I spent the last month of internal medicine at the VA medical center. I had a wonderful team that made my time there a little more fun.  My team consisted of a senior resident, two interns, a podiatry resident rotating through, and two med students (myself included). Though having outpatient (clinic) hours at the end of my rotation would have made it easier to study for my shelf exam, having inpatient hours at the VA wasn’t bad at all. Things run a little slower at the VA and it made it a good place to get a lot of studying done when things got really slow. During my last week I picked an on-call day to keep track of so I could share what a day on the wards is like!

(Some details may have been changed to protect patient privacy)

6:00am. J and I wake up and start our day. He gets ready to go to the gym and I get Melo ready for his walk.

6:25am. I feed melo and start getting ready. I stare at my elliptical and yoga mat in my study room and regret not having time to exercise before work but console myself with the fact that tomorrow is post-call and I’ll get out early enough to get a great workout in.

6:45-7:00am. I grab my salad, overnight oats and apple out of the fridge and hop in my car. I’m lucky that it only takes me 6 minutes to get to work! When I arrive at the VA I stealthily find a parking spot close to my building (it’s a bit of a challenge avoiding security to be able to park in the lots closer to the hospital since students don’t have anywhere safe to park).

7:10-8:30am. When I arrive in the team room I get settled and check to see if both of my patients are stil on the board and they are. I check with my interns to see if they need me to see anyone else and they don’t. I grab my breakfast and go to the conference room where there are extra computers. I go through each patients' chart and check new labs, imaging results, and see if there are any notes from the night team. Once I’ve written down all of the pertinent results and have started a draft of my daily progress notes, I get ready to go see my patients - also known as pre-rounding.

8:30-9:00am. My first patient is asleep and I wake her up to do a focused physical exam that includes heart, lungs, abdomen and checking for edema. She looks much better today and I think she’ll get to go home soon. My second patient is doing well, too, but is having a hard time coming to terms with the changes that will come when he gets bilateral nephrostomy tubes. I spend some extra time with him and let him talk. At the same time I feel sad because I know that this year is the last time in my medical career that I will have time to chat with patients like this.

9:00-9:10am. After seeing my patients I go find my patients’ nurses to see if anything important happened overnight (sometimes even bowel movements are important overnight events!). Then I wait for my intern in the team room so we can discuss the plan for each of my patients. The plans are pretty straightforward and include routine labs and watchful waiting so I don’t have to make any phone calls today.

9:10-9:45am. Our attending is set to arrive around 9:45 for rounds which gives me a solid half-hour to get some UWorld questions done. My team understands that our shelf exam is coming up so they don’t mind us studying whenever we get a chance.

10:00-11:30am. The attending arrives and suggests we do “table rounds” today (we discuss each patient in the room instead of at bedside) since our team is on-call and will start admitting patients from the ED at 2pm. This gives the team some time to write notes and orders before we get really busy. After we finish table rounds me and the other med student eat our lunch and do more questions until we start admitting.

2:00pm. The day-call team drops off the admission pager exactly at 2’oclock and my team gets a new admit almost immediately. I volunteer to take this patient and proceed to do a chart review before going down to the ED to do a full H&P (history & physical exam). My patient’s chart history is extensive and I have to sort through hundreds of old notes to get a good picture of what my patient’s medical history is.

2:30pm. My intern and I have finished our chart review and we head down to the ED with our senior resident to talk to the patient. When my intern and resident have finished asking their questions they give me a chance to ask my own. We then go on to do a complete physical exam.

3:00pm. After the H&P, my intern and I sit down to talk about the plan for our patient. Since this is a new patient we have to have a holistic approach and do a comprehensive workup. I start to work on my admission note (at this VA medical student notes are considered valid and it really helps out the team workload) and it takes me a little over an hour to make sure I’ve written a good note.

4:30pm. A code blue comes through our teams “code pager” and we rush down to the chemo infusion suite (the team on call carries the code pager all day and responds to any code). By the time we arrive, the anesthesia and cardiology code teams have already arrived and there isn’t much for us to do. Once the patient is stabilized, my team heads back up to our team room.

5:00-6:45pm. I go over my note with my intern and get some feedback. Once my note is finished I ask my team if they need me to do anything. I go check on my patients before I sit down to do some UWorld questions.

7:00pm. This is technically the end of our call day and our resident lets me and my co-med student go home. I feel a little guilty knowing that the team will likely stay working at least a couple more hours but I’m really excited to go home, eat and spend time with J & Melo.