out, and then I said goodnight. I am not a night person, so I took a little time to wind down once I got home but was asleep before I knew it!
Sunday
Now that’s a wrap!! Today’s my day off this week. When I have a full weekend off, I try to do something active one day and errands, meal prep, etc., the other day. Alas, with just one day off I tend to do neither and instead take the day to fully recharge. That’s what I did today. This morning I went to breakfast with a friend at my favorite coffee shop in town. On the way home I stopped at the grocery to pick up some food for the week, then headed home to a pretty relaxing day. Read some, worked on my knitting (I’ve been knitting the same blanket for months now!), and watched TV. Like I said, with just the one day off this week, my priority was taking it easy and I nailed it!