While writing this essay on a typical day, I debated about whether to allow the nonacademic and nonclinical part to seep through. To describe my "work" exclusively does not truly give a representative picture of my day. The act of balancing family, career, and "other" has historically been defined as a woman's issue. This is being redefined, in part, as a lifestyle issue. The newer generation of academics discusses the achievement of such balance as a priority. You will therefore find that I have provided some glimpse of that "other part" as my career, family, and personal priorities are intertwined in the structure of my day.

My day typically begins at 6:30 A.M., and by 9:15 A.M., I am in my office, latte in hand. In this time I have exercised, packed lunches, carpooled, and perhaps run some errands such as picking up dry cleaning or a prescription. It's no coincidence that my work, kids' school, physicians, and home are all in close proximity to each other. Today, while reviewing my e-mail and printing off a conference call number for later, I book family and personal appointments. After I have reviewed with my secretary the edits that I have done to the documents and letters that she typed for me, I head off to see patients in the hospital where my office is located. En route, a colleague and I spend a few minutes giving each other curbside consults on both clinical and academic issues. By 10:15 A.M., I am on the geriatric medicine ward. My first patient is Mrs. X, an 85-year-old outpatient of mine with mild Alzheimer's disease. She has been admitted to the hospital with anorexia and dehydration, and the team thinks that she is psychotic. She is hypervigilant, doesn't recognize her longstanding housekeeper, and her language has dramatically deteriorated. She whispers secretively that she is very frightened about strange things that are happening in the bed beside her with dead bodies. I write out my recommendations regarding pharmacological management and agree with their search for underlying medical causes. Mrs. Y's doctor is concerned that she may be suffering from a depression. She is 90 years old, lives alone in an apartment and was found to be in congestive heart failure when she was brought to hospital after a fall. This is her third hospitalization in the past 7 months, each time for congestive heart failure, despite good medication compliance. She complains of being very tired and that she can't walk. She gets up to void every 1 to 2 hours at night. She walks well with a walker but does not feel that she walks as well as she previously did or that she is as strong or secure. Her only son suffers from Amyotrophic Lateral Sclerosis, and she is worried about him and her own future, should she become more dependant. She is eating well, anxious to get home, attending the exercise group, and keeping up with her friends on the phone. I discuss with the team the possibility of physiotherapy to increase her confidence and endurance and whether there is any alternative regimen that might reduce her nocturia. She agrees to come and see me after her discharge for psychotherapy. Mrs. Z is an 83-year-old nursing home resident with a remote history of depression, who was admitted because of nausea, vomiting, and weight loss. Since admission she has not complained of nausea and is eating better, but she is unmotivated and won't get out of bed. Upper gastrointestinal (GI) series is negative and she is awaiting an endoscopy. Is she depressed? When I interview her she has no specific symptoms. She has an expressionless facies, no spontaneous movements, and bilateral cogwheel rigidity. I diagnose drug-induced Parkinsonism and suggest removal of the offending agent.

By the time I return to my office, it is 12:30 P.M. Over lunch, I review more e-mail and make some telephone calls. My resident shows up for our semiweekly supervision session at 1:00 P.M., and we discuss her patients and then some articles that we had planned to review that are relevant to the management of one of them. At 2:30 P.M., I meet with a couple of the nurses on the chronic care floor. We review the behavior treatment plan and progress of a patient with frontal lobe dementia who is aggressive with personal care and intrusive and verbally abusive with other patients.

Back in my office, I quickly review the agenda before I call in to a 3:00 P.M. teleconference. I am chairperson for an American Association for Geriatric Psychiatry (AAGP) annual meeting program for geriatric training directors on evaluation of the core competencies. Today we discuss our progress and firm up the topics, faculty, process, and deadlines. As soon as we conclude, I type up a summary and send it off. At 4:15 P.M., as previously scheduled, I telephone my division head. It is time to determine the annual geriatric placements for 20 to 30 general psychiatry residents. We discuss our anticipated training capacity at the various teaching sites, based on the information that I have collected about our faculty numbers and resources. The few requests I have received for atypical training experiences are complex, and we debate whether we will approve them. After a quick call home to check on my children and discuss whatever can't wait until I arrive, I work on a PowerPoint presentation for an upcoming AAGP weekend conference. I am coteaching the morning session on the evaluation and diagnosis of cognitive impairment. As previously agreed upon, I review my coteacher's content slides and revise them to incorporate the case that I have videotaped and various techniques that will facilitate audience participation and interactivity.

I pack some work to take home and leave the office around 5:45 P.M. On average, once during the week and occasionally on the weekend, I actually open my briefcase at home.