A Day in the Life

A Day in the Life of a PGY-1 Resident
By Laura Powers, MD

Hello, and thanks for checking out our residency! It is challenging to decide how to summarize "a day" in my life as an intern-- of all the years of residency, the first year is unique in its great variety of clinical experiences. As I write, I'm about to begin my third rotation of the year; we rotate every four weeks, doing a total of 6 months in psychiatry, 4 months in medicine, and 2 months in neurology. I started my year on general adult inpatient psychiatry. Each day began with pre-rounding; I glanced through the notes in my patients' charts to develop an idea of how they did overnight, and then I checked in on them briefly. During this morning interval, I often checked in informally with the nursing staff, as well. The nurses on my unit were fantastic; they felt like true allies, providing invaluable feedback about the patients on a daily basis and direct guidance to me regarding management when I needed it. Eventually the team gathered for rounds, which I found became one of my favorite parts of the day. Rounds on Madison 5 (my unit) were "sacred time," so to speak. It was a time when we were nearly free of interruptions, and the whole team-- attendings, residents, medical students, social workers, nurses, therapists, and psychology interns-- put our heads together to share our thoughts and develop a plan for the patients. During the course of the day, the remainder of my time was spent either on day-to-day "floor work," attending didactic sessions, or talking more at length with my patients. The patients' daily scheduled contained a terrific balance of structured and unstructured time; they had the benefit of steady group therapy (and we had the benefit of hearing the facilitators' observations of the patients in a group setting), while still allowing ample time for us to speak to them throughout the day. My attendings made themselves very available to me despite large case loads; particularly during my first month of residency, I often found myself needing to run various situations by them, and they were more than willing to debrief (in some cases even if they'd already left for the day). I couldn't have asked for a better intro to residency-- July tested me and stretched me in ways I hadn't anticipated, but this was what made the experience so exciting and rewarding. I was able to experience the challenges of starting a career as a doctor in an environment that gave me the support I needed to feel equipped for the job. In August, I shifted to the very different world of outpatient internal medicine. I got to experience firsthand the fast-paced nature of clinic work, and broadened my knowledge of primary care and its tremendous overlap with psychiatry. I learned to appreciate many of the unique challenges that come with practicing medicine outside of the "bubble" of an inpatient unit. And now... on to the ER! I'm eager to see what awaits me there, and in my subsequent rotations. Sinai is a wonderful place to train and grow as a doctor, and I'm delighted to be a part of our program.

A Day in the Life of a PGY-2 Resident
By Jesse Costales, MD

Ahhhh, there's nothing like the smell of freshly cut grass in the still morning air. This is probably the first thought that crawls through my brain (which has been deprived of caffeine for over 6 hours) as I water the front lawn and tear out a few weeds. After a quick shower, breakfast and ironing (maybe not…), I head out on the 1 hour trek from my house in Rego Park, Queens to the best hospital in the city… Mt Sinai! If the weather permits, I'll ride my bike in; if not, I have some required reading time on the subway. As I write this, I'm on the inpatient "dual-diagnosis unit" at Sinai, also known as the addiction psychiatry floor. Despite some of the constant klonopin or morphine requests from the patients, I count myself lucky to be here. Some days, I learn more from the patients than I do from my co-residents or attending physicians. Learning exactly how the drug game works from the inside-out is always entertaining, but you need to do more than just watch The Wire to understand the nature of addiction. Where is your "shooting gallery," and "how many balloons?" were concepts foreign to me before this unit, but are now integral in my daily conversations. Watching tears fly down a drug-addled face can poke away at anybody's empathy bone, but how do we get them to stop using? Learning about motivational interviewing and cognitive-behavioral techniques is a tough business, especially when you are trying to help somebody who not only suffers from a debilitating psychotic disorder, but also an incessant craving for heroin! It's all worth it when we do get a (as our beloved, gesticulatory, marathon-superstar attending might say) "success story." Watching somebody you've helped get over a huge hurdle is always a good feeling, even if you know there are more hurdles ahead. Our attending do a fabulous job explaining the elusive topic of drug addiction and it's interplay with active axis I diagnosis.

After a full day on the unit, it's time to get active! If it's a nice day a run in Central Park (one block from the hospital) is a must! It really boosts the spirit to see so many active people in NYC (even the jogglers…). If I'm feeling especially over-achieving, or have had one too many cups of coffee, I'll head to the 92nd Y for a weight lifting session with my co-resident. After all that exercise, it's time for some protein (oh, and tons of carbs too) at any of the amazing restaurants in the Lower East Side (Ippudo Ramen is a must!). On a full stomach, it's time to head home for a little more reading on the train and a piano and/or TV session at home. I truly love it here.

A Day in the Life of a PGY-3 Resident
By Betsy O'Brien, MD

Third year psychiatry is in a way like intern year all over again, but better. Gone are the days of inpatient psychiatry and hands-on supervision from attending psychiatrists. You now get a taste of what it is like to be in private practice and it tastes pretty good. You have your own office, computer, and telephone and your own Rolodex of patients. You make your own hours, choose electives, and at times can choose your supervisors. Basically the experience becomes what you make it and Mount Sinai has a ton of resources and opportunities to choose from to carve out a unique and enriching learning experience. I chose to divide my 3rd year time between the Bronx VA and Mount Sinai and relish the opportunity to work with two diverse populations. I also enjoy juggling different hats and knowing that my days are never quite the same. With that said, the purpose of my rambling is a day in the life of a PGY-3 resident and I will top that with two days.

