Day in the Life

My name is Rachel Gomes Casseres, and I’m a PGY1 at Tufts Medical Center. I was born and raised in the Boston suburbs by my two parents. I knew since middle school that I wanted to be a doctor, like my mom, who is a podiatrist. I went to college at Brandeis University, where I studied chemical-biology. I was thrilled to be accepted to Tufts Medical School during my sophomore year of college, through a special program between Tufts and Brandeis. I spent the remaining years at Brandeis studying classes of my interest—art, linguistics, math… and psychology. In medical school, my love of all my third year rotations left me with a very confusing decision to make about my specialty. Somehow, I narrowed it down to psychiatry and dermatology. I had loved psychology ever since college and that felt like a natural choice. But I had also loved the visual aspect of dermatology. I realized I couldn’t make a decision with the information I had, and took the year off between 3rd and 4th year of medical school to complete dermatology research on the treatment of inflammatory skin disorders with biologics. While I enjoyed my research year, I found myself spending more time talking to my patients about how they felt about their rash. It seemed like I was finding psychiatry at every turn. I made sure to rotate in psychiatry at the beginning of my 4th year, and I fell in love with the field instantly. I’m so grateful to have chosen psychiatry and to have matched at Tufts Medical Center. Tufts MC has the feeling of a small, community hospital, even though it’s smack-dab in the center of Boston! At Tufts MC I have a lot of autonomy and get to make a lot of decisions myself. It feels great to finally be a doctor and be on my way to a great career, all in the hospital that I’ve called home for the past 5 years. So far I’ve had plenty of spare time for my interests: hanging out with my friends and family, walking in nature, crafting, and watching Netflix. 

A Day on Pratt 2

Currently, I am on my inpatient psychiatry rotation on Pratt 2 at Tufts Medical Center. There are a total of 18   patients on the unit, divided into two, attending-lead teams. There are two residents—one intern and one senior resident—assigned to each team, so at any given time, I’ll have 4-5 patients of my own.

We see a huge variety of mental illnesses and large range of severity. Being located in the heart of Boston, we also see patients from all different backgrounds and cultures. Tufts Medical Center is a “safety net” hospital, which means we treat patients regardless of their ability to pay for treatment.  

I get to the unit around 8:00 am so I have time to pre-round on my patients. My pre-rounding consists of looking at my patients’ charts in our electronic medical record system and talking to the nurses who took care of my patients overnight. With the information I gather, I come up with an assessment and plan for every patient. Just before 9:00 am, I check in with my medical student, who is carrying for two of my patients. I do a little last-minute teaching to help them develop their assessment and plan a little further. 

We begin rounds at 9:00 am with my attending, our social worker, my co-resident and my medical student. Our nurses come in to tell us about overnight events, and then we bring in patients to the rounding room to interview one by one. I interview my own patients, but my attending usually jumps in at the end. When our patient leaves, the entire group convenes to discuss our thoughts and plans for the patients. My attending uses these opportunities to teach and I find it very helpful when she explains her thought process about using specific medications, and formulating the patients in general. My medical student is carrying for my remaining two patients and shares their plans, too. I am discharging one patient today  , so I prepared their discharge summary and orders yesterday so that it’s ready for today. Everything is all set for my patient to leave by 11:00 am this morning.

We finish rounds around 10:30 am. I take some time to talk to my medical student about the day ahead. Now it’s time to get to work: I have patients to see. I try and spend 10-45 minutes with each patient; everyone’s needs are different. After that, I sit down and write my notes. Sometimes I have other responsibilities on the unit. For example, somedays I met with a patient and their family to discuss their post-discharge care. With the remaining time I have, I teach my medical student about a topic of their interest—and try to convince them to apply into psychiatry!

On Wednesdays, we have didactics for half the day. “Didactics Day” means I don’t have any clinical duties between 12-5pm, and I don’t have to write any notes in the morning! Even better, I get a free delicious lunch from a nearby restaurant!  Before the pandemic, all the residents got together in-person for our classes, but for now, the classes take place via zoom. Each class lasts 1 hour—this week I have a class on note writing, on antidepressants and an introduction to psychodynamic treatment. Some of the classes are with the senior residents, and others are just for PGY1s. We also spend an hour in residency meeting, where we talk as a group about what’s going well (or not so well) in the program. 

Wednesdays aren’t the only day for teaching. Once a week, the entire psychiatry department gets together for grand rounds, where we have pizza and listen to a lecture from an invited lecturer. On a different day, we have case conference: that’s when a seasoned attending—perhaps even the chair of the department—interviews one of our Pratt 2 patients in front of the group followed by group discussion. It’s a great way to learn interview techniques from the best of the best!

At 5:00 pm the day residents sign out to the overnight on-call resident (PGY2/PGY3). As a PGY1, I take long day call.  This means that 1-2 nights a week, I will help out the overnight resident until 8:00 pm, usually by admitting new patients to the inpatient unit and helping out with any unexpected issues that come up on Pratt 2. However, I can also be asked to help out in the emergency department (ED) or consultation liaison service CL service. 

