In Caring Hands

Robert Henry Becker Arizona Daily Wildcat Dr. Holly Richter attends a Friday morning meeting with other pediatrician and pharmacists to exchange information about patients. Juan Pablo Figueroa is examined for proper respiration, after coming to the hospital with pneumonia. Richter gathers her pat ients's case files so she can write the daily reports.

After graduating from medical school, doctors must spend three years as a resident learning the ropes of their chosen specialty. But what the residents actually do day in and day out often remains a mystery. The Arizona Daily Wildcat spent a day before s pring break following Dr. Holly Richter, a first-year pediatrics resident at University Medical Center, as she explained what it is she does every day.

7:35 a.m.

Although Richter's day actually started at 6:30, I join her as all the pediatric residents sit down for their daily meeting. A first-year resident is also called an intern, and Richter is one of three in the pediatrics department.

At this meeting, the residents discuss every patient in the ward, and the resident who was on call the night before updates everyone on what happened during the night. A social worker and a hospital pharmacist are also present at the meetings to deal with any questions that might come up.

"At these meetings, we see who's being discharged and going home, and what they need first, and we also find out what happened during the night," Richter said.

Richter said she usually comes in around 6:30 so she can check in on all her patients before the morning meeting. She checks on what lab results have come in and who might be able to go home.

"These meetings really are a team approach," Richter said. "We are often tired, so we can catch ourselves when we talk to other people, or they might have a suggestion as to something we should do."

8:30 a.m.

It's time for another meeting. This morning report, which lasts a half an hour, takes place every Monday, Wednesday and Friday.

Here, the residents, specialists and attending doctors discuss one or two patients in depth. Today, a second-year resident tells everyone about a two-month-old boy with severe brain injuries and a wide variety of other problems.

"Everybody looks at it from their own perspective, and we all learn how to approach different problems. Even if it is not your patient, it helps you learn," Richter said.

Twice during the meeting, Richter is paged about the status of her patients. She never gets a rest, even though she is not on-call today.

When a resident is on-call, they are required to be in the hospital from 6:30 one morning until whenever their paperwork is done the next day. The interns are on call every fourth night, and have to be in the hospital every day except for the four days ea ch month that they have off.

9:05 a.m.

Now that the meeting is over, Richter starts to check on all of her patients. Since it is a more reasonable hour, the patients and their mothers will be more awake, she explains.

Richter starts rounds on the West wing of the third floor, where the infant and toddler rooms are. Richter examines each patient to see if anything has changed and talks to their parents about what is going on. The first patient is an 8-month-old boy who is doing well.

After seeing each patient, Richter must document everything she has done and found on the patient's chart, even if it was just a normal check-up.

"I guess we do it this way because it is not as easy to change as it would be if it was done on computer. We can see exactly who did what and when, and you can't change it," Richter said.

Richter's second patient is a 5-month-old boy admitted Thursday with pneumonia. She tells the boy's mother, Ana Figueroa , that if Juan Pablo can stay off of his oxygen overnight, he can go home tomorrow.

"He is doing great now without the oxygen, but the real test will be tonight. We have to make sure patients are OK overnight before we send then home," she said.

Richter said it is especially important for the younger kids that they go home as soon as possible, because it is so stressful for both them and their parents. Babies also have special needs like diapers and breast-feeding requirements.

"We try to get the kids out safely, but as soon as we can," she said.

9:50 a.m.

Richter is paged. A girl on another ward who was supposed to be going home today won't be after all. Richter OKs a high dosage of oxygen for her.

In pediatrics, the chairs fold out into beds, although not comfortable ones, Richter said. She said a lot of mothers stay overnight, although there are, of course, those who can't because of situations at home.

After seeing three more patients, Richter is paged again, and then she returns to recording her examinations.

"The intern year is the worst," she said. "We kind of do some of the scud work."

Next, Richter looks at her last patient in this ward, a little boy who may have an infection. She tells his parents that the lab results were most likely contaminated, but that she will observe him for a little while before deciding when he can go home.

11 a.m.

After finishing with the infants, Richter attends a lecture. These meetings also take place every Monday, Wednesday and Friday. Richter says they give the residents a chance to learn in a small group setting from a specialist about something they are inte rested in.

Today, a pulmonologist, a lung specialist, is telling the residents about new asthma guidelines and how to assess children affected by asthma. Richter said it is a teaching situation and having a different topic each time helps her learn more than she wou ld otherwise.

12:15 p.m.

The lecture ends, and Richter has some free time to talk until she plans to attend a lunchtime lecture at 12:30.

Richter graduated from the University of North Carolina at Chapel Hill medical school in 1994, and spent two years at Stanford as a resident in anesthesiology before realizing that it was not what she wanted to do for the rest of her life. So she chose pe diatrics and is starting over at UMC.

"I really wanted more patient contact, and I like kids, so I decided to do pediatrics," she said. "I'm much happier this year and I like what I'm doing, so I know I made the right choice."

Becoming an intern again means Richter has to spend more evenings on call. She said there is a room for the residents to sleep in, but it is rare that she gets more than three hours of sleep. The residents also get a free meal from the UMC cafeteria while they are on call.

"It's nice that they do that and you don't have to worry about your dinner, but it's still hospital food," Richter said.

She said that her main duties while on call are to "stamp out the little fires as they come up." Each resident checks patients in when they are on call, so the night following they have the most patients to take care of, Richter said, and it dwindles as t hey are released, but then builds up again when the resident is back on call four nights later.

Richter said the long hours and tons of paperwork keep her busy, and that she is lucky to have a husband who is an anesthesiologist and who understands her crazy schedule.

"I like what I do, but there is not much free time. Life is pretty regulated. Besides just seeing patients, there is the paperwork and lots of additional things to do," she said.

12:45 p.m.

Although Richter had planned to attend the lunchtime conference at 12:30, she has been paged and is going up to admit a patient. The patient is a 9-year-old whose blood clots easily and whose leg is swollen and sore. She was in the hospital for two mont hs in 1995.

The girl was taken off of her medicine three weeks ago, but it looks like there are complications, Richter said. Setting up the girl's chart and ordering an ultrasound for her legs takes longer than she had planned.

1:20 p.m.

It's clear that Richter has missed her conference. She said she likes to go to them because you can learn a lot from other people. She was also supposed to eat lunch at this time, but that does not bother her too much.

"You eat whenever you can," she said.

Richter goes to meet her new patient and examine her. She asks her a lot of questions, but also tries to get to know her to make her feel more comfortable. She finds out the girl is in fourth grade, and keeps her talking while a nurse takes her blood.

The girl will have to have an IV in each arm, one to inject her with heparin, which will prevent her blood from clotting further, and one to constantly flush out her arm so there is an area free from heparin from where doctors can draw more blood.

1:45 p.m.

Richter is finished examining the patient, and must now document her findings in the chart. She will then spend the rest of her day, until she goes home between 4 p.m. and 5 p.m., visiting her patients on 3 East, where the older kids and teenagers are .

Richter said today was a slow day, and that there are times the hospital is full and they have to turn patients away to Tucson Medical Center.

She said she is not sure, but she will probably go into general pediatrics rather than having a specialty.

"I don't know what I'm going to do," she said. "I still have two and a half years of my residency to go before that."