Written by our former Chief, Dr. Rodrigo Cordero-Pangrazio.
5:50am Monday. About to start a 4 week stretch of wards on the Green team. Armed with last night’s sign out, I stretch my legs over my bed and start my morning routine. Shower, brush my teeth, throw on my clothes, gather my belongings, and head out to my car. The air outside is crisp, but the sky is clear- perfect San Francisco weather. I hop into my car and flip on the radio. The Warriors are in the midst of a tense playoff run, and the radio is detailing the upcoming game tonight. Before that radio segment is even over, I arrive to the hospital, stethoscope draped around my neck. I say hello to the familiar faces in the hallway as I pass into the elevator, checking my watch to see the arms acutely angled, reading 6:28am.
The elevator doors open to the fourth floor, and instantly I hear the chorus of excited voices down the hall starting morning sign-out. The scrubs-clad night team performs the ceremonial hand-off of pagers, recites the cross-cover events overnight, and digs in deep to present the new admissions before they hustle home for some much deserved sleep. Each case is a mystery, some appearing more complex than others, but each promising to add to our collective medical knowledge. Dr. Mendelson, our program director, ever present at nearly all morning sign-outs, finds the high-yield points in even the most abstract cases, and interesting and novel points in even the most seemingly familiar of cases.
Once the night team has gone home, I huddle with my team, my resident the quarterback calling out the plays for the day. I start my pre-rounding, reviewing carefully the details of the night: vitals, labs, I&Os, imaging, culture data, anything and everything available to me to start piecing together the mosaic that is each patient. Then is the most rewarding part of the day- getting to meet all my patients. There are 8 new faces for me today, each with a unique life, full of ups and downs, turns and twists, the sum of which has landed her or him in the hospital. By 8:30, I have met all of them, have asked them my most burning questions, and have answered some of theirs. It is time for rounds.
My resident starts us off with our first patient, which happens to be a patient of mine. Whereas only 10 months prior I would have shrunk at the idea of presenting a patient, mumbling my way through in a nervous sweat, I now stand calm and share the pertinent information for each patient with aplomb. My resident listens intently, and offers sage advice to my daily plan. Only then does the attending offer the team evidence-based data to further refine our plan. We go and evaluate the patient as a team, reviewing any important physical findings, and in a total of 5 minutes, we are confident with our plan.
We wrap up rounds at 11 am, and start the intricate process of planning our discharges for the day- making sure orders are in, the medications are correct and clear to the patient, and making sure they have follow-up appointments. Some may be on their way home, some to a skilled nursing facility before ultimately going home, and some to a facility for the long-haul. And just like that, it’s lunch time!
Noon conference today is a discussion on different types of cardiomyopathies. One of our many amazing cardiologists is giving the talk, and all the house staff are seated around the table, Thai food piled high on their plates. The talk is fun and informative, and we finish with a few MKSAP questions. Two plates of Pad Thai later, I have the energy for the afternoon. And soon enough, we get the call…the ED has an admission for us. And wouldn’t you know, I am up. I do some quick chart digging on the patient, and together with my resident, we head down to the ED. The case is interesting, a young gentleman with HIV presenting with confusion and worsening headache. His RPR titer is through the roof. After we staff with our attending, the plan is laid out to tap him. We gather all the equipment for the LP, and with the help of my resident and attending, I perform the procedure. We send out all the necessary labs, eager for the results.
After this, the afternoon is, dare I say it…quiet. My co-intern and I write our notes, prep our electronic handoffs, and in a blink of an eye, the night team comes strolling in, once again donning their sky-blue scrubs. We fill them in on the happenings of the day with verbal sign-out, share the most salient pieces of high-yield medicine we learned that day, and prepare for our Green team activity for the evening.
Shirts sleeves now rolled up, we walk into the April sun towards Kezar Pub. There we sit hovering over a plate of chicken wings as the Warriors game begins. One of the best parts about St. Mary’s is that the teamwork doesn’t end once you walk out of the hospital doors. The camaraderie extends to our lives outside of the hospital, which makes our work in the hospital more fun and efficient. The Warriors win, the restaurant empties, and we say our goodbyes, pumped to do it all over again tomorrow.