A Typical Week for Sarah Eckstein, MD
Monday
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Sarah kayaking with her dog Morning: I am currently working on the neurology consult service at “Big Duke” (our nickname for Duke University Hospital, or DUH). As part of our psychiatry training, we are required to rotate on neurology. Luckily, the neurology program here at Duke is very strong and full of wonderful people who love to teach! I am personally interested in autoimmune encephalitis and have been able to learn so much about this pathology from our neurology colleagues on this service. I start my day around 5:45am with my morning routine, including a cup of coffee, homemade smoothie, and brisk walk around the block listening to my favorite podcast or exploring new music with my pup Daisy. I arrive at the hospital around 7am to receive signout from the overnight team. After signout, we have about 30 minutes to chart check our new patients from overnight before table rounding with our attending. At around 9am we head down to the ED and traverse the different hospital floors to see all of our new consults. We generally return to the workroom at 11am to write notes prior to noon conference.
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Afternoon: On Mondays we have med-psych noon conference, so I log onto our Zoom lecture (also in person at DUH) to cheer on my colleagues, grab free lunch from either medicine or neurology (which ever sounds better!) and head out to my car to drive over to my outpatient clinic. My outpatient primary care clinic is through the VA at the Hillandale clinic site, which is about a seven-minute drive from DUH. I usually arrive a bit early so I have time to eat and check in with our wonderful nurses. I have three to four patients scheduled for the afternoon and will skim through my notes that I prepared the week prior in anticipation of our visits. When my patients arrive, I generally spend 20 to 30 minutes chatting, hearing about their chief complaints, asking my healthcare maintenance questions, before going to the attending workroom to staff with my attending. Now that I am a third year, this is usually a quick process and my preceptor rarely sees patients with me unless I ask; although they are always available and supportive. Then onto the next patient! I am usually done seeing patients around 4:30pm, will finish any orders I was not able to do during my visits and head home around 5pm.
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Evening: I am greeted by my adorable pup when I get home. Since it is an earlier day, we will pack up in the car and head to a nearby trail for a quick jog. After, I will go home and finish any notes I have left from clinic. Then I am off to a friend’s house to grill by the pool. I am generally in bed by 10:30 or 11pm.
Tuesday
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Morning: On Tuesdays we have morning report from 7-8am, during which one of the neurology faculty members will walk us through an interesting case that came in overnight. This session is peppered with teaching pearls and helps students and residents build an appropriate differential for a variety of chief complaints. Then we are off to chart check our new patients, round on our new consults, and finish notes before noon.
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Afternoon: Tuesday afternoons are dedicated to psychiatry academic half day (AHD)! As med-psychers, we attend psych AHD when we are on psychiatry services, consults, or ambulatory blocks. AHD is a hybrid of in-person and Zoom lectures from 2 to 5pm comprised of three 50-minute teaching sessions tailored to our specific level of training. It is also a great time to catch up with my co-residents! Sometimes we will have class meetings beforehand or meetings for the different tracks. I am a part of the Clinician Educator Track and so will attend different lectures on topics ranging from how to create a chalk talk to values-based decision making.
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Evening: After AHD, my class will generally get together to have a beer or play pool at a local bar! If this is not happening, I take the opportunity to meal prep for the rest of the week.
Wednesday
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Morning: Same morning routine! I arrive at DUH at 7am for signout and head to neurology Grand Rounds at 8pm, where a faculty member will speak on a specific topic. This week the topic was autoimmune encephalitis, yay! I sometimes will take notes in my Notability app if the topic is pertinent to my training, and of course did so today. Grand Rounds is generally fun because, regardless of the topic, there are always donuts. Afterward, we head back to the work room to chart check and round on our new consults. Some days are particularly busy with multiple stroke codes that take the neurology residents away from rounds, which gives me the opportunity to pick up an extra patient or two to help with our teams work flow.
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Afternoon: I have the choice to either head to neurology noon conference or medicine noon conference. Today I chose neurology noon conference because we got to go to the anatomy lab and look at brains with a neuropathologist. After conference and lunch, I head back to the work room to check in with the neurology senior on new consults that have rolled in since we last staffed. I pick up a few extra consults, go see them, and then we round again in the afternoon with our attending from 2:30 to 4pm. After rounds, I finish my notes, communicate our recommendations to the primary team, and head out for the day around 5pm.