I live in an apartment complex close to Mount Sinai, within walking distance. When at Sinai my walk to work is about 5 minutes and when I go to the Bronx VA I take the subway from 86th street or walk a couple of minutes to the free shuttle that goes from Mount Sinai to the Bronx VA on an hourly basis. So with that said, Mondays I go to the Bronx VA. Mondays are my "earlier day" as I have supervision at 8:00 am. I wake up at 6:30 and by 6:55 I am out the door. I stop at my favorite coffee place on the way to the shuttle and I am on the shuttle at 7:15 to the VA. Upon arriving at the VA around 7:40, I check my emails, voicemail, and set everything up before walking down the hall for my 8:00 am supervision with a member of the Bronx VA PTSD group. I then see patients in the morning. In the afternoon I have elective time in which I see a patient for cognitive processing therapy, a special type of CBT designed to treat patients with PTSD. I usually leave the VA around 4:00 and am home a little before 5, which gives me plenty of time to go to the gym, meet with friends, and sometimes if I am feeling ambitious, cook dinner for my husband.

Moving on to Tuesday. Tuesday is a Mount Sinai day. ;I typically wake up at 6:30 and go to the gym before heading over to Mount Sinai for Child and Adolescent Clinic. After which I go to Psychiatry Grand Rounds. In the afternoon I have supervision for my child case. I then have phone supervision with an expert in CPT to go over my PTSD case from Monday. I then head to midtown to meet with an analyst for more supervision for one of the patients I have in psychodynamic therapy. Tuesday evenings are typically yoga/dinner with a group of friends from residency and medical school.

So as you can see very day of the week is a bit different. I won't give the minute to minute play by play for the other days, but in a nutshell Wednesday mornings I have intakes at the Bronx VA where I see a new patient every week. This has been interesting with a very steep learning curve. It can be tremendously rewarding to be someone's first encounter with mental health. Thursdays I have all day didactics at Sinai including CBT supervision in the morning for an Eating Disorder case that I see at Sinai on Wednesdays in the early evenings. Fridays I have geriatric clinic at the Bronx VA in the morning. Call is at the Mount Sinai Psychiatry Emergency room for 3rd year residents. It is 12-hour shifts about 35 times the whole year. On call you have supervision with an in-house psychiatry attending and many of us have counted our ER experience as one of the most enriching experiences we have. If nothing else, we usually order good take out and the cases can make for good dinner table conversation.

In total, I really enjoy the program and believe that it is as solid and enriching as any. I also think the program gives you a ton of opportunities to create your own experience whether that be writing papers, which many of us have initiated during our time here, or carving out a new elective and clinical experience which I was able to do this year. Furthermore, New York City is just an amazing and fun place to live and I have been able to balance my educational experience with my New York Life well.

A Day in the Life of a PGY-4 Resident
By Hiwot Woldu, MD

At Mount Sinai, PGY-IV year is almost entirely elective time with no call duties. It can be as busy or as laid back as you choose. It's a great time to hone the skills you've developed in PGY-III year, delve further into your interests, and maybe even develop new ones. The schedule is variable and quite flexible- so flexible that, as a resident in the global health track, I will be working abroad for an entire month (all expenses paid) come springtime.

No two days are truly similar in the life of a PGY-IV, but I'll pick Monday to write about as it's my most structured.

Every Sunday night, I make grand plans to wake up early and take a leisurely walk to work. Every Monday morning, I end up hitting snooze one too many times and must take the bus to make up for lost time. In a lot of ways, the New York City bus is my (noisy) weekday breakfast nook; it's where I sit back, munch on breakfast, and read the NY Times before officially starting the workday.

As one of the chief residents, my Monday starts off with an administrative meeting 9:30 to 10:30 AM. After the meeting, my co-chiefs and I walk the couple of blocks over to our outpatient offices - often stopping by a nice little café to pick up lunch on the way. Once at the office, we chat about our respective weekends and map out the chief duties for the rest of the week. By the time we're done catching up and making plans, it's around 11:30 AM.

I then do work-related reading and email correspondence down the hall in the office where I see patients. 1:00 to 1:45pm is time for my weekly psychotherapy patient whom I've been working with for over a year.

In preparation for family therapy supervision at 2:30, I quickly review my process notes on my couple from the previous week. A walk down 2 blocks gets me to joint supervision with two other residents. It's a great learning opportunity to hear their cases and then get feedback as well as suggestions on how to proceed for the following week.

On alternating Mondays, I cross Central Park to the office of an analyst who supervises me on a twice-weekly psychodynamic therapy case I've been seeing since PGY-III year. On weeks when I don't have this supervision, I go back to my office, do some work on a couple of manuscripts I'm preparing and then leave the clinic around 5 or 5:30pm.

