Thoughts on the way back to the car – Episode 2 “A half hour in the morning is worth two in the afternoon”

Today was a call day, which means all day we were admitting patients. But today was different, I tried outs coming in earlier than I ever have before.

Let me back up. The ICU has been a beat down. Long days lead to late nights lead to sleeping in as late as I can which leads to long days again. But one of my fellow residents pointed out that to break this cycle, I needed to come in earlier each morning. You see, the morning is when most of the work on any medicine service is done. It’s the time when you write down morning lab values and vitals, it’s the time when you examine all of your patients, it’s the time when you present all you have discovered to your team and talk about changes in therapy for the day.

Needless to say, the morning is important. So far, I have been waking up at five, getting to work by six, and spending two hours preparing everything for rounds at 8 o’clock. Some days this is sufficient time (when we have few patients), but most days find me furiously scrambling to finish everything before the team starts rounding at 8 o’clock. This means that instead of being well prepared on rounds, I am usually frazzled, thinking about what I haven’t done and how stupid I might look in front of my attending and colleagues when I present each patient. Not to mention, I haven’t gotten to any of my documentation. Meaning I have to write my notes throughout the day. Catching up on unfinished work in the morning, in addition to implementing the plan formulated on rounds, topped with finishing my mounds of documentation all adds up to a hectic day that ends with me getting home a lot later than I would like.

After a couple weeks of getting more and more frazzled, one of my fellow residents gave me the advice I mentioned above. “A half hour in the morning is worth two in the afternoon” he said.

So after a well-deserved day of rest yesterday, I came in half an hour earlier than I normally do. It really was amazing how much more I was able to get them. It was only 30 extra minutes, 1800 extra seconds, but in that extra time I was able to see all my patients, record all my lab values, and even finish all of my notes. The result was, I was more focused and relaxed on rounds, had better presentations, learn more, freaked out less, and got out earlier than I have any other call day during this rotation!

So there you go, your circadian rhythm may revolt, but if you are struggling to get everything in on rounds it is amazing what a little extra time in the morning will do.