A Day in the Life of a UTMB Anesthesiology Resident

Dib, Michael MDMichael Dib, MD - CA 3 (OB Anesthesia)

“Obstetric Anesthesia at UTMB is dedicated to provide residents with a comprehensive experience. From performing an ample amount of procedures, to teaching fellow residents, our residents leave this rotation feeling comfortable managing and placing epidurals, spinals and providing general anesthesia to parturients. The Obstetric department at UTMB is a high volume center with a great number of high-risk parturients.  It’s not uncommon to work in cooperation with our obstetrics colleges to device a plan that provides the best care possible. From workings days to being on call,  OB at UTMB provides our residents with abundant opportunities to perfect their neuraxial procedure skills while at the same time gaining a thorough understanding of maternal physiology and complications that may arise with obstetric anesthesia.

A day on OB typically starts around 6AM. Residents come in and make sure the operating rooms are set up and all the epidural carts are appropriately stocked. At 6:40, residents will attend their daily lecture learning about various subjects relating to obstetric anesthesia. Residents will then take handoff from the on-call residents and learn about the laboring patients and the cases scheduled for the day. The OB day team usually consist of of 3-4 residents and two faculty. Throughout the day, residents alternate from providing anesthesia care for cesarean sections to placing epidurals on the laboring floor.  Residents will work until 4:30PM. At that time, the OB call team takes over and learns about any high risk patients, and the running epidurals on the floor. Some nights on call can be very busy, consisting of what seems like an endless number of epidural request, tubal ligations and crash/urgent c-sections. Although some nights residents may work really hard, we become very comfortable with our skills and ability to take care of any obstetric patient that walks in.”


Beitzel, Michael MDMichael Beitzel, MD - CA 2 (Split Year Track)

"One of the many unique opportunities UTMB offers is the “split-year” intern track (aka splitern).  Traditionally, the four-year residency is broken down into one internal medicine year followed by 3 years of clinical anesthesia. With the split year track (still a 4-year residency), the first year of medicine is mixed in with the first year of clinical anesthesia. These first two years still have the same rotations just in a different order. The benefit of this track is that you get into the OR sooner and get your hands dirty with intubations, lines, pushing drugs and all those other fun things that drew you to anesthesia. For me, getting that hands on experience sooner allowed me to read about and study anesthesia easier and focus on the relevant topics. In addition, your "easy" rotations are typically in your second year which gives you ample study time prior to taking the Basic board exam." 

 

Aggarwal, Shreya DOShreya Aggarwal, MD - CA 1 (Intern Year at St. Joes)

A day in the life at St Joseph's Medical Center in Houston!!
During my day on the St. Joseph's Internal Medicine service, I typically come to the hospital for call at 6 AM to relieve the night residents and get sign out. There are usually two residents on service during the day and we split the patient list to round on. I make sure to grab free (yes, free!) breakfast and coffee every morning before I sit down to knock out my notes. Table rounds are done at 9 AM with our awesome faculty mentor, Dr. Lary Kupor and with 3rd and 4th year medical students from Mexico and UTMB. Dr. Kupor gives updates and highlights from the Daily NEJM and we thoroughly discuss the patient cases with the entire team. While Houston is home to several hospitals, we get to see a LOT of interesting pathology and get excellent practice in treating various diseases. Once rounds are finished, we break to complete any unfinished tasks and grab lunch (again, free lunch!). Every Thursday at lunch, we tune into grand rounds lectures given through the UTMB Dept. of Internal Medicine.  Around 2 PM, we round again with another faculty mentor, Dr. Syed Mehdi.  Throughout the day, we admit patients, perform various procedures, complete discharge orders, and teach the medical students! It's a very rewarding experience and the workload is shared among the interns and some podiatry residents as well. Sometimes if the afternoons are light, I head over to the hospital gym and get my steps in! Then around 6 PM when the night residents come in, I sign out the list and head home for the day.

