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!