A day in the life...

I feel my days are pretty much hum-drum. I do essential the same type of thing, with minor variations day-in, day-out. While I very much enjoy what I do, I don't assume that anyone reading this blog would find those things fascinating, or even mildly interesting. However, I do find that read other people's blogs about what they do all day very interesting. It occurred to me, while reading my niece's blog about her typical school day in the Sudan, that while she thought it was very much typical, it actually was fascinating.

As such (and with apologies if, after reading this you say, "yep, Nathan's life is not so interesting") here is a typical day: Today.

05:21am - Alarm clock goes off. I set it to go off at 5:21 because it has a 9 minute snooze. You can actually set the snooze, but I don't remember how. Sigh. Push the snooze button as quickly as possible to avoid awakening Alicia - the claxon gets louder and louder if you don't. It interrupted an interesting dream about myself and some superheroes (not the typical ones like Superman or Batman, but other superheroes that, in the dream seemed to be very common superheroes, but I don't remember what super powers they had) riding in a limousine. Not really clear on plot, but it was a cool story...

05:30am - Time to get up. Turn the alarm clock off. I don't actually remember how to do it, but have a procedural memory of what to do. In other words, if you asked me how to turn the alarm clock off, no idea. But I can do it without thinking as long as it is about 5:30am.

5:30-6:20am - Shower, restroom, shave. I never seem to remember to put on my glasses when I get up to the bathroom to get ready. After I have showered and shaved, I can't see well enough to really pick out clothes, or at least it is irritating not to be able to see them. I go back into the bedroom to get my specs.

6:20-6:30am - Ask Alicia (and awaken her) if okay to turn on light to find my glasses. She is super sweet. I also Apologize (note the capital letter) for doing so. Finish dressing, say our prayers and head downstairs. Collect my stuff and head out to the garage.

6:30am Am tempted to take Alicia's cool new car to work. It is a sweet ride. Decide that I love her enough to drive the old car.

6:31am On the Road - Salem is a beautiful land to live in. Green forests, lovely trees, NPR on the radio. It is a nice drive. Not too much traffic.

6:36am. Park in physician's parking lot. It is NICE to be a doctor. Finally get to have a parking spot close to the door (though the sign does say "this parking space may be blocked anytime, 24 hours a day, by an oxygen delivery truck". So far I've been lucky, and they haven't paid the O2 delivery man double-time to be at work at 6:30am. Walk upstairs to the locker room.

6:38-6:40am Change into scrubs. Sometimes I wonder why I bother to dress at all. I only wear my street clothes about 18-20 minutes in the morning, and a few hours in the afternoon. I anticipate that I may face legal ramifications if I didn't dress, however. Will continue doing so.

6:41am - Today I'm working at the 2nd building of 3 on the hospital campus. Stop by to pick up narcotics from the nice pharmacy lady. Today is a very slow day for the OR. I only have 2 cases scheduled because 1 was cancelled yesterday. The patient told me that she didn't have the insurance so she wasn't going to come. I tried to let the surgeon know, but he wasn't so interested in hearing about that. So anyway, I have a case that starts at 7:30am, and one that starts at 12:10pm with about a 4 hour break. I plan on driving home and visiting with Alicia.

6:43am Get to my OR. As usual, I'm the first one in the OR. Turn on my anesthesia machine and perform several checks on it to ensure that it works properly, that the ventilator works properly. Draw up emergency drugs in syringes: Succinylcholine 100mg, Rocuronium 50mg, Glycopyrolatte 0.5mg. Also mix up small bottles of pressor agents: 30ml of 5mg/ml Ephedrine, 30 ml of 100mcg/ml Phenylephrine, 10 ml of 10 mcg/ml Epinephrine. Draw up drugs for the case - Fentanyl, Propofol, Lidocaine. Prepare endotracheal tubes - 7-0 with a stylet, 7-5 with a stylet, laryngoscopes: Miller 2, Macintosh 3 and verify that lights are working. Prepare oral airways. Prepare suction cannister. Review in my mind my mnemonic device: SOAP C- Suction, Oxygen (ability to deliver positive pressure ventilation), Airway adjunts, Prepare drugs, Comfy chair to sit on. Also prepare I-pod to deliver beautiful music to the OR. It turns out I'm not only a doctor, I'm the DJ in the OR. Today it is going to be 60's hits starting with "Happy together" by the Turtles. Also, I included all of those drugs and jargon terms so that you would believe that I am actually a doctor.

7:02 - Go to the Preoperative Holding area to meet my first patient. The patient is a lovely lady who, unfortunately, has gallstones. I spoke with her last night. She is "allergic" to lidocaine (likely not a true allergy - allergies are things to which people have an immune mediated reaction). Lidocaine is one of several drugs to which allergies are extremely rare. It makes her feel funny. A favorite joke among doctors is to compare what "allergies" patients have. Some people say they are allergic to epinephrine. That would be impossible. Biochemcially epinephrine is too small, is an endogenous chemical, and is a treatment for allergic reactions. On further questioning they say that, "It makes my heart race." I used to spend lots of time and energy trying to explain the difference between allergies and side effects, but have stopped doing that of late. Otherwise, my patient has some nerve pain, and back trouble. I examine her, listen for murmurs and ensure that her lungs are okay, and that her airway is appropriate for the anesthesia plan I have. We discuss the plan at some length, and joke around a bit. I then go look for the circulating nurse. It is required, at Salem hospital, that we have the circulating nurse review all the patient data one final time before we go to the Operating room. Finally, she is ready. I give a benzodiazepine so that the patient becomes sleepy (a drug like valium), and head back to the OR.

7:23 - In the OR. We ask the patient to move from the gurney to the OR bed. Then we place monitors on the patient. Blood pressure cuff, EKG, pulse oximeter. The patient starts breathing oxygen from a tight fitting mask. Once all of the things are ready, I give the patient IV medicine to make the sleep. No problems today. Using my tools, I place a breathing tube from the mouth to the windpipe, start mechanical ventilation, secure the tube, tape the eyes, position the arms, and turn on the inhaled anesthetic gas. Anesthesia has begun....

(to be continued tomorrow)