A Day in the Life of an Emory Urology Resident

My alarm goes off, but I snooze for 5 more minutes. It goes off again, and I again snooze for 5 more minutes because I am really not a morning person. My partner groans at me to get up, so I roll out of bed and stumble to my closet. I throw on a pair of green Grady scrubs and brush my teeth. I splash some cold water in my face and try to rub the sleep out of my eyes. I start the Nespresso machine while I collect my belongings and give my two kitties a little head pat. I’m out the door of my Decatur apartment within 25 minutes. Decatur is a little more suburban than the city, and I love my little apartment that has a beautiful view of the woods behind the complex. On mornings that I don’t work, I usually curl up in my hammock and read my book while looking into the woods. Atlanta is called “the city in the forest” for a reason.

Time to hop in the car and drive to Grady Memorial Hospital, a twelve to twenty minute drive depending on the time of day. This early, it only takes about 14 minutes.

I grab my mobile order from the Starbucks in Grady, and I walk up to the Urology workroom while the intern is just finishing up numbers. I inhale my bacon, egg, and cheese biscuit while the intern and I chat about one of the new consults that came in overnight for a gunshot wound to the scrotum that was repaired by our overnight team. He’s doing well and we will plan to check on him this morning. Today there are two primary patients and three consults to see. Grady is the Level 1 Trauma Center in town, so days (and nights) are always exciting here. You never quite know what will come through the doors. The intern and I make a preliminary game plan before the seniors get here. Everyone arrives, and then we round before the OR.

Thankfully, the patients are doing really well this morning. Both of our primary patients are ready to go home, so the intern works on the discharges while I run to the OR to check in on things and see if we have all the supplies we need for the first case. It's a busy Friday morning, and on Fridays I typically run the endoscopic OR with one of my favorite attendings. I check in our first patient, a woman with a newly diagnosed 3 cm bladder tumor. She’s nervous because she has never had surgery before, but we bond over our mutual love for the University of Alabama, my alma mater. Roll Tide! Simultaneously, my seniors have just finished checking in their first case (a right laparoscopic simple nephrectomy), and I meet them in their OR to make sure we are all on the same page about plans for our patients.

The first TURBT went super smoothly. The bladder tumor was on a stalk and was easily resected right off the bladder wall with just a few swipes. Sometimes, TURBTs can be super stressful, especially for a junior resident if the tumor is in a difficult location or its very vascular. Thankfully, this one went as planned, and I feel proud of how far my endoscopic skills have come. My attending barely had to touch the scope, and she compliments me before she leaves the room after the case!

After I check-in my next patient, I run down to the workroom to say “Hi” to all the APPs that are doing clinic and to check-in with the intern. He tells me that he just got a consult for a difficult foley placement. The nursing staff has been unsuccessful at placing a catheter and the patient has been in retention for over 10 hours. He has a history of prostate cancer and has had radiation, so we chat about the possibility that he may have a stricture. I tell the intern to give it a shot, and to call me if he needs some help.

A few minutes later, the intern calls me and says that he thinks our fears are true, and he believes that the patient has a urethral stricture. I bring a guide wire and the dilation tray to the bedside. Next, I teach the intern how to sequentially dilate a urethra over a wire using S-curve dilators. We get the foley in and over a liter of urine drains into the bag! He feels sooo much better and thanks us for helping him!

We staff the consult with our attending, and then I have to run to the OR for my next case!

Whew! That case was really, really difficult. We just finished a left ureteroscopy with laser lithotripsy on a 28-year-old man who had a retained ureteral stent. The stent was originally placed over three years ago but unfortunately, he was lost to follow up. Now, stones were encrusting the whole stent and we had to laser the stones off the stent just to get it free from the collecting system. We finally got it out, and the patient pinky promised that he would follow up in two weeks to get the new stent out!

Right as I finish cleaning the betadine off the patient, the intern comes barging into our OR with urgent news that there is a gun-shot wound victim in the OR next to us and they need our help with repairing a couple of cystotomies from the trajectory of the bullet. He quickly gives me and my attending the story while we walk to the adjacent OR. My attending and I scrub in to assess the situation. Usually, the more senior residents help with bladder repairs, but since they are scrubbed in the nephrectomy, it is my turn to step up! The intern also scrubs in since he is otherwise caught up on consults and it’s a really good learning experience.

My attending shows me how to do a two-layer closure on a bladder and then hands me the instruments to complete the closure. This is the first bladder I’m sewing and I am really focused because I do not want to mess this up! We replace the catheter and do a leak test—moment of truth! Its water-tight and I feel a wave of relief.

What a morning! Just as we finish the bladder repair, the seniors are finishing up their nephrectomy. We all decide to run to the Sweet Auburn Food market a block away for some lunch. They have a ton of restaurants to choose from, but I always get the Vietnamese pork and eggroll vermicelli bowl. Yum! We all meet outside after getting our food to debrief about our morning.

My last case was delayed because my patient showed up late due to “traffic.” Honestly, I am not that upset because it gave me time to eat with the team and take a quick break after a busy morning. The last case of the day is a 46-year-old with a very large hydrocele - about the size of a grapefruit! He says that it has been bothering him and stops him from doing his daily walks.

The hydrocele ended up having about 700 mL of fluid in it! I got to do this case with the PGY-4 and my attending didn’t even have to scrub in. She just gave us some pointers from the sidelines. My PGY-4 and I have gotten really close this rotation, and she lets me lead the surgery! We drain it, invert the sac, and close him up. We spend a lot of time obtaining hemostasis so that we can sleep a little more soundly tonight.

I get back to the workroom just as the APPs are finishing up with clinic patients. While the PGY-4 and I were operating on the hydrocele, the intern had some time in between consults to perform cystoscopies in clinic. He diagnosed a new bladder tumor on a 70-year-old gentleman with a strong smoking history and tells me that he is planning to book him for the OR in a few weeks for a TURBT. The service is resident-run at Grady, so we have a lot of freedom to make our own surgical schedule. We pick a day that only has a few other cases, and we put our new patient on the books after briefly discussing the plan with our attending.

The whole team debriefs about the day and the patients on the list. We go over all the new consults that the intern got today and make sure everyone is tucked in before the on-call resident starts their shift for the weekend. We decide that we all need to see a patient that we have been following for recurrent hematuria before we leave to make sure his catheter is draining appropriately since he was having a lot of clots in the tubing earlier today. We get to his room, and his urine looks pretty dark. The intern runs to get the irrigation supplies and then we irrigate the patient’s bladder. Fortunately, the urine clears up with only a few syringes of water, so we conclude the irrigation and give a collective sigh of relief.

Finally, we finish the sign-out email for the weekend team. We are in the habit of splitting the work until it's all done and doing a team walk-out together. We all leave feeling accomplished for the day and laugh about crazy things that happened during this past week on our way to our cars.

Since it's the start of the weekend, I am on the way home to change out of my scrubs and meet up with a few of my residency friends for chips and queso at our favorite Mexican restaurant. I get the big margarita to reward myself for another week getting Gradied (our endearing term for being busy at Grady and thriving.) Bryan, my husband who is not in the medical field, is barely understanding all this doctor-talk and looks like he is on the verge of vomiting after we talk about a particular stomach-turning story about various body fluids. For his sake, we switch subjects and instead chat about weekend plans and the upcoming concert that we are all planning on attending. Bryan is now looking less green and we order another round of margaritas to end the night!

Bedtime!