The last 3 days gives you an idea of what it’s like to try to balance Orthopaedics and fatherhood and your spouse.
On Wednesday I got up and into work by about 6:30am. Which is great because as an intern i was was getting in much earlier. I printed out our patient list to see if any new people were admitted to our service overnight. I also started going through our EMR to make sure folks didn’t have any new PT notes or event notes written. Then I went down to “The Boards”.
The Boards is the official name for the presentation of all the inpatient and ER consults that came in overnight. It is held in our conference room in front of our orthopaedic trauma, pediatric, and hand attendings. At many institutions this is done more privately in front of a computer with the on call attending and the on call resident but at Hopkins we believe in pizazz, lol. No really, while it is more stressful to present in front of all of your attendings and fellow residents, I believe this process better prepares you for what you will experience during your oral boards. So what is a boards presentation like? Well I was taught that a boards presentation should be done all in one breath, and provide enough information to satisfy most attendings questions but not provide so much information that you portray that you know it all making you a target for very difficult questions. For example( this is made up and does not reflect a real patient I saw):
This is a 35 yo female who twisted her ankle while walking in snow and sustained this closed, neurovascularly intact L Weber B ankle fracture. Stress views were negative. She was closed reduced and placed in short leg Bulky Jones splint.
And of course while you are saying all of this you are showing your pre and post-reduction films to the audience. If you are lucky and presented clearly and your reduction looks good you won’t get further questions and you can present your next consult.
As an aside the board presentation should include all the aspects of a regular Orthopaedic presentation:
1. Age and pertinent PMH
2. HPI including mechanism of injury
3. Physical exam
6. Assessment/ Plan
Okay so back to my original post, I went to the board and heard all the consults that came in overnight. Since I was on call that day I grabbed the call pager from the previous on call resident and went to clinic. We had about 40 patients in clinic and so we got to work quickly. Of course I’m still holding the call pager so I would have to leave intermittently when a pressing consult came through. By 5 PM we were done with clinic and so I went to the floor to get sign out from the trauma, peds, spine, and hand teams so that they could go home. By 6.30 pm myself and the overnight PA had the pagers and we set out to take care of patients that were post op.
The consults started rolling in around 8 pm the most concerning of which was a compartment syndrome of the hand with multiple phalanx fractures after a crush injury. This case had to be rushed to the OR immediately and so I was operating from 11pm to 3:30am with my hand attending. After I got out of the OR I saw a couple of other ER consults and them from 4:30am to 6 am I was writing consult notes based on what I had seen overnight. Then I rushed to get my board presentation with accompanying X-rays together for 6:45am. Boards went well and I then joined my normal trauma team for rounds from about 7:30 to 8 am. Afterwards I had to see more consults that had come in before the pager hand off time which was 7am. Afterwards we had grand rounds and teaching which went from 7am to 12 noon. You have no idea how hard it is to stay up for 4 hours of lecture while post call and not getting an ounce of sleep the whole night. So yeah my head was definitely bobbing through out lectures.
After lectures I went home and and my beautiful daughter and handsome son were playing in the living room. Honestly seeing them really makes everything worth it. I played with my kids for about 1 hr and ate some Jamaican bun and cheese that my grandma made for Easter. Then I went upstairs and collapsed in my bed, sleeping until 8pm. I woke up at 8 pm and talked with my wife about her day and helped her pack for our trip to Huntsville, AL for our college alumni weekend. She was leaving earlier with the kids because I had to work the next day until at least 5pm. So I helped her pack the suitcases and put the kids sleep. The next morning was our trauma team post-op conference which involves the PGY-2(me). In this conference the PGY2 gathers together the X-rays for every patient we operated on from last Friday to the next Thursday and presents them to the attendings in the standard format. We look at the preoperative films and the post operative films and discuss a variety of things including indications for surgery, nonop reduction techniques, approaches for getting down to the fracture in question, relevant anatomy, the various types of implants that were used, and what their post op plan is like weight bearing status, etc. As you can imagine this takes hours to get together and often times you end up reading about more than what the attendings pimp you about but it’s great to learn from.
After post op conference I went to the OR and we had a couple of cool cases like two weber B ankle fractures, a retrograde femoral IMN, one modification of a Taylor Spatial Frame, etc. They let me leave at 6 pm so I could get home earlier to pack for my trip to Huntsville. I jumped on the plane to Huntsville and arrived by midnight. The next day I went to church and enjoyed the alumni weekend festivities. On Sunday I went to the board meeting for a missionary group called NAPs (http://napsoc.org) and then I hopped on the plane back to Baltimore, again arriving back in Bmore at midnight.
I slept for 3 hours and got into work by 5 am because I was on call that day… Another 25+ hour shift.