A Day in the Life of a Duke Anesthesiology Resident

Ron Rawlings, MD, CA-2 Resident

Pain Management Anesthesia Rotation

The pain rotations at Duke are great months, and it is not just because of the increase in time-off. I learned much about pharmacology, learned and improved many interventional techniques, and had many educational and enjoyable chats with knowledgeable and available attending physicians. One month is spent on the inpatient Acute Pain Service and another month at the Duke Pain Clinic.

The Acute Pain Service manages pain related issues in all inpatients with indwelling epidural (with the exception of obstetric patients) or peripheral nerve catheters, patients receiving certain medications (i.e. ketamine), and patients who have been referred by their primary team for assistance in pain management. The pain team consists of an attending anesthesiologist, an anesthesia resident, a team of pain nurses, and often one of the pain fellows. A typical day consists of rounding on active patients in the morning, postoperative evaluation of surgical patients with catheters in place, and responding to new patient consults. There is usually a lecture or an informal teaching session each day. There are frequent opportunities for interventions such as epidurals or nerve blocks on this service. The Acute Pain Service is available 24 hours per day, 7 days per week. Your typical day will begin at 7am and end around 2-3pm early in week when the census is small and may end as late as 7pm on Friday of a busy week. The pain nurses assist with postoperative catheter management and with rounds or calls on existing patients and are available until about 10pm when the senior resident on call takes over until 7am the next morning. This is a great rotation to learn pharmacology and the attending physicians spend a lot of time teaching.

The Duke Pain Clinic is a multidisciplinary team that includes specialists in anesthesiology, neurology, psychiatry, neurosurgery, psychology and physical therapy. It is located about ½ mile from the hospital on Morreene Road in a facility that has fluoroscopy and multiple procedure rooms. You are assigned to work with a specific attending each day and about half of your days are procedure days. On clinic days you will see as many of the new patients as you are able and assist with the follow-up visits, you will also likely do minor procedures not requiring fluoroscopy. On procedure days you will assist/perform a variety of interventional procedures either at the clinic or in the OR at the ambulatory surgery center. The pain clinic presents some very challenging conditions and patients but is quite rewarding as many of the patients see tremendous benefit from the interventions and medications provided.

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