Aaron Lam

Class of 2020

Friday, August 21, 2020

"Hey Dr. Fowler, today I had an immediate emergency case with a train wreck patient come into my room this morning. No back-up. Just me! And you know what? I realized how good my training and experience at VCU was. Thanks for everything my friend."

Adrianne Lazer

I arrive at the McGuire VA Medical Center around 6:15 a.m. and change into scrubs. I take a stroll by the main board and ensure that my room assignment and cases have not changed. I begin setting up my operating room around 6:30 and make a list of the special supplies that I will need for my case.

With nine operating rooms, the anesthesia techs are always available to lend a hand with supplies. After most of my room is set up, I draw up my anesthetics for the first case of the day. Most medications at the VA need to be drawn up or mixed, but phenylephrine is provided in premade syringes.

I then go out to meet my patient in the PACU around 7:15 a.m. and wave a quick hello to my attending. I talk with my patient and review the pertinent information from his or her medical history. If the plan for my patient was to complete a pre-operative nerve block, and there is no resident on the Acute Pain Service, I go ahead and do the block with the Acute Pain Service attending. Many times the senior resident on the Acute Pain Service is happy to supervise the junior resident if he/she wants to do the block.

Prior to rolling back to the operating room, the surgeon, anesthesia attending, residents and circulating nurse participate in a preoperative briefing to ensure we have the correct equipment and antibiotics, and discuss any other concerns regarding patient care. After the brief is complete, I address any issues that may have come up in the pre-op brief from an anesthesia stand point. Once I am in the room with my patient, I place the monitors and begin my anesthetic induction with my attending.

Since the VA is 1:1 anesthesia resident to attending, I always have a pair of hands to help me, and my attending is readily available. Soon enough, my attending stops by to give me a morning breakfast break, usually around 9:00 a.m. Some days, I go to the resident workroom and eat a quick snack, while other days I head down to the cafeteria for a hot breakfast. The bacon is always great!

Between cases, I meet my next patient and complete a brief interview, then head back to the operating room to set up for the case. My Omnicell is freshly stocked when I return, and the room has been turned over.

Once the surgery team, anesthesia team and circulating team is ready, I go and pick up the patient and begin the next case. I then take about 30 minutes to eat lunch. Occasionally I pack my lunch, but often I head outside for a delicious meal from the food trucks that are parked at the VA daily. Afterwards, I am back in my operating room finishing up my cases for the day.

Typically my day at the VA ends around 3 to 4 p.m. I check the board for my assignment for the next day, look up my patients and call my attending to discuss the next day’s cases.

Yvonne Nguyen

Cardiac Surgical ICU was the intern classes’ favorite rotation! It was initially an intimidating rotation with critically ill patients with complicated devices and surgeries. However, we were welcomed to the rotation with open arms. As interns, we follow two to four patients each day. We take ownership of these complex patients with the supervision of our upper levels and attendings, which allows us to provide critical care in a safe environment.  

These were some of our earliest days with sign-out at 6 a.m. After overnight updates, we would go check on each of our patients before regrouping for breakfast and coffee before rounds! Rounds on CSICU were extremely structured and interdisciplinary with pharmacy and nutrition engaged in patient care, which helped us really explore and understand the cardiopulmonary pathophysiology in this rotation. Rounds would finish up around 11AM each day, which gave us some time to finish up with some small tasks before having a team lunch!

The rest of the day is busy with lecture, group discussions, procedures and new cases coming up from the OR. The CSICU attendings are all amazing teachers with a vast amount of knowledge they were ready to share and endless patience as they walked us through our first procedures. We were supported by the amazing advance practice providers on the unit, who helped us learn the day-to-day routine. Our co-residents on the team consisted of our very own anesthesiology upper levels, which made it exciting to see the leaders we would become.

The schedule for CSICU was often split up to have “early and late” days. We alternated staying until 6 p.m. for sign-out, so on early days we would leave around 2 or 3 p.m. It allowed us to have a few extra hours during the week to ourselves. With so much occurring during the day and the level of complexity in these patients, it was nice having these extra hours and the free weekends to decompress. It allowed us to process the events of the day and provided us with opportunities to care for ourselves in order to provide better patient care. For some of us, this meant a quiet day resting, exercising, exploring or socializing. Regardless of how the time was used, we all appreciated the value that was placed in resident well-being and mental health care.

Bella Gabice Speight

Class of 2014

Wednesday, September 23, 2020      Facebook Posting

"Had a crazy scenario at work this am. As an anesthesiologist, it's one of those nightmare scenarios you train for. One of the reasons residency is four long years of 80 hour work weeks. So this AM I want to thank all the physicians that trained me. Some are on fb but most are not. Thank you for teaching me, pushing me, challenging me and for trusting me to do this work. After I changed my sweat soaked scrub top, I thought of all of you!"