A Day's Anatomy - Inside the life of a pediatric resident
It's 5:37 a.m. in the River North area of Chicago. While most of the city is still asleep, Rishi Lulla, MD, is already en route to Children's Memorial Hospital, where he is a senior resident. Lulla is one of 86 young physicians enrolled in one of the most sought-after pediatric residency programs in the nation. In fiscal year 2007, more than 800 applicants competed for 31 positions at Children's Memorial. With the popularity of television programs like “Grey's Anatomy,” the role of residents is attracting greater interest. Lulla's role is a critical link in patient care at an academic medical center like Children's Memorial.
6:09 a.m.: Lulla, whose rotation this month is in childhood cancer and blood disorders (hematology/oncology) begins his day on the hospital's fourth floor, consulting with nurses to learn how his patients fared overnight. He discovers that two new patients were admitted just after midnight. He reviews laboratory results and begins pre-rounds. He checks on his patients whose conditions range from hemophilia, a genetic blood disorder, to leukemia, a common form of cancer. Most are sleeping at this hour, but some, like Jared, 7, are running a fever and unable to sleep soundly. Lulla reassures him that fevers are to be expected and should resolve soon. He monitors patients' vital signs, particularly blood counts. One child's hemoglobin level is low, and he makes a note to order a blood transfusion.
7:03 a.m.: Lulla meets up with his hematology/oncology resident team for Patient Management Rounds. As a third-year resident, Lulla is an important teacher to others, especially first-year residents, known as interns. During the group's examination of each patient, he quizzes the interns, correcting them when necessary. Together they devise a plan for each child for the day, which will be presented to the attending physicians later that morning.
8:19 a.m.: During the Morning Report, Lulla listens to residents present atypical medical cases to faculty members. One case involves a 6-month-old infant recently diagnosed with sickle cell anemia, a condition usually identified at birth. Robert Listernick, MD , an attending pediatrician and professor of pediatrics at Northwestern University's Feinberg School of Medicine, questions the residents to explore hypothetical scenarios for progress of the child's condition under different treatment options.
9:01 a.m.: Lulla participates in Rounds, a daily meeting where a multi-disciplinary team, comprised of residents, attending physicians, registered nurses, pharmacists, nutritionists, social workers and case managers, discusses each patient's progress. In addition to physical condition, the group may discuss a child's psychological state and any family issues that may affect his or her treatment or long-term recovery. The team is concerned about a patient family that is struggling with financial and transportation challenges and they formulate a plan of assistance, led by the hospital's social workers. It is important to ensure that the child, who is battling a rare form of cancer, has access to proper nutrition, supplies and medication once he returns home.
11:07 a.m.: The next hour is a flurry of follow-up activity for Lulla and the team as he places orders for transfusions and laboratory tests and other procedures. They also schedule consultations with other specialists and re-examine patients.