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A Day in the Life of a UofL Anesthesia Resident

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Sunny Huang, CA-1

 

Hometown: Harrisburg, PA

Undergrad: Penn State University Schreyer Honors College

Medical School: Geisinger Commonwealth School of Medicine

Anesthesia interest: interested in cardiothoracic, but not planning on doing a fellowship

Hobbies: Latin/hip-hop dancing, hiking, singing karaoke, movies, carrom board game, and exploring Louisville with my husband

Favorites in Louisville: outdoors (hiking trails), a variety of ethnic restaurants, and hanging out with colleagues

Why I Chose UofL Anesthesia?

So many reasons! UofL was my only away rotation as a 4th year medical student as my then boyfriend (now hubby) was already a resident physician here, so it was important for me to see if I could see myself here for the next 4 years. Within the first 2 weeks, I knew this program was the one. The attendings were engaged in teaching, very approachable, and provide enormous autonomy to the residents. The genuine camaraderie/support amongst the residents was another major reason that makes this program so special. 

In the beginning of my intern year, I had to take a six-month unexpected medical leave. Initially, I was really worried about how that would affect my residency training, but thankfully, this program treats your well-being and health above all else. I was told to focus on my recovery and that they would accommodate my needs and always have a spot for me if I needed more time off. My co-residents, likewise, have had my back and helped in any way they can since my return. I couldn’t have picked a more nurturing and supportive program. 

 

As mentioned above, I am interested in cardiothoracic anesthesia, but not planning on pursuing a fellowship. With so many great mentors (especially cardiothoracic-trained attendings) and unparallel exposure to heart and lung cases at one of the most renowned transplant hospitals in the country, I am confident that I will be fully competent and comfortable providing care to complex patients undergoing heart or lung procedures upon completing residency at UofL. 

A Typical Day of a CA-1 Resident

A typical day at the VA 

Night before: call the attending to present pts & anesthesia plans, and discuss certain topics

0630 – 0715: set up the room, pre-op the patient, etc.

0715 – 0745: morning lecture – keyword presentation by residents or case-based learning led by attendings

0745 – 0800: touch base with the attending, briefing with surgeon & nurses in pre-op, & roll back to OR

0800 – 1500: OR time (15-minute morning break & 30-minute lunch break). End time varies. Attending is in the room for key points and this is also when teaching/discussion happens.

  • In August of my CA-1 year, I did two thoracic cases back-to-back in a day, in which both needed a double-lumen tube, an arterial line, multiple drips for hemodynamic stability and ERAS pain management. I really bonded with my patients and built a good relationship with them as I visited them daily after the surgery. It was truly satisfying to see how well they did post-operatively and when your patient told you, “You gave me strength.” 

 

 A typical day at the UofL Hospital main OR

Night before: call the attending to present pts & anesthesia plans, and discuss certain topics

0630 – 0730: set up the room, pre-op the patient, touch base with the attending, etc.

0730 – 1500: OR time (15-minute morning break & 30-minute lunch break). End time varies. Attending is in the room for key points and this is also when teaching/discussion happens. 

  • In July of CA-1, there is a resident-led lecture from 3:30pm – 5:00pm every day. CA-1s are assigned high-yield keywords to teach fellow residents with an upper resident supervising and providing guidance. Starting August of CA-1, there is a weekly lecture on Tuesday 3:30pm – 5:00pm, given by an attending. In addition, two residents are assigned to present ITE or BASIC exam keywords during this time. The amount of didactics that we received at the beginning of our anesthesia training has been extremely valuable in helping us build our foundational knowledge, and create a habit to study and do questions on a daily basis. 

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Hello

Adam Crisologo, CA-2 (Junior Chief Resident)

 

Hometown: Cullman, AL

Undergrad: Asbury University 

Medical School: University of Louisville School of Medicine

Anesthesia interest: Regional & Acute Pain/OB anesthesia, I plan on furthering my education in regional anesthesia and will be applying for a regional and acute pain fellowship.

Hobbies: spending time with my wife, daughter and giant 100lb chocolate lab, grilling on my Big Green Egg, enthusiastic (but nice) Alabama Football fan ;), cornhole, hanging out with my co-residents!

Favorites in Louisville: very outdoor friendly city (biking, parks, hiking, pets, etc.), excellent variety of restaurants and entertainment, low cost of living for size of city.

Why I chose UofL Anesthesia?

I was fortunate to attend UofL for medical school, so I had a first-hand experience on what good of an anesthesia program it was. UofL “checked all the boxes” that I was looking for in a residency training program. Excellent clinical training with a wide variety of difficult cases. I wanted to see everything I could in residency, so that I knew I would be prepared to go out into the real world when I was finished. I knew if I matched at UofL for

anesthesia residency, I would be well-prepared at the end of my training.

It provides an academic environment that would prepare me to be successful on my board exams. UofL has provided structured didactics both at the VA and UofL, several opportunities to present keyword topics to your co-residents, and journal clubs once a month. In addition, throughout residency you have an opportunity to practice with many of your Attendings for oral boards. 

 

Lastly, I knew from getting to know the faculty and the residents, that I would truly fit in here at UofL. My co-residents in the CA2 class get along so well. This year we have all started something called “second Friday’s.” This is just a day set aside that we all try to attend, as able, to get together to hangout as a class. We often host it at each other’s houses, or meet up somewhere, like at Big Four Bridge Park this last month. 