The Pratt 2 week is over before I know it, and it’s time for the weekend. Two weekend days out of the month, I’m on call at the hospital. I arrive to the hospital at 8:00 am to take care of Pratt 2, the ED, and consult psychiatry patients. Like my weeknight call, I have a senior resident and medical student to help me. I’m finished by 8:00 pm. For all other weekend days, I am completely free—my computer is shut down, my phone is on silent and my pager is off!

Hi everyone, I’m Michaela, a second year psychiatry resident here at Tufts Medical Center! I am originally from Sweden, but my family moved around to Southeast Asia, New York, and finally Texas. I went to college at Austin College (the Kangaroos), majoring in ceramics and biology. I spent much of my free time in the art studio, leading the environmental group (the piles of red solo cups that were non-recyclable in that city still haunt me), working at a national park, and doing outdoor ecology research. I then went to medical school at UT Southwestern in Dallas and completed the dual MD-MPH program. I loved my public health courses and felt they complimented the medical education well (and were a nice break from memorizing). I was one of those people who loved every rotation, but was drawn to psychiatry for the personal connections. I appreciated the many gray areas in psychiatry, and being able to function as “the tool” rather than relying on diagnostic tests. I also helped run a free clinic for underserved communities and did research in trauma psychiatry working with Oklahoma City bombing survivors. 

After four years, I matched in Boston, and I’m glad I did for many reasons. We have amazing proximity to outdoor activities! I spend much of my free time camping, hiking, skiing, and doing water activities with my dog. I have found plenty of free time to live my best life and travel on weekends. Our residency is also quite social, and we love to visit local restaurants and play games. I’m also on a casual kickball team with some other residents!

Here is a typical day on the consult psychiatry service as a second year resident:

I commute on the train ~20-30 minutes and show up around 8:00 am to run the list with my co-resident and our medical students. The students help with pre-rounding so it gives us an opportunity to teach and to be more thorough with our patients. We then see any follow-ups from the days before and any new consults from overnight. After that we hold the pager and see consults throughout the morning. If we have questions, the Consult Liaison (CL) Attending, Dr. Manuel Pacheco is on site and always available to help guide us. This gives us the opportunity to learn how to develop our own formulations and plans. There is usually plenty of time to teach students, socialize with the team, and grab lunch before rounds. We are consulted for a variety of different questions, so it keeps things interesting. For example, we get asked to help with determining capacity, managing delirium and/or agitation, and optimizing outpatient psychiatric medications for medically ill patients.

Rounds with Dr. Pacheco start at 1:00 PM. We run the list with him, staff new consults, and discuss our preliminary plans for the patients. Dr. Pacheco is extremely enthusiastic about teaching and doing what’s best for the patient. After table rounds, we go on walking rounds with him throughout the hospital. Our C/L service is well-known in the hospital for taking up all the hallway space with our team of residents and students. After seeing our patients with Dr. Pacheco, we sit down and discuss specific cases. Then it’s time to finish notes.

On a typical day, we sign out to the overnight resident at 6:00 pm and I am home with my dog by 7:00! We have didactics on Wednesday afternoons and get delicious food delivered (recently it’s been Mediterranean, Indian, sushi, burritos, yum!). Didactic time is protected for all residents. As a second year, I also have my own outpatients that I schedule throughout the week, and my co-resident covers the service during those times. I usually see outpatients for 1h hour appointments about 2-3 times per week. I also take 24-hour call, 2-4 times a month and my co-resident will cover the service alone when I am post-call. This program provides a lot of autonomy, and I have noticed so much growth in my confidence and knowledge in just one year!

My name is Kat Han and I’m currently a PGY3 at Tufts Medical Center. A little bit about me…I was born in Mississippi, but moved up north when I was 10 and grew up in Cheshire, CT (about halfway between New Haven and Hartford). I went to college at the University of Connecticut, where I double-majored in English and Molecular and Cell Biology. I became a huge college basketball fan and lifelong lover of huskies. I also discovered a love of ballroom dancing and jujutsu (but don’t ask me to do both at the same time!). After graduation, I decided to stay in Connecticut and attended medical school at the University of Connecticut. I initially thought I might become a pediatrician, but after my psych rotation, I found that I never wanted to leave the inpatient psych unit. I never gave up on my dream of working with children though and am now applying for child and adolescent psychiatry fellowships with the goal of working in inpatient child and adolescent psychiatry. 

Outside of work, I love hiking, cooking (I semi-regularly update a food blog), traveling, and playing with my two extremely fluffy cats, Rory and Shakira. I love exploring new areas of Boston, which is super walkable and often feels more like a collection of distinct neighborhoods than a traditional city. Despite growing up a couple of hours outside of New York City, I’ve always felt more attached to Boston for its beautiful outdoor spaces and more laid-back feel. That same laid-back, down-to-earth vibe and friendliness is what also drew me to Tufts MC. 

