Around the Clock

August 30, 2011
Authored by

4:15 a.m. Lauren Finely’s iPhone alarm buzzes. Finely, a 26-year-old first-year medical resident, slips on baby blue scrubs, grabs some fruit, and makes a coffee-to-go for her 15-minute commute to GW Hospital, where a long day is about to begin.

Finely, an obstetrics and gynecology intern, is the first person to visit each patient in the morning. She takes vitals, conducts a physical exam, and orders any necessary tests or medications.

Residents like Finely are the backbone of teaching hospitals like GW. When students graduate from medical school and officially become doctors, they’re required to complete graduate medical education at a teaching hospital where they’re supervised by attending physicians. Depending on the specialty, a residency can last three to five years.

For Finely, a day can include delivering a baby, conducting a C-section, or performing a hysterectomy while still finding time to study and prepare for the third part of the United States Medical Licensing Examination, which residents are required to take halfway through their second year.

“One of the hardest things about residency is being here for 75 to 80 hours a week and then having to go home, pull out your textbook and read about things you didn’t understand or need to prepare for the next day,” says Finely. “There’s a lot more expected of you.”

6:30 a.m. Finely and the other residents, as well as the attending physician on call, gather in a conference room, coffees in hand, to discuss the OB/GYN patients on the third floor of the hospital. Finely reports on each of her patients and the chief resident, Rachel Seay, M.D., fires questions at her.

The role of doctor and teacher go hand in hand.

“There’s a big emphasis at GW on learning how to be a teacher,” says Seay, a third-year resident. “I try to make sure someone really understands the idea behind the factoid. They need to understand the bigger picture.”

Most first-year residents, also called interns, are required to participate in GW’s Residents as Teachers program, which trains residents on how to teach medical students, who shadow residents as part of their rotations in the third and fourth years of medical school.

“GW has a culture of creating good educators, and I think it’s something we are good at and take pride in,” says Nancy Gaba, M.D., associate dean for graduate medical education and director of the Obstetrics and Gynecology Residency Program. “You’re always teaching someone. Interns teach medical students. Chief residents teach interns. Attending physicians teach chief residents, and everyone teaches the patient.”

As chief OB/GYN resident, Seay is responsible for all the OB/GYN patients in the hospital. An intern dedicated solely to obstetrics and another intern dedicated to gynecology reports to Seay, and an attending physician oversees the entire staff and unit.

In addition to delivering several babies a day and consulting with patients, Seay spends about 15 percent of her time in the operating room — or OR, as it’s known inside the hospital walls — doing procedures such as removing benign tumors in the uterus.

To get through the hectic days, Seay drinks a lot of coffee, keeps several granola bars in her bag, and wears what she describes as “really ugly but really comfortable black slip-on shoes.”

“I’ve come to the point in my life where I don’t really care how I look. It’s all about comfort — at least when I’m at work,” she says.

Seay, who went to medical school at the University of Colorado, was drawn to OB/GYN because it’s a mix of primary and specialty care. For many women, their OB/GYN is their only doctor.

“I wanted to do something that involved surgery but also preventative health,” says Seay, who wanted to come to GW for residency because of its large volume of patients and its faculty. “We have really amazing teachers here.”

The most challenging part of the job, Seay says, is bringing the same level of dedication to each patient visit. A doctor may deliver a baby several times a day, but for each mother, it may be the first and only time she experiences childbirth.

“When you walk into a patient’s room, you have to set aside whatever you were just doing, set aside how tired you are or how stressed you are and be present in the moment for the patient,” she says. “There are moments where it’s hard to do that, but that’s part of our job and our responsibility.”

8:30 a.m. “You’re doing fantastic. Push, push, push,” Finely says as she coaches her patient through childbirth.

As the fetal heart rate monitor beeps in the background, the woman delivers a healthy baby boy, and Finely helps the new father cut the umbilical cord and then delivers the placenta.

“Congratulations,” Finely says. “He’s beautiful.”

Although this is only Dr. Finely’s fifth week on the job, she has managed dozens of deliveries already. An attending physician always observes or assists her.

“Everyone is really nervous when they start as an intern. You still have people backing you up and that you can turn to for questions, but it’s kind of the first time you can mess something up and hurt someone,” she says. “But it’s really exciting to finally be doing what we’ve gone to school for the past eight years.”

Finely, who went to medical school at Wake Forest University, always knew she wanted to be a doctor, but it wasn’t until she went on a medical mission trip to Kenya, Cameroon, and Ethiopia that she discovered her passion for OB/GYN.

“I fell in love with women’s health issues in Africa,” says Finely, who plans to move to Africa to practice OB/GYN after finishing residency. “I saw a large number of women that had negative outcomes because of the lack of prenatal care. The women there suffer quite a lot and have tremendous consequences to overcome.”

10:30 a.m. Dressed in a sterile gown, mask, and gloves, Elizabeth Phillips, M.D., carefully uses an ultrasound to insert a central line into a patient’s internal jugular vein.

Thankfully, the procedure is just practice. Phillips, an emergency medicine intern, is sharpening her skills on a patient simulator.

Most interns are required to practice in GW’s Simulation Lab on the sixth floor of the hospital. Inside the lab are medical supplies and patient simulators that medical students and residents can use to practice various procedures.

The Simulation Lab is just one part of the training that residents receive outside the hospital units.

Before this year’s 85 new interns even set foot in the hospital, they went through a three-day orientation, where they learned about everything from sleep deprivation to employee benefits to paying off student loans. They also received their individual white coats embroidered with their names.