During intern year at St Joseph's Medical Center (SJMC) you complete 5 months of Internal Medicine. The other 7 months are 1 each of general surgery, NICU, ER, and elective at SJMC and 1 each of Pain, OR, and SICU at UTMB in Galveston. My intern year at St. Joseph's Medical Center has been one of the best years of my life, and not a lot of residents can say that. As future anesthesiologists, we are expected to be the primary airway and resuscitation experts. Over the past couple of months, I have been in situations where I am at the head of the bed intubating the patient and/or the one running the code. I've had the opportunity to treat hundreds of patients from different backgrounds and get one-on-one guidance and direct feedback from my attendings. SJMC taught me how to become proficient, self sufficient, and independent early on in residency.  During my surgery and ER rotations, I have performed a good number of central lines, IVs, chest tube placements, and intubations. I feel that my intern year has very well prepared me for my upcoming years in anesthesia residency and I’m confident that this will be one of the most rewarding years of residency for you too!


Allain, Alexander MDAlex Allain, MD - CA 2 (OR Call)

There are two types of OR call at UTMB: SR and “Bubba.” The type of call CA-1’s and split year interns are first exposed to is Bubba call. As a Bubba your responsibility is to be the resident in the OR for any cases that may come your way. You are the person carrying out the case with the assistance of the SR resident and faculty on call with you. On call, any emergent case can come your way and often does. Cases can range from simple I&D’s, to emergency appendectomies, to traumas, to kidney transplants and the occasional roll back craniotomy. It is a great opportunity to gain early exposure to complex cases. On weekends this means working a 24-hour shift from 6:45 am. On weekdays, your call begins at 4:30 pm and lasts until morning lecture. Bubba call is also great because you can remain focused on only one case (yours) at a time. There are no responsibilities outside of the OR when you are in a room. When not in a case, your time is spent relaxing in the lounge, sleeping in your call room, or assisting the SR with any emergent airways on the floor.

Further along in your training, you can be assigned SR call. The SR has many functions and responsibilities on a call. First and foremost, the SR acts as support for their two “Bubbas”, giving breaks, assisting with induction and emergence, and performing the preoperative assessment for any emergent or add-on cases the call team will have. The SR also acts a sort of junior-faculty, assisting with the prioritization of cases, helping to formulate an anesthetic plan, and being available for any intraoperative problems the residents in the OR may have. The SR also carries the code pager and is responsible for responding to any emergent airway in John Sealy, Jennie Sealy Hospital, or Shriner’s Burn Hospital. SR call is great exposure to the variety of clinical experiences you may have as an attending one day.

OR call is usually a great learning experience at UTMB. The typical call day consists of a steady stream of cases during the day. Much more often than not, there is some time to relax in the evening. Of course, there are the calls that seem to be non-stop action with little to no down time, but equally likely is a quiet call spent hanging out in the lounge or studying. The ability for early exposure to “upper level” cases really can help you grow in skills and confidence as an anesthesiology resident and this really cannot be overstated. The comradery developed with your team and attending during a difficult call is invaluable. The call teams also have the added perk of being provided dinner from a local restaurant, something that often elicits jealousy from our surgical resident colleagues. On call anesthesiology residents are vital to the function of UTMB, which in and of itself is a very rewarding responsibility.

 

Nguyen, Daniel DODaniel Nguyen, MD - CA 2 (Operating Room Rotations)


At 5:15 AM, my alarm goes off and the bedroom lights come on. I’ve never been a morning person, but automated lightbulbs have made getting up in the morning so much easier. I get up and brush my teeth while my dog stares at me as she waits for her morning walk. We take a quick trip outside, and when I get back, I pour a cup of coffee into my Yeti to bring to work. “Alexa, lights off.” I pet my dog goodbye and I’m out the door around 6:00 AM.

