Top Doctors 2018

6 a.m. I wake for an early tumor-board meeting, so my teenage son needs to be up, too. We have less than an hour to get him to school by 6:45 a.m. and me to the meeting by 7:15 a.m. I bribe him with pizza for dinner.

7:15 a.m. Tumor board this week focuses on patients with metastatic neuroendocrine cancers. There’s a new FDA-approved peptide-based receptor radionuclide therapy (PRRT) for that group of diseases. Most of the discussion this morning revolves around what this will mean for them and us in coming months.

8:30 a.m. I meet a patient in the pre-op area to discuss the liver surgery he’s about to undergo as part of his cancer treatment. After answering a few questions and escorting him to the operating room, I have 45 minutes to call the referring physicians and update them on the next steps.

9:30 a.m. Today’s surgery is a liver resection for a large primary liver cancer. Because of the size and location of the tumor, and the fact that the liver function was well preserved, we all agreed that surgical removal of the cancer was the best option for him. We spend 3.5 hours teasing a football-sized tumor out of the intricate network of bridging structures within the liver.

1 p.m. As we’re wrapping up, I take a picture of the tumor for the patient and send the specimen to pathology. I have an hour before clinic starts, so I wash up, then check on a few patients.

2 p.m. At today’s clinic, we see five patients being considered for liver transplants. As director of the liver cancer program at IU Health, my role is to explain the transplant evaluation process.

4:30 p.m. After clinic, I head back to my office. My assistant has left a pile of papers on my chair: paperwork to sign, patient images to review, and phone calls to return. My thermos of coffee is still sitting on my desk from this morning, and I consume that with some peanut butter and crackers over the next 90 minutes as I handle the administrative work.

6 p.m. I still have a handful of things on my to-do list, but if I leave now, I can meet my husband for a workout at Orangetheory Fitness near our home. So I do.

9 p.m. After a workout, I log on to complete my notes from clinic and record my operative note from the case this morning.

10:30 p.m. Unable to focus any longer, I watch a couple of Death in Paradise episodes on Netflix until I fall asleep.

6 a.m. As soon as I wake, I log on to my laptop and check the hospital census to see who’s currently admitted. I’ll be covering not only my own patients today, but some of my partners’.

7:30 a.m. At the hospital, I confer with one of my partners who was on call the previous night. The most pressing case is a woman in early labor with a pregnancy complicated by gestational diabetes. The second most pressing issue is a patient who is 15 weeks pregnant with a severe headache and fever. We’re trying to rule out meningitis, so we order a spinal tap.

8 a.m. I examine my laboring patient and break her water. She’s currently dilated to 3 centimeters.

8:10 a.m. Heading to another ward, I check on my 15-week patient with the headache. She’s obviously not feeling well, but I don’t think her symptoms are severe enough for meningitis. We await the results of the spinal tap later this morning.

8:30 a.m. I start to see patients in my office, which is within walking distance of the hospital. The first young woman is 36-weeks pregnant with her first child, and she’s excited. For me, this is also a moment of joy, having known her since she was a little girl who played soccer with my daughter.

9:15 a.m. I see another young woman who is at 36 weeks. She had been physically abused by her boyfriend earlier in the pregnancy, which required hospitalization. Luckily, the baby has not shown signs of injury, but we’re watching her closely with ultrasounds and monitoring.

10:30 a.m. After seeing a few more patients in the office, I walk back to the hospital and check on the woman in labor. The fetal heart rate is reassuring, and she’s at 5–6 centimeters dilated now.

11 a.m. My wife—who is also a physician and my professional partner—asks me to take a quick look at one of her patients, who has an unusual lesion on her vulva. It doesn’t look cancerous, but neither one of us is quite sure what it is. After digging out a textbook, we come to the conclusion that it’s lichen planus, a form of dermatitis, and prescribe the appropriate ointment.

11:55 a.m. My labor patient is nearing delivery, so I change into scrubs. As the patient begins to push, the fetal heart rate drops from 130 to 60—low enough for me to perform an assisted delivery. I quickly obtain consent and proceed with a vacuum extraction. The baby has two loops of umbilical cord around its neck. After I loosen the cord loops, the baby quickly recovers. I congratulate the new parents.

1 p.m. I grab a quick cup of coffee on my way back to the office. My first patient has some benign bleeding issues and has tried multiple treatments, including hormonal therapy. We decide on a hysterectomy.

2:30 p.m. My wife calls me once again to examine a new patient with a worrisome lesion on her cervix. It appears to be cervix cancer, most likely Stage 2 or greater. We counsel the patient and schedule her for a biopsy.

3:15 p.m. I check on my 15-week-pregnant patient with the headache and fever. The lumbar puncture didn’t show meningitis, but the chest X-ray did show pneumonia. We agree she should stay in the hospital for another day or two for antibiotics.

4 p.m. My last patient’s breast tumor was found and treated two years ago, but she recently was diagnosed with a bone metastasis. Both she and her oncologist are requesting removal of her ovaries, a surgery we schedule for the following week.

4:45 p.m. It’s Friday, so I call my partner who has on-call duty this weekend to discuss the plan for my patient with pneumonia as well as several postpartum patients still in the hospital.

5 p.m. My wife calls and tells me to meet her at Vino Villa for dinner. My children, having finished at an internship and football practice, are on their way.

6:30 a.m. Immediately upon arriving at the hospital, I meet with my colleague who worked the night shift to get an update on any patients who came in overnight. I like to come in early to check my inbox and read through medical records of patients I’ll see today.

7:25 a.m. A patient came into the ER yesterday afternoon after collapsing from a heart attack and sustaining a serious head injury from the fall. Unfortunately, the brain bleed worsened and the patient died this morning. Another colleague and I give the sad news to the family.