The rest of the week has a sprinkling of other supervisions, co-leading of a psychodynamic women's group, and sessions with patients for couples and individual therapy as well as medication management. All of the patients I see are ones I've kept from PGY-III year. This gives me an opportunity to gain experience in long-term therapy and improve my skills with invaluable guidance from multiple experienced supervisors.

Even though my workdays are quite varied, they all end in the same way with me taking a relaxing, scenic 35-minute walk home. Most of my route is down 5th avenue with world-class museums on my left and central park on my right. It is a most lovely way to unwind and wrap-up the workday. Commutes (and residencies) really don't get much better than this!

A Day in the Life of a PGY-III Physician-Scientist Research Track Resident
By Le-Ben Wan, MD, PhD

My third year has felt like a tentative step toward independence, toward leaving the safety of my mother's shadow and striking out into a foggy psychiatric playground. For me, the playground has consisted mostly of research, outpatient psychiatry, and psychotherapy. It so happens that research has played a major role in my training, beginning when I matched into the research track, and continuing with my involvement, one year ago, with a mood and anxiety disorders research clinic. In my third year, the training program has given me time to become much more involved in the day-to-day operations of several research studies, including a study to test if lithium can maintain an anti-depressant response to intravenous ketamine. My outpatient caseload consists mostly of patients recruited through the research clinic: those who do not qualify for a study are referred to me for standard pharmacological management, and those who are finished with a study are referred to me for follow-up care. My caseload also consists of psychotherapy patients, one of whom I was lucky enough to have started seeing in my second year of residency. In addition, I spend an afternoon a week seeing intakes and getting supervision at a child or a geriatric psychiatry clinic, and I moonlight on some evenings and weekends at an outpatient mental health clinic. Moonlighting takes up the smallest proportion of my time, but provides an invaluable outpatient experience in a community setting.

So on a typical day, I might start out seeing participants admitted to an inpatient research unit for a ketamine study. I assess for safety, provide reassurance, and address questions. Thankfully, the nuts and bolts of each study are handled by a well-trained study coordinator, whose job seems to include the essential task of reminding me where to be and what to do. Afterward, I might see my outpatient cases, go to my child clinic, and see one of a number of supervisors for research, psychodynamic therapy, cognitive-behavior therapy, or my overall caseload. Throughout the day, I try to catch up on paperwork and on my own writing. Thursday is class day, a six-hour mid-week respite from the usual hustle and bustle of third-year, a day to relax and take in the show that, once a week, other people are finally putting on for me. I also take call, several times a month, in the psychiatric emergency room at Sinai. Here is what I tell myself, as I'm being crucified by a steady onslaught of patients at four o'clock in the morning: after a year of taking call all by myself, an hour away and in the Bronx, this is a welcome return home and a chance to consolidate and strengthen what I've learned throughout my residency. This, I think, is more than just a silver lining that I've created for myself in my mind. Nevertheless, I look forward to the freedom of next year, when I won't be taking call at all. When the day ends, all too quickly, I take the 20 minute walk home - down Madison avenue, past Park, Lexington, and Third. As I enjoy the walk I think about how I ended up in New York and what the city will hold in store for me. But mostly, I think about how lucky I am to be where I am right now: on a pathway littered with curiosity, excitement, and anticipation.

A Day in the Life of a PGY-4 Physician-Scientist Research Track Resident
By Laili Soleimani, MD, MSc

Finally a PGY4! Though, it feels that everything happened in the blink of an eye.

If you are one those people who loves to be independent, this is the glory year for you.  You can pursue any area you ever wished to explore in psychiatry; from a more independent psychiatric ER management to the field of alternative psychiatry and acupuncture. If you tend to like more structure, you still get a lot of that in the two months of the Consultation-Liaison (CL) rotation. Needless to say, you will continue to follow up on a handful of your patients from the PGY3.

As I am interested in Mood disorders and Cognition, I have arranged my electives so that I get a lot of clinical and research exposure to the both areas. So far, in the second month of my PGY4, I have started a hands- on elective on ECT, with Dr. Charles Kellner, who happens to be one of the pioneers in this field, as the supervisor. Previously, I had training for repeated Trans-cranial Stimulation (rTMS) and I hope that I will be able to expand my experience in the rest of the year. I am also working closely with the Mood and Anxiety Program (MAP) at Mount Sinai Hospital, through which I see many patients from different ongoing outpatient and inpatient clinical trials. Some PGY4 residents chose to spend some of their elective time outside Mount Sinai, and some times even out of country. I made arrangements so that I can work closely with one my mentors at Columbia University for a couple of hours every week.

I found the CL rotation to be a nice wrap-up of all one's training throughout the residency years. You suddenly find yourself back on the medical and surgical floors, which reminds you of the internship year in a lot of ways. However, this time you feel a lot more confident. You are literally patients' in-house psychiatrist and use a lot of your expertise of therapy and medication management to build rapport with the patients and families, and to guide the team in providing the psychiatric care for the patients in the midst of the medical crises.

I am starting to feel the excitement (as well as the stress) of finishing residency and moving on to the next step. However, I believe that by the end of this year, I will be ready to face whatever is out there to explore.