One of the benefits of living in Galveston is that everything on the island is generally within a 15 minute radius. For me, the hospital is 7 minutes from home, door-to-door. I drop my backpack and coffee off in the anesthesia lounge and greet the senior resident who was on call last night. They tell me about their night with a rollback crani and a couple of airways on the floor. I head down to the ORs to set up my room. MSMAIDs, check. Next stop, OR pharmacy to say hi to Sonya and Brad and grab a few extra medications.

At 6:40 AM, all the residents convene in the conference room for morning lecture. While we’re in lecture, our faculty are talking to the patients and getting consent for anesthesia. When morning lecture is done, I head down to pre-op holding, greet the patient, the OR nurse, and talk to faculty to see if there are any changes we need to make to our anesthesia plan we discussed the previous day. No changes. We wheel the patient back to the OR for our 7:15 start time.

Move the patient over from the stretcher to the OR bed, hook up the monitors, one last safety check, and it’s off to sleep (for the patient). My faculty hangs around while the surgery starts, and we talk about anesthesia in relation to this particular case and the patient’s comorbidities. Shortly after, they go to check their other operating room and I’m flying solo. After a few hours, faculty returns to check on the case and give me a morning break. I head up to the lounge, take another sip of coffee, chat with the other residents about how the Rockets have a real chance of beating the Warriors this year (ouch). Break is over, head back to my room. Surgeons are about halfway through. I start preparing for my next case. Once they’re done, I let faculty know we’re finishing up, we wake the patient up and proceed to PACU.

Once I hand off the patient to the PACU nurse, I close the anesthesia chart, and head back to my room to turnover for the next case. Faculty breaks me out for lunch after we get the next case under way, and I head down to Einstein Bros Bagels to order myself a cinnamon-sugar bagel with honey-almond schmear. I throw in a Dr. Pepper too, treat yo’self. When I get back to the room from my lunch break, I start eyeing the finish line. I’m not assigned to a late room today, so I should be done by 4:30 PM – or earlier, if all my cases finish before then. I get a text from one of my co-residents. It’s the list of room assignments for tomorrow.

At 4:15, a resident comes in to take over my room. There are a few more things to take care of before my day is officially over. I head up to the lounge and look at my cases for tomorrow. Hernia repairs for healthy TDC patients – score. I get in touch with my faculty for tomorrow and give them my plan for the next day’s cases. We talk about any anesthetic concerns, and topics to review pertaining to cases for tomorrow. I grab my things and stop at the scrub machine before heading out for the day. It’s only 5 PM and the weather’s nice, so I meet up with a few other residents at the tennis courts next the hospital. We hit a few balls before I head home and unwind for the day.

Over the last few hours of the day, I usually do a variable combination of reading, eating, sleeping, taking my dog to the beach, and watching TV. There’s always something to do here on the island if you’re looking for it too. Whether it’s happy hour, softball practice, or interview dinners, our department is good at finding things to do together. As the day comes to an end, I’m usually in bed around 10 PM. I used to think that was pretty early, but after a solid day of putting people to sleep, it’s quite nice to get some of your own.

 

Chehab, Sarah MDSarah Chehab, MD - CA 3 (Shriners Burn Hospital)


The Shriner's Pediatric Burn Hospital is one of our most unique experiences here at UTMB! You will rotate there as a CA-2 and again as a CA-3 as an elective. At the Shriner's, you learn valuable skills such as awake nasal fiberoptic intubations, pediatric central lines (subclavian and femoral) and volume resuscitation. Pediatric patients are transferred from all over the world following catastrophic injury including but not limited to, flame burn, electrical burns, acid burns, inhalational injury, adverse medication reactions such as Steven Johnson’s and Toxic Epidermal Necrolysis, and all the sequela these lead to. Because of this exposure, by the end of the month, you will become very confident taking care of acutely critically ill patients in the operating room. You will see a variety of cases, from acute burn debridement and grafting, to outpatient procedures such as burn scar contracture releases and occasionally major reconstructive cases. Aside from the clinical experience, the people that work at the Shriners are very kind and compassionate; they make you feel like family on day 1.

