Meet the Residents

Message from the Chief

 

Welcome to Tulane Anesthesiology! For decades our residents have graduated with world-class training based on a diverse clinical experience, focused didactics, and experienced faculty dedicated to teaching and providing the best well-rounded educational experience for every resident. After three years of managing anesthetics for such challenging cases as liver transplants, craniotomies, redo heart valves, traumas, and high-risk obstetrics, our graduates have the skills to handle any clinical situation presented to them, no matter the complexity.

 

"Laissez les bon temps roulez". This famous phrase embodies the spirit of New Orleans and also encompasses the spirit of the anesthesia program at Tulane. Having been born and raised in Houston and spending my entire life living in Texas, when I was applying for residency I thought I would stay in the state I spent my entire life in. However, once I visited Tulane on my interview day and had a chance to get to know the faculty and residents, I knew that Tulane was where I wanted to pursue my residency training.

 

 

There are many great things about Tulane that has made my time here special. What stands out  the most is that Tulane Anesthesia is like an extended family to me. The camaraderie among residents stems from being a mid-sized categorical program with 20 residents where we get to share experiences starting as interns training in internal medicine.  We are a diverse group, hailing from all over the country, but the bonds that form during our four years together are friendships that will last for a lifetime. From celebrating holidays together, attending classmates' weddings, enjoying the amazing food and festivals that happen year-round in New Orleans, and of course Mardi Gras, Tulane provides endless opportunities to hang out and enjoy the city and everything it has to offer while building the friendships that make this program so special.

 

 

As I enter my CA3 year as the elected Chief Resident, I couldn't be happier with my decision. I chose Tulane largely because of the people and the depth and breadth of clinical experience. The cool thing is that the residents also chose me! The residents in our department have a strong voice in everything from their daily OR assignments, rotation schedule, and “rank list party" where we collectively decide which applicants would be the best fit for our program. In addition to an awesome work environment, I am proud of the training experience that Tulane has provided me.

 

 

At the end of the day, my experience here as a Tulane anesthesiology resident has been second to none. I believe that our program has the ideal mix of clinical and academic experiences, but we are also a close-knit family, and we have a lot of fun. While residency can be demanding at times, it has also been very rewarding, and I know that Tulane has made me a well-prepared anesthesiologist. It has provided everything I could want in a residency program.  I invite you to come visit and see if it would be a good fit for you as well.

 

 

Jen Jou, M.D.: A Typical Day for the Anesthesiology Resident

 

It’s sometime around 5:30 a.m., and I only have half an hour to get to the OR. Some might be in a panic, but the anesthesiology resident is always ready. We tend to be an organized lot, and I’ve pretty much got my morning wake-up ritual down to a science. Fifteen minutes, and I’m out the door. Admittedly, it helps knowing exactly what I’ll be wearing every day and that I will never have a bad hair day underneath a scrub cap. By 6 o’clock I’m saying hello to the morning nurses and making my way to check the OR schedule board.

 

Things are always changing in any hospital, and the operating room is no exception. I head to my assigned OR, throw on some music, and, before I know it, I’ve got my machine checked out, monitors ready, and drugs labeled and lined up neatly in a row.

 

I take a few moments to go over everything. The mark of a good anesthesiologist is being prepared for anything, and my morning set-up makes me ready to anticipate any problems that might arise.

 

By 7 o’clock I’m at the patient’s bedside to say hello and review his or her chart. I’ve learned quickly that two people undergoing the same surgery can react very differently under anesthesia, and reviewing the pre-op evaluation will provide invaluable information as to how the patient will react.

 

By 7:15 I’m in a whirlwind of activity. A lot happens in the few minutes before the surgery is underway, and this is the time to be quick, focused, and aware. Some days I’m teaching visiting medical students the basics of anesthesiology, but most of the time, it is me who is being taught. All the attendings I work with have developed their own finesse in what they do, and I enjoy trying out and picking which techniques I will eventually adopt as my own.

 

I typically find that as soon as I’ve got my patient settled into surgery, a friendly and invaluable CRNA has arrived to offer a mid-morning break. On days that I need it, a cup of coffee is in order. Otherwise, I like to see if there is anything I can do to prepare for my remaining cases of the day.

