blank'/> A LITTLE BIT OF LACQUER: A Day in the Life: Dermatology Resident

November 11, 2016

A Day in the Life: Dermatology Resident

Hi all! I've been meaning to do a post like this for a while now, they've always been some of my most-appreciated posts (at least that's what you guys tell me hahaha)! For those who have missed prior ones, I've been doing them since med school - you can catch a day in the life on surgery (as a med student), on medicine (still as a med student), on night float (as an intern) and on medical wards (as an intern). And now it's time to get a peek into my day as a dermatology resident!

As you guys may have gathered by now, much of medical training happens in blocks - regardless of your training, we're almost always learning based on a rotation schedule to get the most out of training. So just like in medical school where you may spend a month or two on medicine, and some on OB-Gyn, and some on radiology, etc, and intern year where (despite being all "medicine") you spend a month on wards, and a month on ICU, and a month in clinic, in dermatology (and all other residencies) it's again more of the same rotation schedule. In dermatology some of the rotations include the VA (the Veteran's hospital, which for us is primarily a surgical rotation where we remove a ton of large skin cancers), inpatient consults (where we get consulted on dermatology cases for hospitalized patients), clinics (which vary from general to pediatrics to wound to cosmetics and more), and even a Hansen's disease clinic! The list seriously goes on and I am so spoiled at my program with the amount of amazing things we get to see and do! So with all that said, the day really varies based on what rotation you're on - if you're just doing clinics you can usually be done by 5 most days and have weekends off (incredible) - if you're inpatient you may be there until 8 wrapping up consults and then are carrying the consult pagers over the weekend as well (not so incredible, but seriously good teaching).

Ok. Whew that was a big preface. Now let's get into the day. For this post I'll share a more typical day of clinics that includes some surgery as I think it gives a nice example of some of the different things we get to see and do in dermatology!

4:45 N's alarm goes off and he hops out of bed and starts getting dressed for his run (I have a crazy husband/fitness freak who jogs 6 miles to work nearly every morning). I stay in bed just a tiny bit longer.

5:15 I get up and make a cup of coffee on our Keurig and get back into bed with my mug and my laptop. Usually in the mornings I'll try to get through a couple emails, check my calendar and to-do list, and get a few minutes of studying in. I'm still trying to figure out the best way to study for dermatology, especially since with our schedule right now (ie busy as hell) we don't have much time. The best thing I've found so far is reviewing old kodachrome lectures - depending on the cases it only takes about 10-15 minutes but is really high yield, especially in developing our differentials!


5:45 Hop in the shower and get ready for work. Stay tuned as I'm currently working on a new daily skin care and makeup routine post that will be up very soon!!

6:15 I hear Elli start fussing so I make her a quick bottle and give it to her and she dozes back off.

6:30 Leave the house. For the most part it's only a 10-15 minute drive to work, but you really can never estimate Miami traffic, and God forbid it rains, the entire driving community acts like it's a blizzard or something - so I usually try to give myself plenty of time to get in in the morning!

6:50 A good traffic day - I pick up some breakfast from the hospital cafeteria (we have a meal card there so it's "free" - yay!) and walk over to lecture.

7:15 Our AM lecture starts. Nearly every morning at from 7:15-7:50 we have either resident lectures (where a fellow resident lectures on a chapter or chapters from our derm textbook, Bolognia) or pathology sessions where one of the dermatopathologists will sit with us at the 12-headed microscope and go through path slides. Today's lecture is by a co-resident on connective tissue diseases.

7:50 Lecture wraps up and we all part ways - I'm headed to our AM surgery clinic. On this current rotation we do surgeries every Monday and Thursday morning.


8:15 Our first surgery patient arrives - I get them all checked in, ask a bit of history and contraindications to surgery or any reasons I'd have to operate a little differently (it's always helpful to know if a patient is on a blood thinner or if they have a pacemaker) and decide whether or not they'll need prophylactic antibiotics. It's a 60-something year old Hispanic woman with a large squamous cell carcinoma of the upper arm. Should be an easy enough case - just take it out with margins and do a repair in a linear fashion - it gets way more complicated in troublesome areas of the body or when the tumors are really large - that's when we start doing flaps and grafts if need be. But this is nice and simple and I get her consented and prepped for surgery. Meanwhile some of the other surgery patients come in who the other residents grab - one is a cyst excision and the other is a Mohs closure (it's common practice that one surgeon will do the Mohs excision but not the repair, so they come to us (planned of course) with a hole in their face that needs to be closed)!

8:40 The attending comes in and we present the mornings surgery cases. We go to each room and talk about the surgeries and then each grab a procedure room and get started! We'll typically have 3 cases running simultaneously and the attending and chief resident in and out as needed for guidance. It's nice though, because once they trust you, you can pretty much do everything independently which I think is incredible for training and really perfecting your art!

9:30 As predicted, it was a really simple case with nothing unexpected so I had the patient in and out in less than an hour. She'll come back in 2 weeks to have the sutures removed and see how she's doing. I wrap up my surgical note and pathology form and then start seeing wound checks (people who come in for their post-op visit and suture removal 1 or 2 weeks after surgery - typically 1 week for the face and 2 weeks for the rest of the body).