 

Albert LaCasse, MD and Stacey Warner, MD (PACU/Regional)

PACU/Regional RotationAs the PGY-3 residents on the PACU/regional rotation, we definitely get a “well rounded” experience. Our day starts at 6:45 with taking the code pager from the senior resident on call overnight and attending the daily morning lecture. We are also responsible for providing airway management for the codes throughout the hospital. This experience gives you autonomy and the confidence to manage emergency airway situations. One of us is often asked to assist junior residents to start more challenging cases, transfer intensive care patients to and from the operating suites, or help with preoperative evaluation of cases that are added on during the day.

Finally, we attend to PACU issues such as pain control, nausea, hemodynamic management, or any other post anesthesia care. At the end of the day we will review the next days OR schedule to prepare for first case blocks the following morning. At 4:30, we hand the code pager off to the senior resident on call and give them report on the day’s activities.


Jackson, Andrew Thomas MD

Andrew Jackson, MD - CA 3 (Anesthesiology Pain Service)

The “Block Team” starts their day around 6:15 a.m. We take a look at the O.R. schedule the day before so we know what first start cases we need to prepare for regional anesthesia. When we arrive we draw up our drugs for the first cases and call our patients to holding if they have arrived. We will talk with our faculty about which cases to prioritize and how we will approach our cases for the day. Once our first patient has arrived we will bring them to the block room where we will place our block and then send them on their way with the OR anesthesia team that will take over their care. On busy days we will spend most of the morning placing blocks either prior to surgery in the block room or post-op in the PACU. Sprinkled throughout the day will be acute pain consults that we become aware of either by the EMR or our pager. We try to get away at some point for lunch and then meet up with our faculty to round on our acute pain consults on the floor. After rounds we finish our notes, complete any more blocks in the PACU, and start to plan for the next day. We don't finish our day until we have emailed a notification to the surgeons and anesthesia residents the planned blocks for the following day and followed up on all the blocks we placed that day.

Our block rotation is very different from our regular OR months. At times it can be hectic, but we get a lot of practice placing blocks. The faculty take every block as an opportunity to teach. By the end of the rotation I felt very comfortable placing all of the most common blocks, as well as some lesser used blocks. My grasp of neuroanatomy and local anesthetics also improved tremendously. And finally, it was very rewarding to have a patient in pain and then to provide almost immediate relief with a well-placed block.

Martinez, Robert MDRobert Martinez, MD - CA 3 (Surgical ICU)

After morning lecture (around 7:15 a.m.) you’ll head to the SICU and start chart reviewing and checking on your patients before rounds.  We cover a wide variety of patients including (but not limited to) vascular, cardiothoracic, general surgery, gynecology, ENT, plastic surgery and transplant patients requiring critical care.  On any given day you will cover 2-3 patient.  You’ll check in with the over-night resident to get any updates and then do the same with the nurses.  This is also a good time to check on your patient.  On most days there will be a medical student working with you who will present your patient during rounds.  Just before rounds I usually sit down with the medical student and go over their presentation with them, filling in any gaps.  Rounds start between 9-10 a.m. and are great for teaching. Faculty cover anything from ventilator management, hemodynamics, sepsis, infectious disease, hematology, etc.  On most days a resident will bring a COW (computer on wheels) with them and enter orders as we round.  After rounds you’ll enter any orders that weren’t entered during rounds and do any procedures that your patient needs.  These include arterial lines, central lines, bronchoscopy, etc.  You’ll spend the rest of the day following up on labs and communicating with the various teams and consult services that are also caring for your patient.   Most faculty will do a lunch lecture.   After lunch you continue following up on labs, doing procedures and taking new patients if it is your turn.  Residents will be in the room when the patient arrives from the OR and will get a hand-off from the OR anesthesia resident and the surgical team.  Afternoon round start around 4 p.m. and are designed to update the over-night resident and faculty about any changes that happened with your patients during the day.  On most days your shift end when afternoon rounds are done.