 

After a few more hours in the OR, I’ll get a lunch break around noon. I like to catch up with what the other residents have been up to, both in and out of the hospital. We’re a pretty social bunch, and living in New Orleans makes it easy to trade stories about restaurants, concerts, movies, and games we’ve been to.

 

The rest of the day is just as fast-paced as the morning, which makes the afternoon fly by. At 3 o’clock I’m done with my OR duties and will drop by the pre-op clinic to review my cases for the next day. This means that I’m out of the hospital by 4 p.m. and have the rest of the afternoon and evening to study, work out, meet up with friends, or run errands. I personally love to cook and like to use my free time trying out new recipes. At the moment, I have a small obsession with bread making and use my roommates as taste testers.

 

Of course, an early morning means that an early bedtime is a must. By 10 o’clock I’m ready to go to sleep, feeling satisfied with what I’ve done with my day and ready to start another. Tulane's Anesthesiology program provides me the opportunity for a balanced lifestyle, including not only intellectually-stimulating cases and a superb learning environment, but also time for family, fitness, and hobbies. This is a big reason why I chose this program, and I am happy to say that I haven't yet been disappointed.

Brent Dilts, M.D.: Mission to the Dominican Republic

 

We live in a country with the best health care in the world. For this we should all be very grateful. Instead, we live in an entitled society that expects the best care for minimal cost, and if we don’t get it we will complain, whine, and sue. I do admit that this is a bit of a generalization. I have had many grateful patients, but this is sadly not the norm. When you pile this frustration onto the added stresses of being a resident, it has often been difficult to keep in perspective what I am here to do, to help others.

 

I recently had an opportunity that helped me rediscover those core desires that led me to medicine in the first place. A friend notified me that a surgical mission trip in conjunction with Rush School of Medicine was in desperate need of three anesthesia providers at the last minute, and I jumped at the opportunity.

 

What am I doing? Why did I go to medical school? Is all of this debt worth it? I accrue more interest than I make in one month! I can’t possibly see all of these patients before rounds. No matter how much I study, Dr. Brain, my attending, finds a way to make me feel inadequate… This is too hard. The hours are too long, etc. etc.!

 

These are all valid questions and statements that residents ask themselves every day. All of the thousands of different stories that lead an individual to pursue a career in medicine started with one common question… Why go to medical school? The answer: To help others. All too often the stress, pressure, and fatigue of residency cloud this picture to a great extent.

 

We live in a country with the best health care in the world. For this we should all be very grateful. Instead, we live in an entitled society that expects the best care for minimal cost, and if we don’t get it we will complain, whine, and sue. I do admit that this is a bit of a generalization. I have had many grateful patients, but this is sadly not the norm. When you pile this frustration onto the added stresses of being a resident, it has often been difficult to keep in perspective what I am here to do, to help others.

 

I recently had an opportunity that helped me rediscover those core desires that led me to medicine in the first place. A friend notified me that a surgical mission trip in conjunction with Rush School of Medicine was in desperate need of three anesthesia providers at the last minute, and I jumped at the opportunity. My Residency Director and Department Chair encouraged three of the residents to go.

 

It was decided—we were going, and all we were responsible for was packing our bags and showing up at the Santo Domingo Airport on a Saturday afternoon. A company called Endeavor took care of the logistics of transportation, meals, housing, and anything else that came up. We actually did not need another penny for the entire trip unless we wanted souvenirs or an occasional alcoholic beverage.

 

After we landed in Santa Domingo and met our guide for the week, we spent Saturday evening exploring a trendy part of the city that was only a few blocks from our hotel. We had some delicious local fare, a few cocktails, and tried to predict what the upcoming week had in store for us.

 

Sunday morning breakfast at the hotel was the first time the entire crew would get together and meet. The group consisted of about fifteen physicians, some residents, some attendings, and two nurses. Everyone was very personable so it was not long before we were all very close. We spent the rest of Sunday touring the city and a local museum where we had the opportunity to learn some Dominican history. By the afternoon it was time to depart our cushy air-conditioned hotel and head for the hills…

 

Literally, we were heading for a small town in the mountains of the DR called Peralta. This is the town that the group has been serving for over 5 years. So after about a 3-4 hour drive west along the coast and then north and up the mountain, we arrived. There were many smiling faces at the local medicine clinic, fresh iced tea, and delicious cornbread! Everyone was truly happy to see this group arrive, which is a testament to the amount of good work others have been doing for several years. Now, it was time to put those two weeks of Rosetta stone to the test… I will admit that the Tulane folks struggled with their Spanish! But all was well, everyone was patient and we had many translators!