“It was like being a grown-up for the first time,” says Phillips.

GW’s Office of Graduate Medical Education also schedules several professional development lectures throughout the year on topics such as patient safety, electronic medical records, alternative medicine, and duty hour restrictions.

Earlier this summer, the Accreditation Council for Graduate Medical Education instituted new restrictions on a resident’s work hours. But the hours remain grueling. Interns are still permitted to work up to 16-hour days, and all other residents are permitted to work up to 24-hour shifts. All residents are guaranteed only four days off a month.

Regardless, the lure of medicine continues to bring in strong groups of residents year after year. Phillips chose GW for residency because she thought it had the strongest faculty, who were especially engaged in influencing national health policy.

“I think my generation of physicians is going to be challenged with some huge sweeping changes in the structure of health care,” she says. “I’m hoping that by being in D.C. and doing my residency at GW with physicians who have such broad research areas, it will allow me to be involved in policy.”

12:30 p.m. Hope Jackson, M.D., is exhausted — and for good reason. Jackson has just finished a 24-hour shift.

“There’s a Potbelly milkshake with my name on it,” she says.

As a third-year surgical resident, Jackson does about four surgeries a day. More than two-thirds of the surgeries are scheduled, and the rest are trauma cases. And although she’s been working full-time in the OR for two years, she still gets excited every time she scrubs in.

“Surgery is one of the only specialties where you’re able to use your own hands and sometimes place them in someone else’s body and make them better,” says Jackson. “That’s such a great gift. I feel like I’m really helping people.”

Jackson, who went to GW’s School of Medicine and Health Sciences, once wanted to be a pediatrician. To her, surgeons were overly competitive, mean, and uninvolved with their patients. But during her surgical rotation at GW Hospital, she realized her perceptions were wrong and ended up falling in love with surgery.

Depending on the surgery, she can be inside the OR for 15 minutes or 15 hours. One of her favorite surgeries is a hernia because “the anatomy is really fascinating,” she says.

“It mentally challenges you to understand the components of the abdominal wall and how to put it back together,” says Jackson, who chose to stay at GW for residency because she felt like it was the place that pushed her to be her best.

While Jackson was wrong about surgeons in several regards, she was right about one thing – their competiveness.

Each Wednesday, the surgical residents play softball against the orthopedic, anesthesiology, or radiology team.

“It’s really competitive, and it gets very serious around the playoffs,” says Jackson, the captain of the surgical softball team. “But it helps build a nice working relationship with everyone.”

3 p.m. Phillips walks into GW’s Emergency Room to begin her nine-hour shift. She's immediately responsible for 12 patients. One needs an X-ray. Lab results are pending for another. And a third patient is waiting on an ultrasound.

For Phillips, the hardest part is feeling like she’s always behind.

“I feel like I can’t catch up. I’m juggling all these patients, and the list just gets longer and longer,” says Phillips, who went to medical school at Case Western Reserve University. “GW has an extremely busy Emergency Department.”

Phillips, who started her residency on July 1, has one main goal right now: try to not make a mistake.

“Everyone is terrified when they’re first starting out. There’s just such an immense amount of knowledge and skills you have to learn in a short amount of time,” she says. “The transition from being a medical student to a resident is one of the steepest learning curves of your life. And I’m still not used to being called ‘Dr. Phillip’ all the time.”

Despite feeling like she’s treading water most of the time, Phillips thinks she was made to work in the ER.

“I’m not overly Type A, so I’m able to go with the flow and deal with all the surprises that come up and not get overly stressed,” she says.

Emergency management residents work nine-hour shifts during the week and 12-hour shifts on the weekends. During any given shift, GW’s ER will see an average of 100 patients.

“We get to see all walks of life — young, old and every background you could imagine — especially at GW. You could get a diplomat, a homeless person, a student, or anyone in between,” she says. “We’re really the first people that put the pieces of the puzzle together.”

8 p.m. After finishing a pile of charts and discharge papers, Seay and Finely head home for the night. They’re both starting new rotations tomorrow. Seay will be working at Inova Fairfax Hospital — one of GW’s many affiliate hospitals. Most of GW’s 37 residency programs require their residents to spend a few months at different hospitals.

Finely will be working in GW’s Intensive Care Unit — one of the four non-OB/GYN related rotations OB/GYN residents are required to complete. Most of GW’s 430 residents are required to work in the ER, the ICU, and internal medicine, regardless of their specialty.

While Seay and Finely will have about 10 hours away from the hospital before starting their next shift, it’s difficult to leave the mental baggage at work.

Specific patients are still on their minds. An upcoming surgery is keeping them from relaxing completely. And part of a case today was confusing, so they pull out their textbook and study.

“There’s always something to learn. There’s always something to do,” Seay says. “With medicine, it’s never done.”

Balancing personal and professional lives can be challenging.

Seay, whose husband is a naval aviator stationed in Norfolk, Va., struggles to find time to cultivate her relationship with her husband, family, and non-medical friends when she’s exhausted after working an 80-hour week and still has material to study.

“It’s very easy in medicine to get very consumed with this and the people you work with because you form a really strong connection with the people here that are doing the exact same thing you are,” says Jackson.

But finding that balance is possible.

Jackson and Seay both say they look up to attending physicians in their departments who manage the demands of being a doctor along with the demands of being a wife, mother, daughter, and friend.

“I think that it’s important to maintain your personal life because that maintains you being a human being,” says Phillips. “And when you maintain being a human being, you’re a better doctor.”

 This story was originally published by GW Today.

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