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Evening: I get home just in time to catch the last 30 minutes of the Durham farmer’s market, which occurs every Wednesday evening and Saturday morning. I pick up some fresh vegetables and beautiful flowers, unlike any I have seen anywhere else in the country! After that, my dog and I go on an evening jog around my neighborhood. I live downtown and there is a trail system about five minutes from my apartment building that we love going on, especially when we need a little bit more time in nature. I then cook some of my fresh vegetables and have a great dinner while I look over and prep notes for my outpatient psychiatry clinic tomorrow. I will also spend about 30 minutes to an hour reviewing labs that have come back from my VA outpatient clinic.
Thursday
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Morning: We again have morning report from 7 to 8am, before going back to the work room to look up our patients, examine brain imaging, all before rounds at 8:30 or 9am. We round on new consults, write notes, and communicate with primary teams before noon.
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Afternoon: I log into the Zoom psychiatry Grand Rounds while I pick up free lunch and drive over to Duke Regional Hospital, where my psychiatry outpatient medication management clinic is located. This is a clinic we start in our third year and have for one half day a year as PGY3 med-psychers. I generally have three patients scheduled starting at 1pm. New consuls will get a 90-minute slot, with returns getting a 30-minute slot. During these visits, my preceptor will video in and can watch the encounter through a computer in the room. The extra time during these clinic appointments allows me to truly get to know my patients and have a good grasp on how they are doing with the medications we have started them on. After chatting with my patient, I head back to my preceptor’s work room, where I give him a quick summary on the patient’s progress. We discuss different medication options and ultimately agree upon a plan before we both head back to my clinic room and present the plan to the patient. I then schedule a follow up appointment, send off their new prescriptions, and pend the note before seeing the next patient. Our clinic schedule is only booked until 4pm to allow time for teaching from 4 to 5pm. During this time, all the residents in the afternoon clinic meet with our preceptor, who tells us about new studies or technology that is applicable to the outpatient setting. We also discuss interesting cases that we had in clinic that day.
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Evening: I arrive home by 5:15pm and work on my notes until about 6 or 6:30pm. Then I am off to a girls’ dinner at one of Durham’s fabulous restaurants! For being a small town, Durham has a great food scene with new restaurants popping up monthly. After that, we stop by our favorite wine bar for a glass of wine on the patio to enjoy the beautiful summer evening.
Friday
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Morning: I arrive for signout at 7am and then head to neuroradiology rounds! This is a fabulous learning opportunity where a neuroradiologist volunteers to walk residents through complex neuro images from our current patients. This is always educational and clinically helpful as we use this information to guide our differential. We then are off for our normal rounding am routine.
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Afternoon: We break for neurology noon conference and, of course, free lunch. We come back in the afternoon to see a couple more consults. Since it is my last week on the rotation, the attending sets aside time to give me feedback and ask for feedback on the rotation. I also set aside time to provide feedback to the medical students I worked with while on the consult team. I get out around 4pm, as my senior lets me out early since there are not as many consults this afternoon.
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Evening: I rush home, grab an Uber, and am off to Vancouver for a conference! I am presenting at the American Academic Psychiatry annual conference with my fellow residents on values-based decision making, something I became passionate about through the Clinician Educator track.
Weekend
My weekends vary a lot over the year depending on time of year, if I have a golden weekend, and so on. I consider myself an adventurous person, and so I am frequently leaving town on golden weekends. Luckily, Durham is a 20- to 30-minute drive away from an airport with direct flights to many places. A few weekend trips I have made over the past years include Washington DC, NYC, Miami, Austin, Dallas, and San Francisco.
During the summers there are countless outdoor activities that I love, from standup paddle boarding on the Saxapahaw River to kayaking on one of the many lakes, to outdoor food/art/music festivals at Durham Central Park. Because everything in Durham is so close, these activities are accessible even if I only have one day off a week. My weekend is usually a combination of fun activities to reset, catching up with friends and family, exercise, and of course the normal chores needed to maintain a regular busy life as a resident!
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