Time Well Spent

A medical resident's life is often a hectic one, filled with unexpected events and long, challenging days. Angela Saxena, M.D., a second year OB/GYN resident at UofL, is certainly no exception.

But Saxena knows the four years she'll spend as a resident are a crucial component of her medical training, offering invaluable experience that will serve her well in the future.

"The days when I have a 24-hour shift are challenging, but it's a great opportunity to learn more and spend extended time with patients," Saxena says.

Before leaving home at 5:53 a.m, Saxena called University Hospital to check the status of the labor and delivery floor, so she knows things are fairly calm. But that could change as the day progresses.

6 a.m. -- Saxena arrives at University Hospital

Today Saxena will be on call for 24 hours. Residents typically work a 24-hour shift every three days.

"Today could go well," Saxena says as she sips her morning coffee. "Or it could go crazy-you just never know."

6:20 a.m. -- Charts and rounds

Saxena reviews patient charts with a medical student in preparation for conducting rounds. As a second-year resident, Saxena has responsibility for the care of patients in the postpartum ward, some of whom are recovering from C-sections.

That responsibility, Saxena says, makes residency a "very demanding job."

"It's a huge change from being a medical student, because now you feel very responsible for someone's life and well-being."

The opportunity to work with medical students was one of the reasons Saxena chose to do her residency in a university setting.

"It's kind of like being a teacher as well as a doctor," she says. "You've got medical students asking you if they're doing the right thing, and you've got interns asking, 'What should I do next?' It forces you to learn, it forces you to read, and it forces you to be a more proactive learner, because all of these people are depending on you for your knowledge."

7 a.m. -- Morning report with Daniel Edelstone, M.D.

All residents, interns and medical students who have been on the floor through the night, together with those who will be on today, gather for the morning report with Edelstone, chair of the Department of Obstetrics and Gynecology at UofL. The night team has questions about a woman who delivered overnight, leading to a discussion about the interpretation of fetal monitor strips.

8:45 a.m. -- High-risk outpatient clinic

Several days a week, all second-, third- and fourth-year residents see patients at the high-risk obstetrics clinic. This clinic serves women who have medical conditions that complicate their pregnancies.

9 a.m. -- Baby delivery

Saxena is called away from the clinic to deliver a baby, her favorite aspect of being a doctor and the reason she chose her specialty.

"I always thought I would go into pediatrics, because my father is a pediatrician," says the Harlan, Ky., native. "But in medical school during my OB rotation I did my first delivery, and I just knew this was what I wanted to do."

This delivery goes smoothly, and there's a new baby girl by 9:25 a.m.

"Sometimes when I deliver a baby, I think, 'This is the little child whose development I've been following.' It's very gratifying because I get to be part of such a special time."

This is the first of three babies Saxena will deliver while on call. The others will arrive this afternoon and early tomorrow.

For now, however, it's back to the clinic for more examinations.

1:35 p.m. - Lunch

On the way back to labor and delivery, Saxena grabs a quick lunch. Typical for residents, the meal is eaten between questions from interns and medical students as Saxena consults with another resident.

4:35 p.m. -- C-section

A patient whose pregnancy is complicated by diabetes and prematurity needs to undergo a C-section.

Saxena performs the surgery, with her attending physician and chief resident assisting and supervising.

"I really enjoy the surgical aspect of OB/GYN," Saxena says. "It's exciting to do surgery and it adds another facet to the practice."

By 5 p.m. the baby is delivered. It's a 2-pound girl, and she's rushed to the neonatal intensive care unit while Saxena completes a tubal ligation and closes the incision with the assistance of her chief resident, her attending physician and a medical student.

7:30 p.m. -- Working the phone

As the evening progresses, the only patient in labor on the ward is having complications. With each contraction, the baby's heart rate fluctuates, which is not abnormal but it does require careful monitoring.

Later in the evening a decision is made to perform a C-section, but Saxena is busy with other patients in triage and is not involved in the surgery.

1 a.m. -- Charts and consultations

Saxena consults with Melanie Story, M.D., a family and community medicine resident, before grabbing a quick dinner. She then spends a good portion of the morning updating patient records to reflect their ongoing treatment.

5:45 a.m. -- End of shift

Nearly 24 hours after arriving at the hospital, the time comes for Saxena to brief the incoming day team on her patients' status.

"This was pretty typical of nights on that floor," she says of her shift. "It was pretty busy, but it could have been worse."

All in all, Saxena says her residency is preparing her for life after training, when she plans to join a practice "somewhere between Harlan and Louisville" so she can stay close to her family.

With 2 1/2 years left to go, she's happy to continue learning while also continuing to take care of patients.

"Overall, it has been a lot of fun. I wouldn't do it another four years-it's not that much fun! But it's been a really great experience."