 

We were handed the boxes and bags that were labeled “Anesthesia” and we took inventory of everything that we had. At the same time, everyone that was scheduled to have surgery that week was getting a pre-operative assessment by the medicine docs. After a few hours of work we loaded up in the vans and they took us to our new homes.

 

There are two large houses up the road that are donated for the weeks that the mission comes to town. Everyone bunked in a room with 2-3 people. There was one shower in each house that was shared, and we had electricity most nights… if it went out they were quick to fire up the generator! They took very good care of us.

 

Every morning from Monday-Friday would begin at 7:00 am, when we would go to the local pastor’s house, where he would provide us with breakfast. The hot chocolate was the best I’ve had in my life, and then the discovery of coffee combined with the chocolate changed my life! From there the surgery group would split from the medicine group. The medicine group would go to a number of clinics throughout the week, and the surgery group would take the van to the town of Azua where they rented two operating rooms for the week.

 

After organizing all of our supplies in the OR as best we could it was time to proceed with the cases for the week. At first glance at the case list for the week, it seemed as if this would be a cakewalk, even for the CA-1s. The majority of patients were very healthy, and most of the surgeries would be considered routine general, urologic, or gynecologic surgeries. The challenges were not in the cases themselves, but in using limited and different resources than those to which we were accustomed. Only one anesthesia machine had end tidal CO2 monitoring, we used halothane and paracetamol (not used in the U.S.) for the first time, we did not have any IV narcotics so multimodal analgesia was a necessity, etc… By the end of the week supplies were running short so we had to constantly modify and adjust our anesthetic plans accordingly.

 

We would finish our day in the OR by about 5 PM, and the surgeons would then round on their patients that were still in the hospital. We would leave the hospital by around 6-7 PM, and then head back to Peralta.

 

We would typically drive straight to the pastor’s house where they again had a delicious meal waiting for us. Many of the children from the town would be eagerly waiting for our return to play and chat with the visitors from the U.S. After dinner, it was time to kick back! We would hang around and catch up with the medicine group, telling stories from the day, and sampling the different Dominican rums… They were oh so smooth and delicious!!

 

After a week of hard work, it was time to really put our feet up!! Friday in the OR finished earlier than usual. We cleaned and repackaged everything into the different boxes and bags that they came in then headed to the beach! Five days of hard work and service to the community of Peralta is rewarded with two nights in an all-inclusive beach resort! The trip was already one of the best and most rewarding trips of my life, and now this was just the icing on the cake! Days were spent on the beach sipping cold cocktails, and the nights were spent dancing merengue… or in my case I should say attempting merengue!

 

The three residents who attended that year all agreed that it was an excellent experience, both personally and professionally. We had such a good experience that we have collaborated with Rush School of Medicine and agreed to provide three residents and one staff for their yearly surgical mission to the Dominican Republic.

 

We faced daily challenges of limited resources, which quickly made us appreciate all of the little things we have at our disposal at home. We learned how to troubleshoot many issues, without simply calling the tech to provide us with what we are accustomed too. Aside from the challenges and difficulties we faced, which undoubtedly made us grow as physicians, it was an extremely rewarding trip. What was lacking in equipment was made up for by a very pure desire, by everyone involved, to help others that were in need. This desire, that is at the core of everyone that goes into medicine or nursing, was never more evident to me than it was on this trip. Nobody ever uttered the words "that is not in my job description", or even balked at anything that needed to be done, that was not routine for them. Everybody involved did whatever it took to safely provide the services that our patients needed. Needless to say I am anxious to go in the future, and glad to see Tulane Anesthesia residents will have this opportunity for years to come!

 

Jeff Anderson, M.D.: A Day in the OR for a CA-1 Resident

 

Depending on what cases I have scheduled for the day, my alarm starts going off anywhere from 5:00 to 5:30 AM. Yeah, some days that is early, but the body adjusts pretty quickly. I grab a cup of coffee and get ready for the day.

