The third year of medical school is widely accepted as the busiest year leading up to residency. Classroom learning is over (for the most part) and now you are training in the hospital. Some of the questions I had during my first two years of medical school were “What makes third year so busy?” and “What do you actually do during third year?”. So for students who are still asking these questions, let me share with you a day that I recently had, and which I have found to be fairly normal for third year. This is during my OB/GYN rotation.
5:00 am – Alarm goes off and I’m out of bed. If I get moving fast enough I’ll be able to eat an extra bowl of cereal, which may be the last bit of food I see for a while.
5:30 am – Out the door and driving to my hospital parking lot, which is actually located closer to a different hospital system and is a 15 minute walk. I can never decide if walking through the city in the dark is peaceful or creepy.
5:50 am – As I’m walking I realize I’m already behind schedule, so I sprint the rest of the way.
6:00 am – I arrive on my hospital floor huffing and puffing, and begin the process known as “pre-rounding”. I print off the list of patients on our service and look for familiar names. Yup, there is a patient that we operated on yesterday. I pick her name, as well as another patient that must have been admitted overnight. I try to manage at least two patients most days. I snag a computer in the hallway and look up both patient’s medical charts. The patient who we operated on seems to be doing well. Stable vital signs, and a normal blood count. The other patient’s chart takes a lot more time to go over, since she is a new admit. I learn that she’s here for severe abdominal pain, and that this is not her first time being admitted for this reason.
6:13 am – Finish writing down preliminary lab values and vital signs, then I’m off to examine the patients. I still feel uncomfortable waking patients up so early in the morning just to examine them, but I have a job to do. The first patient wakes up easily and seems pleased to see me. I ask her about her pain, bowel movements, urinary frequency, and a host of other pertinent questions. Her recovery seems to be going well and she’s meeting all her postoperative milestones. I perform a focused physical exam and thank the patient for her time.
6:25 am – There’s still another patient to see and I haven’t started writing notes in the computer yet. Time to speed things up. I head to the second patient’s room. She’s harder to wake up. When she is finally conscience she is not happy to see me. I try to go through her history but don’t get much. Examining her abdomen doesn’t tell me much about her pain either. In fact, it’s all pretty nonspecific. My differential diagnosis is wide: ovarian torsion? pelvic inflammatory disease? appendicitis? ventral hernia? inguinal hernia? endometriosis? factitious?
7:00 am – I’ve written my notes (I may be the only person who ever sees them, but it’s great practice for the future). My residents and attending are here and it’s time for real rounds. Outside of my first patient’s room I give an oral presentation. It’s fairly short because we all helped with the operation the day before, so it is basically an interval history and physical exam. We then go into the room and do basically the same thing I did earlier. Outside of the room we all agree she can be discharged home.
The second patient’s presentation goes longer, since it is a complete history and physical. I trip over a few of the details in the patient’s history, but I get through it ok. When I present my assessment and plan the chief resident surprises me with a report that I hadn’t found during the chart review. This new report shows all the places where the patient has recently obtained narcotics. It is extensive. Suddenly our suspicion is very high that the patient is drug seeking.
7:35 am – It’s surgery time! Today’s schedule has a hysterectomy, a dilation and curettage, and an ovarian cystectomy. I scrub in with my team and suddenly I’m at the bedside. As a medical student I get to help with stitches, suction, and lots and lots of retraction.
8:40 am – I’ve been retracting for the last 40 minutes and my arm is getting tired. But even if my job is to hold open the body cavity for several hours in a row, I can’t let my mind wander. This is because surgery is a great time for your attending and residents to “pimp you”. This is hospital terminology for asking you lots of rapid fire questions. Today I am asked extensively about the arteries that perfuse different pelvic organs and muscles. Then the pimping turns to questions about abnormal uterine bleeding, the classification of miscarriages, and details about the patient’s medical and surgical history. I’m grateful I studied the case the night before, as I get more questions right than normal.
9:45 am – The first pains of hunger hit. Far too early!
10:30 am – The first case is done, but we’re still behind schedule. I help move the patient back into their hospital bed and then take them to post op. Then it’s on to the next surgery!
11:10 am – Retracting more. Wait, what’s that feeling?! I look down to realize that blood is dripping in my shoe. Rats! My shoe covers don’t cover my shoes perfectly. Oh well.
11:50 am – Noon is approaching. The cases have been really interesting so far, but now I’m really getting hungry. The current surgery looks like it’ll end in half an hour. Maybe I can get food then?
12:25 pm – RING RING!!! The team’s pager goes off. Looks like we have an emergency department consult. The intern and I scrub out and head down see the patient in the emergency room. It turns out to be a woman having a miscarriage and it is very sad.
1: 15 pm – After doing all we can to comfort her, we say goodbye and head back to the operating room because another surgery is starting. But we never make it. We are paged for another consult in a different part of the hospital. The chief complaint is vague abdominal pain. I go to see the patient alone because the intern needs to get to afternoon clinic. I perform a history and physical. The patient is pleasant and ready to go home. Looks like gynecology was consulted to cover all bases. My diagnosis matches the medicine team’s diagnosis. I head back to the OR to report to my team.
3:15 pm – The last surgery is finished and the patient is in post op. We trudge up to the resident lounge. Looks like no lunch today. The attending asks me to give a presentation on Preterm Premature Rupture of Membranes. I had prepared the night before and had a powerpoint presentation. It goes over well, and I seem to have hit the important parts.
4:00 pm – It’s time for lecture! In this rotation 4-6 pm is reserved for medical student lectures. All the students on my current rotation meet in a hospital conference room and we are taught by physicians on the chosen topic of the day. Today is on normal labor. There are 8 students, and we practice delivering a fake baby through a pelvis.
6:00 pm – It’s time to go home! I trudge back to my distant parking lot
6:40 pm – Finally home. My amazing wife Mrs. DA has made dinner, and both she and the food are a sight for sore eyes.
7:30 pm – I look over the cases for the next day and read about surgeries I haven’t seen before. If I’m lucky I even make time to do practice questions for my upcoming shelf exam.
9:30 pm – Bedtime.
And that is a fairly typical day in third year! It is a busy and exhausting ride, with ups and downs. The best part of third year are the times when you get a glimpse of how much you have learned, how confident you are becoming with patients, and how much you are growing.
*some of the details regarding patients, including their diagnosis and symptoms, have been altered. I do this to try to be sensitive when it comes to writing about patients.