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White Coat Diary: Saba Fatima, MD

White Coat Diary asks Doximity members to share how they spend their days or nights inside and outside of the hospital, clinic, or office.

Name: Saba Fatima, MD
Specialty: Pediatrics
Institution: Einstein Medical Center
Location: Philadelphia, PA

5:30am: The alarm won’t stop. It is like a shrill sound piercing through my soul. The blanket seems so warm and cozy, tempting me to ignore my enemy: the heartless alarm. I hit snooze; it gives me momentary peace. Then I realize that I must show my face at work at 6.30, so I ignore my inner demons and jump out of bed.

5:45am: My husband broke his ankle last week after slipping on the ice after the snowstorm (on the first day of Spring). He is currently non-weight bearing and in a slightly crappy mood for being out of work. I hustle to the kitchen to fix him a quick breakfast and lunch.

6am: I am still struggling at home, and I have a 30-40-minute commute to work. Ouch! need to work on time management skills soon.

6:30 a.m.: I MADE IT TO WORK ON TIME! Skipping details of what happened meanwhile. Can policemen give tickets based on blogs? I wonder, but I will play this safe. Okay, enough of my personal life, time to switch to doctor mode! Sign-out has now started.

7:15am: It’s a Monday, so sign-out took forever. I am now expected to see 18 patients in 45 minutes and show up to morning conference at 8 a.m. Oh well, so what? No one ever said residents were human.

9am: Rounds have now officially begun. I have managed to grab a granola bar for breakfast in between seeing 18 patients. As senior resident, expectations from me for rounds are to know everything about the patient which the intern may have missed. I am also supposed to read up on the different conditions each patient has. Failure to thrive, complicated pancreatitis, respiratory failure secondary to hypotonia, histiocytosis……it goes on. We are also doing something called family-centered rounds, so we are giving more time to each patient and parent explaining in simplistic terms what’s going on with their child. It’s great but sometimes can take forever to execute during rounds.

12:30am: Yes, we are still rounding! So far, I have been pulled out multiple times by phone calls regarding patients (sometimes not so urgent). I haven’t had much face-time with the parents and the children. The sugar levels to my brain have started to cease slowly, and my legs have started to give up. Is this ever going to end?

2:30pm: I have spent the last two hours on the phone with an insurance company trying to get prior authorization approved for a medication a baby urgently needs before they can be discharged from the hospital. Have been redirected four times by four different people, only to find out that I still have not reached the correct person who can handle my request. My rant against insurance companies is going to be worth another 1,000 words and a topic for another day. Right now, there is just one voice in my head screaming, “This baby urgently NEEDS this medication. I wouldn’t have wasted my precious time calling you if they did not!!”

3pm: Caffeine break, giving the insurance company a chance to pull their act together before I can lose my mind.

4pm: Have been behind the computer typing away furiously, documenting plans and notes for the patients for an efficient transition of care to the next team. The fax machine is now whirring as I type.
That fax carries the best news I have heard all day: “Your prior authorization for the requested medication has been approved.”

5pm: It’s almost time for sign-out to the night team. The nurse just called. There is an angry parent in the hallway not happy with our care. I feel too mentally exhausted to deal with the situation. I plaster a big smile on my face, take three big deep breaths, and show up in their room. This is one cute kid, sitting on the bed, not feeling so well. I try to focus on his face for two seconds before I look at the angry parent. I need to remember my purpose and find a few minutes of gratitude in my work so I can feel ready to help these parents. I then turn around and start the conversation. They calm down eventually. All they wanted was to be heard. Did we forget to do that in our busy day?

5:30pm: It’s time for sign-out, wohooooooo. The night team has a lot of suggestions about what may have gone wrong today. I am finding myself going into a mental spiral of questioning our decisions for the patients.

6:30pm: I am in my car, ready for my commute back home. I put on loud music to disconnect from work. Sometimes it helps, sometimes it only disrupts the peace.

7:30pm: Home. There is no healthy food in the house. Of course, because I didn’t cook any. There are demons in my stomach growling for food. There is a battle between my stomach and my mind for the packet of Cheetos on the kitchen counter. My mind loses the battle, like most times. I will spend this next hour lounging on my couch, drowning in Netflix and Cheetos. I can’t tell you for sure if it will make me feel better or worse tomorrow.
My husband asks me “How was your day?” I don’t have much energy left to revisit how tiring it was. I can only muster, “It could have been better.” We enjoy our silence among occasional giggles as Friends runs on the TV. I feel aimless but good.

9pm: I can’t keep my eyes open; it’s time to sleep. But should I? There are still dishes in the sink, clothes in the dryer and trash in the can. Hmm. Today I choose sleep. After all, I must do all this again tomorrow. And isn’t burnout and wellness this big thing in residency?

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