 

In general, I try to be at the hospital at 6:00 AM so that I can take my time setting up my room. I believe one of the signs that I have chosen the right career is that fact that I find filling syringes and checking my machine to be strangely satisfying. If I have relatively simple cases scheduled, everything should be set up with my drugs lined up just the way I like them within half an hour. If arterial lines, fluid warmers, or central lines are needed it may take another fifteen minutes.

 

This gives me time to drop in a see how my fellow residents are doing before being at the patient’s bedside at 7:00. I start an IV, examine the patient, answer questions, and make sure they did not stop at McDonalds on the way to the hospital. At 7:15, we are rolling back to the OR.

 

After the patient is settled in for surgery, it is usually time to talk over some concepts with our attending whether it involves the inner workings of the anesthesia machine, the implications of sleep apnea in the perioperative period, or even goals for future practice. I will often have a medical student in the room as well which gives me the opportunity to evaluate which topics I have learned well enough to be able to teach. My specialty right now is neuromuscular blockade and the National Football League. Plus, the students often have keen insight into the culinary world that exists outside the walls of the hospital. At Tulane, education is a two -way street.

 

Over the course of the day, I receive a short break in the morning, which I usually use to infuse additionally coffee into my system, and a lunch break. I grab food in our cafeteria and retreat to the resident lounge to hang out with my fellow residents for a few minutes before heading back into the operating room.

 

At approximately 3:00 PM, one of our invaluable CRNAs comes and takes over my case. This is one of the most important aspects of our department and residency program. As residents, we are not the workforce. If the case has a great deal of educational value, I will stay and finish the case. If my time can be better spent reading or going over my pre-ops for the next day, I have that ability. Once I am relieved, I run and check the schedule for the following day. Then I review the patients’ preoperative evaluations and charts. I will call my attending to discuss our plan and any important points as to the patient or the case. By and large, I am walking out into the beautiful Louisiana sunshine by 4:00 PM. This gives me plenty of time to read, see my family, or just be somewhere else.

 

Wednesdays offer a break from the norm as surgeries are not scheduled to begin until 8:15. Grand Rounds, M&M, or Problem Based Learning presentations are scheduled in the morning. At 12:30 PM, all residents are relieved from clinical duties to attend our educational conferences. The afternoon consists of medical student presentations followed by a variable combination of didactic lectures, mock orals, presentations, journal clubs, and resident run board review. We also invite outside speakers such as local or state politicians and business leaders to better equip us to practice out in the “real world.” In addition, we have class-specific conferences for CA-1s and sessions in our Simulation Center to help round out our education.

 

Our call schedule is generally pretty favorable. Starting January of CA-1 year we begin taking “day call” from 6:30 AM to 7:00 PM and involves providing support to make the ORs and, really the hospital, run. Responsibilities include doing pre-ops for any first case starts in the morning and any add-ons, doing post-ops for inpatients after surgery, and carrying the Code pager. As residents, we provide the in-house call coverage on Saturdays. One senior and one junior resident is on call every weekend from 7 AM Saturday to 7AM Sunday. It averages out to about one in-house call per month. If you factor in the day call schedule as well as rotations in the SICU, I will be on call around once per week.

 

One of the great things about Tulane is that it is located in the heart of New Orleans with all the culinary, cultural, and historical complexity that makes the city great. And, fortunately, as residents we allowed time to enjoy life outside the hospital. The food in New Orleans is outstanding. The festivals are just about weekly. The music scene is among the best in the country. And Mardi Gras is, well, Mardi Gras. Have you ever lived in a city which pretty much shuts down to have a good time? As a residency we are pretty tight knit group and often choose to get together outside of work. On Thursday nights the residents’ softball team plays in one of the local coed social leagues with generally positive results. (For the record, we will be graduating our current 3rd baseman and pitcher in July.) The annual fantasy football league allows for some friendly competition during the fall. In addition, there are the annual Beginning of the Year, Christmas, End of Year parties which allow everyone to get together as a department.

 

Most nights I try to be in bed by 10:00 PM so that I will be ready to go when that alarm goes off ever so early in the morning.

 

Have any questions? Shoot me an email and I will do my best to provide an answer.

 

janders7@tulane.edu

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