7:45 a.m. I talk to our discharge nurses about a couple of patients I am sending home, emphasizing what needs to be done before and after that happens.

8:10 a.m. In the lab, I put on my lead apron to do the first cardiac catheterization procedure of the day. The imaging shows a serious narrowing of the patient’s artery. I consult with a vascular surgeon and advise the patient that a bypass surgery will be needed to increase blood flow.

8:55 a.m. I go to see another patient to talk about a transfer to an extended-care facility for rehabilitation. When delivering difficult news, I prefer to sit in a chair next to my patient’s bed so we can be more at eye level when we talk.

9:25 a.m. I go into my next cath procedure with a patient who had an abnormal stress test. The patient’s spouse had passed away recently, which can be such a stressful time for a family. Fortunately, the results came out clean, and I was able to give good news.

10:05 a.m. I meet with a device company representative about equipment I use in the lab. So much of what we do is technology-based that it’s good to stay on top of what’s out there.

10:24 a.m. Another cardiac cath, another patient with several blocked arteries. The patient will need a coronary artery bypass surgery, so I call the cardiac surgeon’s office for a consultation.

11:30 a.m. I sit down for a minute while an ER patient is moved to the cath lab, and I do some charting as I pull up highlights on my phone from the Packers football game last evening that I wasn’t able to watch.

11:40 a.m. I go in for a cath on the ER patient, and luckily, no intervention is needed. I deliver the good news to the family.

1 p.m. After grabbing a quick bite to eat in the cafeteria, I start a cath on a patient with low blood supply to his foot. His artery is totally blocked. It’s a challenging case that consumes almost two hours, but with the help of another colleague, I’m able to get the artery open to re-establish blood flow.

3:10 p.m. I make a phone call to an insurance company to get prior approval for a procedure. It goes better than these usually do.

3:30 p.m. I sit down for a minute to clean out my inbox and review test results. Then I create a list of my patients, their problems, and their care plans for my colleagues covering the upcoming weekend.

4:30 p.m. I meet with the physician assistants to follow up on my patients who had procedures today. There are multiple late admissions to the ER and other hospitals with cardiac diagnoses on the board, so I’m checking to see where I can help my colleagues.

4:50 p.m. I get a page from the ER about a patient coming in with chest pain and ST-elevation on their EKG (having a heart attack), so the patient goes directly to the lab for an emergency heart cath. I’m able to open the LAD artery (“the widow maker”) and re-establish blood flow. I talk with the anxious family and let them know the procedure worked.

6:15 p.m. I leave the hospital for the day. Given that it’s Friday, I’m especially happy there are no after-work meetings.

6:45 a.m. My twin boys are out the door to meet the bus, and my oldest son and I soon follow.

7:30 a.m. I arrive at the office in time to review a few lab reports and check messages before my first patient.

7:45 a.m. The morning starts with follow-up visits for hypertension, diabetes, and hyperlipidemia. I review labs with patients, answer their questions, and make sure their medication lists are up to date.

9:05 a.m. Several physicals follow. I see some of my patients only once yearly, so I enjoy catching up with them and learning what’s going on in their lives.

10 a.m. A patient comes in for a procedure to have a cyst removed from her back. It goes smoothly, and she’s out the door with instructions to return for suture removal.

10:30 a.m. I continue to see patients while trying to keep up with the ever-lengthening list of messages that need to be answered today.

11:15 a.m. I take a quick minute to respond to a text regarding my availability to pilot a three-wheeled bike next week for Cycling Without Age, a nonprofit organization I’m involved with that provides bicycle rides for the elderly and people unable to cycle independently. Awesome group, and I love seeing older people getting outdoors and being mobile.

12:30 p.m. I finish my morning only a half-hour behind, which is typical for a busy morning. I spend 10 minutes eating lunch while listening to a pharmaceutical rep fill me in on a change in the administering information regarding an insulin drug.

12:45 p.m. I have 15 minutes to review more messages and answer some emails before my afternoon patients start to arrive.

1 p.m. I begin the afternoon with a physical. I do a lot of them.

1:30 p.m. Between patients, I look into some of their questions on UpToDate, a research-based site for healthcare professionals.

1:45 p.m. A pharmacy isn’t receiving the electronic prescriptions from our office, so I send an email in hopes of getting the problem resolved.

2 p.m. I see a new patient with carpal tunnel syndrome and back pain. I send a message to the nurse to get prior imaging reports and set up follow-up appointment, so we can discuss the results.

2:35 p.m. I close out the afternoon seeing a hypertension patient and doing several more physicals.

4:20 p.m. I head home to see my twins, who arrived there from school at 3:30 p.m. We review what homework they have. Between working on messages and reviewing labs, I begin making dinner and throw a load of laundry into the washing machine.

6 p.m. After picking up my son from marching band practice, I stop at the rehab/long-term care facility where I often see patients. I visit a patient in assisted living, who has been dealing with a cough recently. I make sure her lungs are clear. Geriatrics is one of my passions, and seeing patients here makes me happy.

6:40 p.m. I head down the hall to attend the 70th anniversary celebration of two of my patients. I enjoy seeing younger pictures of them, and it’s a good time to connect with their family.

7 p.m. My son is ready to go home. When we arrive there, I finish up dinner and spend a little time talking with my family around the table.

8 p.m. I help my boys with their bedtime routines. As I come down the stairs, I’m greeted with a mound of clean laundry on the living room floor that requires folding. But I have more work messages to respond to, labs to review, and prescriptions to authorize. It will be a couple of hours before I can call it a day.