Hey guys! How's it going?
I'm Dr. Amit Pandey.
I'm a third year Internal Medicine Resident at UC San Diego
and this is a 'Day in the Life'.
So, I'm on a Intensive Care or ICU rotation.
It's about 6:15 in the morning.
I'm headed in for my shift that starts at 6:30 a.m.,
usually lasts till about 5:00, sometimes up to 7:00 p.m.
And then tomorrow I work a longer day,
which starts around 8:00 a.m., goes through the night.
I'm 24 hours until the next morning, usually around 10 a.m.
We take care of all the ICU patients and anyone newly admitted to the ICU.
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The way the day usually works is the patients are all divided up amongst the residents.
And we come in and do what's called 'Pre-rounding',
where we look at all the vital signs,
all the labs and any overnight events.
We examine the patients.
See if there's any new medical issues that need to be addressed.
Then we meet as a team with the 'attending',
who is the supervising doctor for the whole team,
and we discuss the plan of action
and go through our plan for the day.
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So, this is a typical 'call room' in my hospital, nothing too fancy.
We got a bed here as you can see
but unfortunately no pillows, kind of tough times.
We're also lacking a chair.
This is a particularly unique call room.
But anyways, you got a computer, you got the bathroom.
Basically, you know, just the basics, in case you need to take a quick nap.
Call Nights get quite busy frequently, especially in ICU,
so often we don't even get to use the room and sleep,
but the space is here if you need it
as obviously, we spend long hours.
All right, so in the afternoon, we like to get some procedures done
or as patients are acutely ill, we'll do them as they are needed
throughout the day.
And one of the procedures that we do is a Central Line and this thing is--
[Kevin] Hold on, you are internal medicine, you guys do procedures?
- Yeah, unlike surgeons, we actually use our hands and our brains.
[Kevin] Ouch.
- No, I'm just kidding, but yeah, this is one of the procedures that we do, Central Line.
So this is one of the old kits that we have lying around the call room
or the workroom to teach the new residents.
And so what we do for the central line is we have this needle
that we use to access the vein, either in the neck or the groin.
Next, we put in a wire through that needle
and the wire-- you make a little nick with the scalpel after that,
and the wire allows you to introduce this catheter into the vessel
and what the catheter does is,
it allows us to provide special kinds of medications
and allows it to get to the place where we need
and usually that's really important for critically ill patients in the ICU.
- All right so what's going on now? - So, we just finished up our morning.
We rounded as a team, we had a moderately busy day,
had about 15 patients in the ICU to see.
We go around with the attending and make a plan.
And then I actually had to break off from the team for a little bit
to go see a patient in the emergency room,
they needed to be admitted up to the ICU.
I took care of that patient, got them up there
and then reconvene with the team to finish up the plan,
and now I have a little break.
There's no guarantee that you get that every day,
but have the chance to grab some food, take a quick lunch break
and then we go from there.
- So Amit, why internal medicine?
- Yeah, good question-- - Versus plastics, which is you know...
- Oh, they of course, the natural for sure-- - Yeah, the logical choice.
It took me a while to figure out in medical school exactly what I wanted to do,
but I ended up on medicine because I love how broad it is.
It has a really great exposure to really all the working systems of the body
and we learn a lot about Physiology and Pathophysiology,
how the organs work and what diseases can go wrong with them,
and I love that part of medicine.
- It's a very-- a kind of cerebral field--- - Intellectually challenging.
- Exactly. Yeah, I love that
and I also love specifically Cardiology, super interesting physiology.
I did a research in that as an undergrad and medical student
and that's one of the subspecialties of internal medicine,
so I pursued medicine for that reason.
- I am not surprised that you love cardiology so much...
- Yeah.
So, Amit and I, we were classmates at UC San Diego, we...
- Yup. - We studied together a lot
and one of our favorite blocks was actually Cards,
- Oh, yeah. Absolutely. I loved it. - Cardiology.
- Looking back, that was along time ago... - That was.
We worked hard but it was actually really fun to learn,
really get your-- like the nitty-gritty of Physiology
and more details than you actually get to really understand in undergrad.
- Okay, I'm convinced that internal medicine...
- Respect! - Oh, yeah.
- But why be a doctor in the first place?
Why go to medical school? Why do residency?
- It's a long arduous process. - Yeah. Oh, definitely and
it's a great point that you bring up, so I think it's something
that should really be thought about, to make sure it's the right thing for you.
So it took me some time to figure that out.
Kind of started getting interested later in high school.
My dad is a Physician, so I always had the opportunity to observe him.
He's an internal medicine doctor.
And then in college, I realized that I love learning about biology, organ systems,
a couple of classes I took, great.
And then I realized that I didn't want to be doing a job
where I was just sitting at a desk all day, kind of on my own.
I wanted something where I was interacting with people throughout the day.
And honestly, medicine is perfect for that,
so there's not a lot of fields that I can think of,
where you have as much like intellectual stimulation,
but also that interpersonal stimulation.
I think every patient is different,
so every day is different and that's why medicine was right for me.
[Kevin] What's going on man? - What's up man! How's it going?
[Kevin] How was the day? - It was good, it's good.
First thing we did in the afternoon was a couple of procedures,
we had a Central Line to do.
And then we also did a Paracentesis,
which is a procedure where we put a needle into the abdomen to remove fluid
and to check that fluid for infection usually,
and that typically happens with liver disease
and some other kinds of abdominal infection and diseases as well.
And then after that, we had a couple more admissions.
It was a good busy day.
The last one I just did was a patient came into the emergency room
with respiratory failure, requiring a really high level of oxygen,
so much so that they needed to be intubated,
which is when we put a tube down the trachea,
hook the patient up to a ventilator to help them breathe.
Luckily the patient's stable now, doing much better.
Overall all, all in all, pretty good day.
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- Now, ICU is known as being one of the most challenging rotations in residency.
And Amit, I'd like to hear from you, how does ICU differ from other rotations?
The main difference in the ICU is that you're taking care of the sickest
and the most critically ill patients.
And that can be really, really challenging
but also really exciting and rewarding.
We take care of patients that are as critically ill as you can possibly be
and with the right treatments within, you know,
several days, they can be walking out of the hospital healthy,
and that is just an awesome feeling, super rewarding,
but at the same time, you know,
there are some patients that are so ill and their disease process is so advanced
that no matter what medical treatment we provide,
there's really nothing that we can do;
and obviously, those cases are really, really challenging.
Of course, for the patient, for the family and that's really crucial,
one of our roles is to support the family through these difficult experiences.
And it's also taxing to the provider.
And you know, this is something that I've spoken about recently in a blog post
on the medschoolinsiders.com blog.
It's something that's really taught me a lot
and I've done a lot of introspection about it
and it's helped me learn a lot about my interaction with patients
and my role as a Physician.
All right, just got home from work, had a good day.
Usually when I get home at this point, I like to have some dinner
and then get a workout in, if I can.
It's not always feasible based on the schedule.
After that I usually do a little bit of research.
Big part of a resident's life is often doing a research project in their area of interest.
I'm doing Cardiology research at the moment.
And then the last thing I generally do is
some of my projects for medschoolinsiders.com.
If you're interested in becoming a Physician,
whether you're a pre-medical student or a medical student,
Medical School Insiders is here to help you achieve your goals.
Learn more at medschoolinsiders.com.
So, that's a day in the life of an Internal Medicine Resident.
I'll see you guys next time.
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