11:40 All of the cases for the morning are done - it's always nice when we finish on time! Sometimes we have really long excisions or Mohs repairs that take hours! On almost all of my surgery days I wear scrubs and my Nurse Mates ALIGN Dash sneakers. They're cute and sporty feeling but also provide incredible support - think like an orthotic clog without the orthotic "look" - I've even worn them with workout leggings! Anyway, we get out with enough time to walk together as a team to pick up some lunch (to go) from the cafeteria.

12:00 Back to our derm library/conference room where we now have our PM lecture. Today we have one of our dermatopathology attendings giving us a talk on psoriasiform disorders.

12:50 Wrap up lecture and head back to the hospital for our PM clinic. I'm currently rotating at our public hospital that serves patients with no health insurance and many immigrants from other countries, and it's pretty much one of the most rewarding clinics I have (other than the clinic we sometimes run at the homeless shelter). Not only are the patients incredibly grateful, but the pathology is unlike anything you'd see in the US.

1:00 First patient - a gentleman who comes in with a "growth" that's been getting bigger and he finally decided he wanted looked at. It's in his groin and actually about the size of a large head of broccoli, and we decide to shave it off and send it for path (probably just a really large acrochordon - ie skin tag - or maybe even a neurofibroma; whenever we remove anything off of anyone's body we always send it to be looked at by a pathologist even if we're sure it's benign). I numb up the area with lidocaine and take it off by cutting it at the base with a 15 blade, then use my electrocautery to stop the bleeding and bandage him up. A little procedure heavy for PM clinic, but also not something I want to make him schedule a surgery appointment for. Definitely happy I'm wearing my ALIGN sneakers and have been comfortable on my feet all day! I also love that they're really easy to slip on/off so I can slip out of them while I'm charting hehe!

1:35 - 4:45 Go through clinic seeing the rest of the patients. We essentially just have 4-5 residents working and pulling charts from the one (seemingly never ending) pile of patients until we see the last one. As first year residents we almost always have to present our cases and what we want to do to either the attending or the third year resident, who can then add in their teaching! The cases for the afternoon ranged from an incredible case of leukoderma of (undiagnosed) scleroderma, many many likely basal and squamous cell cancers, some ulcers, a potential macular amyloidosis and a TMEP, and a few allergic/irritant contact derm cases. It's always an interesting range of common derm and really interesting stuff.

5:00 Head out and off to pick up Liv. I had a little time before leaving so I picked up a small coffee on the way out - I call it my fuel up for the "second" shift - ie getting home and being mom!


5:20 Get to Liv's preschool and pick her up. I love how excited and happy she is when she sees me - she always runs full speed into my arms and then runs to show me her art project of the day.  We grab her backpack and get in the car and she gets her afternoon "treat" that keeps us all sane on the sometimes long drive home (traffic is always unpredictable) - today it's a caramel apple pop.

5:50 Get home and get to see my Elli-belly (who during the day stays home with Grammie who lives with us). I get some snuggles in and then head into the kitchen to whip up a quick dinner. I boil some whole wheat pasta, cook some ground turkey and pasta sauce, and then through in some fresh chunks of buffalo mozzarella and we have our dinner. I usually eat with the girls all together, but N almost always is home later than us thanks to their schedule that requires them to work at the eye ED at the end of their clinics almost every evening!

6:45 Playing with the girls on the floor for a bit as we all relax and wind down for the night. Liv throws a fit here or there about whatever it is she's upset about for 30 seconds and she gets sent to her room twice, but ends up getting over her attitude and we enjoy the rest of the night together lol!

7:45 Get the girls into the bathtub for bath time! They both adore bath time. Daddy gets home too while the girls are in the tub. After both girls get into PJs

8:30 Make Elli a bottle a get her down for bed. Liv stays up a little later, I've found that she (and I) really appreciate the alone time. We play a game together on her iPad (a tea party!) and chat and then by 9 I get her into bed too.

9:15 Grown up time - I catch up with N about our days and then we both usually study on the couch (or if was a particularly hard day we'll just pick a movie or show to watch)!

11:00 Calling it a night - wash my face, brush my teeth, and snuggle up under the covers to get some rest for tomorrow!

I hope you guys enjoyed this peek into one of my days! Like I said before - everyday is different - there are days PM clinic runs until 6:30pm and my mother-in-law has to pick up Liv, or days that I'm definitely not cooking dinner and Liv and I pick up Pollo Tropical (rice and beans and chicken is a no brainer in this house lol), you get the idea! 

PS!! - For those of you who wonder how it's possible to "do it all" - be a full time working mom and in a happy relationship and have kids and still find time for yourself, I strongly encourage you to check out my E-course that I've now opened for enrollment again! It's an incredible series of 30 10-minute videos that address all of the skills you need to get to where you want to be professionally, family-wise, and with your self that I think every woman can use! Read more on the course page and make sure to use the code GIVETHANKS for 10% off, that will be good all throughout the month of November. **UPDATE - For Thanksgiving and Black Friday we'll be having an even bigger discount - get 30% off with code BLACKFRIDAY good Wednesday 11/23 - Monday 11/28)!**

And a special thanks to Nurse Mates for sponsoring this post! Their ALIGN Dash shoe really is one of the most comfortable I've worn (although they've got another shoe that might take the cake - I'll be talking about that one soon too)! 