A typical day at Tufts MC

Here’s what a typical day looks like for me! Of course, this is anything but a typical time so instead of seeing patients in my own office, I am seeing patients at home over zoom or on the phone. Just imagine that when you’re here as a PGY3, things will be back to normal. 

9:30 am – 1:00 pm: Outpatient psychiatry and medication management appointments.  I sneak in a brunch/lunch sometime in here as well. I’m a night owl, so I tend to see patients later in the morning and finish up later in the day. Since we do our own scheduling at Tufts MC so I can tailor my schedule to my own preferences. 

1:00 pm – 3:00 pm: General psych intake clinic with Dr. Paul Plasky: This is all held over zoom these days, but it runs remarkably smoothly. For this weekly clinic, I see a new patient seeking to establish care with outpatient psychiatry. It’s usually Dr. Plasky, another resident, one or two medical students, and me in the room with the patient. I love watching how Dr. Plasky approaches a new patient and quickly establishes a rapport with them while obtaining a comprehensive history. Afterwards, we discuss a formulation and plan moving forward. We invite the patient back to ask some more questions and discuss the plan together. If we agree that the patient would benefit from outpatient treatment, I will work with them going forward. I currently follow around 30 outpatients,   but we have various specialty intake clinics with different outpatient attending physicians throughout the year, which will give me a larger and more diverse outpatient case load over time. I’m especially looking forward to my child and adolescent intake clinic next month.

3:00 pm – 5:30 pm: Outpatient psychiatry and medication management appointments. I usually have one patient after intake clinic. The rest of the time is spent finishing up notes or taking care of other administrative tasks. On other days, I have supervision during this time. Seeing each of my 2 supervisors once per week is really the highlight of my week, since they help me see different perspectives on my patients, understand the art of outpatient psychiatry, and give me guidance on how to approach my outpatients when I’m not sure what to do. 

After work, I typically go for a run, cook and relax for the night. On weekends, if I’m not traveling, I try to spend one day at home just relaxing with my husband and the cats and one day downtown with friends. About once every 14 days, I am on call and spend my post-call day running errands and then relaxing at home. 

My name is Sarah Alraddadi and I am currently a PGY4 and chief resident of inpatient psychiatry. Given my Mediterranean heritage and my love for sun and beach, I never expected that I would love living in Boston as I do now. I live in the North End (Little Italy) which is about 16 minutes to Tufts Medical Center via public transportation and 30 minutes walking. What I love most about living in this neighborhood is the fact that I can stop at restaurants, coffee shops, music or art venues, stores, and parks all on my walk home! I have met new people and made new friends all because of my walks on this beautiful route. There are a lot of fun things to do in Boston; I enjoy live music especially Jazz and Reggae. I have been able to enjoy my favorite food after work including Mediterranean, Italian, Greek and Thai food as there are so many good restaurants around Tufts Medical Center. I have memberships in a few museums, and I have been enjoying some music and social activities at the ICA and MFA in Boston.

A typical day

It has been great to be back on the inpatient service after spending a year in outpatient world. I have missed the sense of urgency, the acute diagnostic challenge and witnessing the daily improvements in some of my patients. I attend morning inpatient rounds from 9:00am to 10:30am four days a week. My role is to teach and guide the PGY1s and PGY2s on my team. Just as importantly, I am learning how to work more like an attending. At noon on Tuesdays, I teach 3rd year medical students and on Thursdays, I lead article presentations after rounds for my team. On Fridays, I work from home and I have a very flexible schedule. I work closely with Dr. DiBlasi, the chief of the inpatient unit, to make improvements to the inpatient rotation for residents. She has been incredibly open and is very supportive. Currently I’m working on a small project to have residents to use therapy techniques for patients while they are hospitalized.

Supervision, research and diversity

I usually see outpatients from my continuity clinic weekday afternoons. I’ve had great experiences discussing therapy dynamics twice a week with my 2 outpatient supervisors. One of the things that I most enjoy about supervision is discussing my own counter-transferences in therapy, which has helped me to understand my own interpersonal dynamics. Tufts MC is a psycho-dynamically oriented program, however, the diversity in teaching and practice helps residents develop their own therapy style. The diversity among my own mentors has been greatly beneficial to my academic growth.

The PGY4 year has a flexible schedule that allows one to read more, research, and participate in whatever scholarly activities one so chooses. It’s also important not to forget self-care! I’m currently working on being involved more in teaching both residents and medical students and I have been working with my supervisors to gain more experience in cognitive behavioral therapy (CBT) and supportive psychodynamic therapy. I have often heard the saying, “bloom where you are planted” with which I relate, as my experience in Boston has been transformative and enlightening overall.