While there is no one “typical” day for me, here’s a little glimpse into life as the intern on labor and delivery.
*day to day routine varies based on what rotation/service you are on…variety is the spice of life, right?*
4:45-5 am: ALARM!
[Thankfully, "getting" ready takes all of 10-15 min given I wear scrubs every day. I eat breakfast on the way - a Picky Bar and a green juice, usually. And coffee #1 of day.]
5:15-6 am: Get to the hospital somewhere in this time frame depending upon the number of postpartum patients to round on that morning. Get sign out on post partums from night resident.
[Sign Out = Running through the list of patients and active issues with them. Ie Ms X had a fever last night and x,y,z was done. Or Ms A has severe pre-eclampsia, is on magnesium until 5 pm today, tox labs q 6 hours, blood pressures have ranged X to X…or something like that]
Until 7 am: Round on the post partum patients. Write notes. Usually ranges between 10-20 patients.
How best to describe post partum rounds?
7 am: Get sign out on the “board” (triage and laboring patients) and antepartum patients from the night resident. Give sign out on post partums to nurse practitioner (aka the intern’s God send).
7:30 am: Didactics (educational activity)
8 am: Sign out “the board” to all of the staff on labor and delivery
8:45 am to 5:59 pm: “Run the floor”
There are four basic things you do as an intern in a day on labor and delivery.
***Intern = first year resident***
1. C-SECTIONS: There are always scheduled C-sections each morning, usually at least two and sometimes three. Interns do all primary C-sections, meaning the first C-section anyone has ever had. Repeat C-sections or those on people with prior abdominal surgery usually get bumped up to the second year resident, unless they are in clinic. Really complicated patients may get bumped up to a chief. In general, the labor and delivery intern ends up with at least a few sections every day.
All residents bow down to the holy check box so I’ll include that in this post as to neglect the check box in a post about “the day in the life” would basically be leaving out the meat of my day.
In “check box” terms, C-sections get five check boxes: history/physical exam, consent form, pre op orders, cross for blood products, post op orders, baby orders.
2. TRIAGE: Triage is like our OB emergency room. Anyone over a certain number of weeks pregnancy gets sent to our triage. Usually, it is people who are coming in to determine if they are in labor, if they broke their water, etc etc.
Triage patients get four check boxes: history/physical exam, consent form, triage orders, call attending to discuss plan for patient.
3. LABORING PATIENTS: This entails watching the “tracings”, checking in on them, monitoring or managing their labor course/starting an induction, and, hopefully, delivering them!
*Tracings = external fetal heart rate monitor and contraction monitor*
Laboring patients get the following check boxes: history/physical, consent form, admission orders, cross for blood, baby orders, post partum orders.
4. PAGES: It beeps (a lot). You answer it. Pages can be for anything – from a colace order to someone with severe range blood pressures who needs to be evaluated for pre-eclampsia to a post partum hemorrhage.
I wear my pager on my ID necklace/lanyard along with looping my four color pen. Suffice it to say I look super cool when I’m at work.
During the day, our nurse practitioner covers the post partum pager and patients. This probably saves the intern at least a billion pages per day.
The antepartum service (i.e. those admitted prior to labor) is covered by the second year resident. However, they are sometimes in clinic and you hold the pager at all times and, therefore, are also responsible for the antepartums in some capacity each day.
6 pm: Sing out the entire service to the night resident. Hand off the pager to said resident.
6:30-7 pm: Leave hospital!
***There is, of course, always the possibility of the 5-5:30 pm high acuity situation in which you get a bit delayed on the 6 pm sign out or you may need to catch up on note writing or some aspect of patient care from the day and stay a bit later than what is listed above.***
At some point, you eat lunch and, hopefully, drink water. I drink at least two coffees a day, minimum and sometimes shove down a Picky Bar in the afternoon, especially if I’m going to run or spin that evening.
I was on a huge diet ginger ale kick during my last month on labor and delivery. There’s something so satisfying about the little mini cans of diet Shasta (ginger ale) apparently only available at hospitals. Combined with hospital ice (the soft ice like they have at football games), its heaven in a small styrofoam cup.
I usually crash by 10 pm. Sometimes earlier. And hopefully not any later than that.
And then you get up again and do it the next day!
So, that’s it.
Until next time…
[And if you have any questions, ask! Not sure if what I wrote is common knowledge or jargon…]