A Day in the Life of a Duke Anesthesiology Resident

Erin Rose, MD, CA-2 Resident

Duke North Night Call

Duke North call for anesthesia residents is a week of nights, from Saturday night to Friday night. The call team consists of a senior (CA-3) resident, a junior resident (CA-1 or CA-2), a CRNA, and an attending anesthesiologist.

At 6:30 PM, the residents arrive at the “big board” or scheduling board to see what cases are running, which cases need to be started, and gossip about the day’s events. Usually, the famous “waiting room sign” gives a good warning of what’s to come—i.e. as you are walking back to the department of anesthesiology, you pass by the surgical waiting room. If the waiting room is packed, it’s a sure bet that the OR will be busy as well.

By 7 PM, the residents and/or CRNA will set up the trauma room for the night so that everything is ready if an emergency case comes up the back elevator from the emergency room. Depending on the flow of the evening, residents may relieve their colleagues or begin emergency add-on cases.

The CA-3 resident on call takes a lead roll in managing the operating rooms at night and is responsible for coordinating staff, scheduling cases, formulating an appropriate anesthetic plan for each patient, and supervising junior residents and the night CRNA. The CA-3 carries the emergency airway pager overnight and responds to calls for emergency intubations all over the hospital (and occasionally to other sites as well). The aptly named pain pager is also passed to the CA-3 resident at night, and all calls from the acute pain service at Duke North are covered from 11 PM to 7 AM by the anesthesia resident team. Overall, the call experience for the senior resident serves as a transition from resident to attending.

The junior resident on call has the opportunity to tackle many new situations. Whether relieving a colleague or starting an emergency case, the junior must be flexible and open to new situations and sometimes very interesting stories. Each case starts by interviewing and examining the patient and writing up an anesthetic assessment. The pace goes from slow (for example an incision and drainage or wound dressing change) to lightning fast (for example a multiple stabbing or gunshot wound from the ER). An anesthetic plan is formulated with the senior resident and the attending anesthesiologist. The junior resident will roll the patient back to the operating room and proceed under the supervision of the senior resident. Once the case is underway, the senior resident will step out to take care of his/her myriad of other duties.

The week of nights offers an opportunity to further develop camaraderie among the residents and staff, as we are able to work more as a team in this setting than during the normal day shifts. It has become a Duke tradition to celebrate the end of the week of nights by going out to breakfast on Friday morning with the call team. We leave the hospital as the sun is rising at 7 AM and head downtown for breakfast to spend some time together recapping the week, happy no matter what the “waiting room sign” says.

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