The VA

I'm at the VA for my first two months. It's a good place to start. After I got to know it as a medicine intern (I spent a third of the year here), I've realized it's a smaller place than it seems, and the community of physicians here is really easy to work with. I like the patient population; veterans are hardy, candid, encouraging, and gruff. They do come with a complicated past medical history though; many of our vets have hypertension, hyperlipidemia, some measure of coronary artery disease, COPD from smoking, diabetes, obesity, psychiatric comorbidities, and substance abuse. This can make anesthesia difficult; it's harder to secure an airway in an obese patient with poor dentition, it's harder to ventilate someone who's an active smoker with lung disease, and it's more important yet harder to maintain stable hemodynamics in patients with such comorbidities.

In any case, I'm enjoying it. I get in at around 6am to set up my room, draw my medications, and meet the patient at 6:40. I prepare the patient, place the IV, and we're in the operating room a little after 7. The attendings are incredibly supportive and since it's a small group, we have a lot of continuity from day to day. We get a few breaks and most rooms end mid-afternoon. Around that time, I look up my patients for the following day and talk to that attending about my concerns and plans. It's a smooth routine.