30 comments:

  1. What's your opinion on Obamacare?

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  2. I always seen your posts on Instagram and wished that I had your life but your life actually sounds overwhelming AF.

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    Replies
    1. Lol it's not cut out for everyone. Most people just see the good and forget all the work that goes into actually getting and keeping what you want. To each their own.

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  3. How many years does being a resident last?

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    Replies
    1. Depends on residency - derm is 4 years which includes intern year, so I'm in year 2/4.

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  4. Do you see regular patients with skin problems like acne?

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    1. Yup! That's why I mentioned at the beginning it depends what rotation you're on - there are some rotations we pretty much only see acne or pediatric problems, some where we only do cosmetics, etc.

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  5. You are a superwoman! Loved getting a peek into your day! :)

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  6. Do you do anything special for baby?

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  7. How much time do you spend on social media?

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    1. Depends on the day - some days it's only checking IG here or there during downtime, other days I'm spending a few hours creating a blog post and planning my social media posts.

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  8. Are you kissing Livi's foot in the last picture? Lol so cute!

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  9. You do a lot of sponsored posts nowadays.

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  10. Jeez, some people have the strangest comments...

    Anyway, loved seeing what your typical day looks like. Still amazed that you are married, have two babies and one on the way, and are a resident AND still find time to blog once in a while. If someone is paying you to write such an interesting post, I say make that money, honey! Keep up the great work :)

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  11. Hi Laura! I just LOVE this post! I'm also a full time mama/doctor (doing my general surgical pathology fellowship currently) and I so appreciate your summation of relaxation and family time at the end of the day. That is where I struggle most as a woman/mother/physician. It's easy to feel that the mornings and evenings are nothing but a race to get things done, out the door, etc. I remember in earlier posts you mentioned that Liv used to co sleep with you and your husband. My little one (16 months) co-sleeps and I wouldn't trade it for anything, but I do notice sometimes (like early morning alarms or trying to figure out when to have husband and wife time) it gets tricky. Any advice on keeping the babies close at night while managing alarms/morning routines/staggered bedtimes/husby time? Thank you! :)

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  12. You make it all seem manageable. Kudos!

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  13. Oh my gosh, I LOVE this post! SO inspirational and completely motivating!

    xo,

    Aïchatou Bella
    www.stilettosandstandards.com

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  14. It makes a lot of sense why you don't Snapchat as much anymore. I thought you just didn't like us anymore ��

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  15. Do doctors still use pagers? Lol? I'm just curious.

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  16. You are amazing Laura! I really appreciate you sharing posts like these. i'm a full-time graduate student and the mother to a beautiful 3 year old girl. I don't have a community of fellow mommies yet, but I come to your blog for inspiration. I appreciate you sharing your truth. Thank you!

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  17. Love these post Laura! Although I am going into a differnt role and finishing up my studies to apply for PA school. Your post and lectures are AMAZINGly motivating and I've basically invested in them to give me guidance throughout my journey as a Healthcare professional. I do have one question waaay off topic. My honey and I have been talking about kids....do you drink caffeine coffee to keep you going throughout the day while your preggos?? I'm trying to get an idea of how you working mothers find that boost!!

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  18. eep! I was waiting for this post! You are such an incredible inspiration - call me crazy, but you make me want to go into derm! i love that you guys work with VA and immigrant clinics on the reg, as well. excited for your skin care post! <3

    https://smpdiaries.blogspot.com

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  19. You are an inspiration! And so lucky to have your mother-in-law as a live-in nanny. Speaking from experience daily drop-offs and pick-ups can be rough. Just curious what would you think would be the '2nd best' option to be able to maintain your brutal/unpredictable schedule and have trusted, affordable childcare for more than 1 child?

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  20. Much respect to you and N and certainly your mother in law! That's so awesome you and your husband can get up and go to work and leave your cherubs in good hands! For people without kids it may be hard to understand how overwhelming it can be to get the kids ready, go to work, go to school, pick the kids up, make dinner, do homework etc. So having a live in full time helper is a life saver! I think it's very humbling for you to say you're spoiled by how much you get to learn. You're appreciation for your education is very apparent. Keep up the good work!

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  22. You are such an inspiration and what you've been able to make of life, it's the way it should be, honestly! I wish you and your family the best!

    Regards, a scared and hopeful doctor-to-be in the near future.

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  23. nice blog
    thanks for sharing information.
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  24. Hi Laura, I must ask, looking at your crazy schedule - do you ever get sleep deprivation and how do you cope with that? I try to balance everything as well as you do, but when times are hectic, there is no way I get 7-8 hours of sleep and I don't function well at all when that happens - my productivity is low, I get cravings etc. Do you have any tips? Thanks!

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