A Typical Day of a CA-2 Resident

A typical day on OB Anesthesia 

 

0645-0700: Receive checkout from OB Night resident about current laboring patients, running epidurals, any scheduled procedures (c-sections, ECVs, etc)

0715-0745: Do a machine check in both OB ORs and ensure all equipment ready for ant planned or emergency procedures

0745-0815: Touch base with OB team to discuss any concerning patients, or pending OR cases.

0815-0900: If no schedule cases, see post-op patients (POD1 from SVD/C-section on those who received anesthesia care). 

0900-1845: Preop laboring patients/patients with planned procedures. Provide neuraxial(epidural, CSE, DPE, spinal)/GETA anesthesia to OB patients according to their needs. 

1845-1900: Handoff to night OB resident

 

***I really have enjoyed my first month on OB as well. Very procedural based subspecialty. Very gratifying to help this patient population in a very exciting time in their life. So special to be a part of it all!

 

A typical day on Regional and Acute Pain 

 

0645-0800: Place any 1st start surgical blocks or epidurals. Consent for all first start post-op blocks. 

0800-0900: Round on any running epidurals on the floor placed on surgical patient’s, or any other acute pain consults. Write notes and discuss plans with Attending.

0900-1500: Continue to place perioperative blocks at UofL main OR. Occasionally will go over to outpatient surgery building to do more blocks. At around 1430-1500, early resident will go home.

1500-?: Late resident stay to finish any post-op blocks for later start cases. Often done around 1700, but can be later depending on the day. 

 

For weekend call, often pairs moonlighting while coming in to round on any patients on the acute pain list. Number of weekends vary depending on how many residents are on during the month. Most of the time just 1-2. 

 

***Blocks I did during my first month: adductor canal, axillary, erector spinae, femoral, interscalene, popliteal, quadratus lumborum, supraclavicular, superficial cervical plexus, transverse abdominal plane, ilioinguinal, thoracic epidural. Types of blocks will vary depending on the surgeries being done that day. 

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Hello

Bradford Marsili, CA-3

 

Hometown: Harlan, Kentucky 

Undergrad: Eastern Kentucky University 

Medical School: Lincoln Memorial University - Debusk School of Osteopathic Medicine 

Anesthesia interest: Cardiothoracic Anesthesiology Fellowship at Johns Hopkins University in 2022

Hobbies: College football and basketball, running, hiking, going to one of the many beautiful parks with my wife and newborn daughter, cooking, exploring bourbon distilleries in the area. 

Why I Chose UofL Anesthesia?

Why I liked UofL program: I attended four away rotations as a medical student and without a doubt I enjoyed my time at University of Louisville the most. From day one I was met with hospitality from both the residents and the attendings. I immediately felt like I was a part of the team and had a crucial role in the patient's care. The attendings took me as their own, as if I was already in the program. I believe the faculty at U of L selects candidates with outgoing personalities and high standards, because these are the residents I am surrounded by daily. 

 

The breadth of cases is vast at U of L and there are many of them; you will likely get all your required anesthesiology numbers set out by the ACGME before your CA-2 year is over. The clinical training you will receive at U of L is unmatched. Above all, it's the people at this hospital that make me want to return to work each day. 

 

The program has seen recent increases in residents per class, has had a chronic pain and critical care fellowship, and has recently been approved for a cardiothoracic fellowship that will house two fellows starting in 2022. If you choose to do a fellowship, you will already be well endowed in these types of cases and patients. 

Jewish Hospital at University of Louisville is nationally for its novel surgeries. Jewish Hospital has been selected as one of only four institutions in the nation that has begun using the Carmat Total Artificial Heart. This heart was designed in France and has been implanted in approximately 20 patients oversees and its use has now spread to the United States. We were the second institution to implant this in a patient and the first to implant in a female. Jewish hospital is on the cutting edge of surgical procedures and technology. Here, you will manage a broad array of cardiac surgeries including CABGs, mitral and tricuspid valve surgeries, aortic surgeries, surgeries that use circulatory arrest, off-pump cardiac surgeries, TAVR procedures, ECMO, RVAD LVAD and BiVAD surgeries as well as heart, lung, kidney, pancreas, and liver transplant. There are few institutions that can give you this kind of experience in residency. As a resident you will have more exposure to cardiac and thoracic cases when compared to other residents across the nation. 

A Typical Day of a CA-3 Resident

A typical day at Jewish Hospital as the Cardiothoracic resident:

 

0500-0600: Arrive to the hospital to set up the room. This includes your airway materials, cerebral oximetry, and bis monitors. You will also set up all the drugs and drip lines that you will potentially need throughout the case. 

 

0600-0630: Report to the preop area where you will meet your patient. After examining the patient and obtaining consent, you will place an arterial line. 

 

0630-0715: You will take the patient to the room, hook up monitors and induce and intubate the patient. Afterwards, you will position the patient to place the 9-french MAC line that will be used for infusion and product replacement throughout the surgery. A Swan-Ganz catheter will be floated for PA pressure monitoring. The TEE probe will be placed as the nurses are prepping and draping the patient. 

 

7:15-7:30: Surgery start time. The resident is responsible for the hemodynamic and anesthetic oversite while the attending and fellow will acquire TEE images. As you progress through your rotation and become comfortable with the flow of the case, you will also learn a great deal of TEE during this rotation. You will be responsible for readying the patient for bypass and coming off bypass. At the end of the surgery, you will transport the patient to the cardiovascular ICU where you will give hand off report to the physician taking over. The length of surgery depends on the case but drop off is usually anywhere from 11:30am to around 2pm.