Have you ever wondered what the day-to-day life of an Emergency Medicine resident is like? Emory Emergency Medicine PGY-2 resident Aadil Vora outlined a typical day in his life so we can catch a glimpse.
5:00 am – Wake up and hit the snooze button. I should be getting ready for the gym. It’s in Ponce City Market (PCM), an unapologetically hipster food hall and shopping center in my neighborhood, Old Fourth Ward. My gym, PCM and the Beltline sidewalk I take to get there are some of my favorite places in this outdoorsy, active city. I have a shift starting at Emory University Hospital Midtown at 6:30 am; I can squeeze a workout in, but last night I went to Dr. O’Shea’s house for a St. Patrick’s Day party that went late. I am truly thankful for attendings like him who have welcomed residents like me, brand new to Atlanta, into their homes and families. The bowls of homemade Irish beef soup I had at his party are sitting in me heavily still and I decide to sleep in.
6:00 am – Time to get to Emory University Hospital Midtown (EUHM), it’s a ten-minute drive.
6:30 am – Shift starts! Today I am working in the Gold Zone at Midtown with Dr. Daniel Wood EUHM is a smaller community hospital sitting on the border between Midtown, a more affluent urban area in metro Atlanta, and underserved downtown. Grady, our Level 1 county hospital, is quite different from Midtown. For example, we coordinate care with PCPs at Midtown regularly, consult private practice physicians on-call and admit directly to attendings. Our residency program rotates through Midtown to give us the experience of practicing Emergency Medicine at a community hospital, the setting most EM physicians work in.
I meet Dr. Wood and introduce myself to his scribe and the Charge nurse. It is a busy Tuesday morning and there are three patients already who need to be seen in my zone.
7:00 am - My first patient is a middle-aged man with epigastric abdominal pain radiating to his back. His physical exam and history point toward a gallbladder or pancreatic issue. I hone in on his history of alcohol abuse and that his pain gets worse when he lays down. His labs come back showing the beginnings of DKA, pseudohyponatremia due to his lipemic blood and lipase in the thousands. To rule out a stone Dr. Wood suggests getting an Ultrasound, which shows distorted ducts indicative of pancreatitis. After we start this patient on an insulin drip, fluids and pain medication, I call the ICU.
8:00 am - The next two patients I see are quicker to disposition. The first is a gentleman in distress endorsing suicide ideation. A psychiatric assessment team visits the patient and agrees with my plan, he should get involuntary held and be admitted to their unit. Seeing psychiatric patients is always emotionally exhausting, but a good learning experience because we don’t see psychiatric patients at Grady since psychiatry is its own unit in the ED. The next patient has a surgical site infection, I call her vascular surgeon. He is able to set up an appointment to see her later this afternoon. I love it when the stars align like this! Just as I am finishing up this phone call, EMS brings in a critical patient and Dr. Wood and I drop what we are doing and rush to the resuscitation room.
9:00 am – EMS rolls in a man who was found down, unconscious outside a government building with a bradycardic pulse to 40, no blood pressure, hypothermia, hypoxia, and agonal respirations. Every single vital sign needs to be addressed, this patient is peri-arrest. Dr. Wood is coaching me through this resuscitation. “Start off with your ABCs.” He and I agree that the airway is stable for now and we can tolerate the poor breathing effort too because we need to address circulation since the blood pressure will likely drop dangerously low when we intubate. A rapid EKG shows junctional bradycardia. We do a quick echo and see a poor squeeze but no dilation of the ventricles, so obstructive causes like PE drop on our differential. We dose atropine and then start transcutaneously pacing this patient. It works temporarily but we need a better MAP, so Dr. Wood mixes together with a quick epinephrine push dose pressor. This helps. We now have a blood pressure that can likely sustain intubation. The stimulus from the pacing has improved this patient’s mental status. I move to the head of the bed and intubate the patient with a Video Laryngoscope Mac 4 blade. My eyes are focused on the pharynx, but Dr. Wood can see exactly what I can on the screen while I am intubating. We confirm the airway and then I quickly get set up for a central line. Once the line is in some labs start to come back and we give the patient calcium and pressors. He has hyperkalemia. Does he have other metabolic derangements, is he septic? The patient has been successfully stabilized, but he will need close monitoring. I call the ICU to admit him and also help brainstorm the inciting event for this undifferentiated patient. My lead differential right now is something toxicology due to his labs, pupils, dry axilla and cardiogenic shock, but metabolic, infectious and obstructive causes are still possible.
11:00 am The next five patients I see are lower acuity, thankfully. I reassure a lady with non-cardiac chest pain. I treat a college student’s migraine in a dark room. I admit an elderly nursing home patient with a complicated UTI.
1:00 pm - My shift is almost over when I get a call from a clinic upstairs. They are sending down one of their patients who was found to have persistent tachycardia. By the time I get off the phone, the patient is in a room and nursing staff has placed her on a monitor. Before I walk in, a nurse tells me this patient is transgender. I walk in the room to find a pleasant lady laughing at all the hubbub around her. “Ya’ll, why the fussing? Relax! I feel fine!” Meanwhile, the monitor is pulsing 130 times a minute and I don’t see P waves. Before I explain to her my concern, I introduce myself as an ally. I am honored to be able to take part in the care of a member of the LGBTQ community. I understand the prejudice they face and resulting in hesitation in seeking care. I am privileged to have this pleasant lady trust me. Atlanta is a special, progressive community which welcomes diversity, I see it reflected in the department daily. An EKG tech sticks leads on the patient and Dr. Wood and I look at the rhythm strip. It seems to be a Supraventricular Tachycardia, but it is on the slower side. We first try fluids in case this patient simply has sinus tachycardia. After more scrutiny, we are fairly certain she has an SVT. After trying a vagal maneuver, we give the patient a medication that resets the heart. We hold our breath when we see the temporary asystole, and she converts to a normal rhythm temporarily. We double the dose. It works this time and keeps her at a regular rate and rhythm. I admit this patient to our observation unit where she will get an echo and an Electrophysiologist will meet her in the morning.
2:30 pm - My shift is over! It was quite a day. I took care of some of the sickest people in the hospital and also discharged several not-sick people home in an eight-hour shift. I finish my notes in about an hour and head home. Since I put off the gym earlier today I am going to go this evening before dinner.
5:30 pm - Gym time!
7:00 pm I stop by my co-residents place to hang out on his rooftop and play with his cat, who I am allergic to but find too adorable to keep from.
9:00 pm - Time for bed, tomorrow morning is conference, but it starts at 8 am. Maybe I’ll make it to the gym this time.
As you can see, Vora’s typical day starts around 5 am and finishes by 9 pm. It is a long day, but he is passionate about his career and wouldn’t have it any other way. Vora is a newly minted PGY-2 resident and Chair of the Emergency Medicine Residents Association’s Research Committee.
Aadil grew up in Fremont, CA and completed a combined 6-year Undergraduate and Medical degree at Nova Southeastern University, in Fort Lauderdale, FL. He chose to specialize in Emergency Medicine because of its unique character as the “15 most important minutes of every specialty.” While he enjoys the acuity and variety of Emergency Medicine’s practice, he loves the broad view of medicine it provides, which instills within physicians the perspective and experience to become leaders in healthcare.
Patient demographics have been changed to protect their privacy.