6:30am: National Public Radio’s (NPR’s) Jean Cochran heralds the morning news on my clock radio. Quickly, I hit the snooze button, hoping my Golden Retriever did not hear her voice, but no luck. About 15 seconds later, a cold, wet nose is nudging my arm. The morning routine is streamlined to a science. In the next hour, I get ready for work, quickly check overnight e-mails and phone messages, walk the dog to doggy daycare, then continue on my hilly trek to the hospital (this is San Francisco after all).

8:00 a.m.: The day begins with psychodynamic psychotherapy supervision. We discuss the case presentation I’ve been preparing for next week’s grand rounds. My supervisor knows about this complicated patient well, as we’ve discussed her management at length over the past 8 months. I show him the PowerPoint presentation I prepared over the weekend and review some of the modifications made for the presentation. At 5 minutes before the hour, he wishes me well on the presentation, and I sprint several buildings over to spend the next 2 hours seeing consecutive medication management patients: a 44-year-old man with schizophrenia; a 72-year-old widow with depression; a 33-year-old woman with bipolar disorder, who proudly brings in pictures of her newborn son; and finally a 58-year-old woman with obsessive compulsive disorder (OCD). Before my next patient, I set up the video camera in my office to tape my upcoming therapy patient partaking in cognitive behavioral therapy (CBT) for his anxiety disorder.

Noon: I grab a sandwich-to-go from the cafeteria and head to the conference room for child-adolescent didactics. Today’s presenter discusses evaluation modalities for attention deficit hyperactivity disorder (ADHD). Psychopharmacology class follows, where we review a recent article on pharmacological approaches to treatment-resistant depression. I have 1 hour before my next appointment (a new patient coming to the clinic for an intake evaluation). I check more messages, finish writing some notes, return calls, then take a walk to the library to refine a Pub Med search for the topic I’m discussing at Journal Club (administering psychotropic medications during pregnancy, a topic actually inspired by my aforementioned new-mom patient with bipolar disorder). I save 15 minutes before heading back to the outpatient clinic and detour away from the hospital to walk through a nearby scenic park. My last patient at the clinic is a 19-year-old man, diagnosed as a child with Asperger’s disorder, who had recently experienced new-onset auditory hallucinations and delusional thoughts. I’m pleased to hear from the patient and his father that the atypical antipsychotic medication started 4 weeks ago is relieving his disturbances and that he’s back in school.

My final meeting of the day is with the residency director, whom I’m asking to participate in a symposium that my colleagues and I in APA’s Committee on Residents and Fellows are presenting at the upcoming annual meeting (I’m the Area 6 representative). Before leaving his office, I sneak in a quick discussion on goals for my upcoming fourth year of residency: opportunities to teach a seminar for first-year residents and medical students, elective rotations in geriatrics, and a hospital-sponsored research month on the therapeutic effects of Hawaiian scuba diving on academic psychiatrist in training. Well, it was worth a shot.

6:30 p.m.: I head out of the hospital, make it back to doggy day care to pick up an exhausted but exuberant companion, then head home for the typical evening rituals—a little downtime with family, a call or two to friends, dinner, a nighttime walk through the neighborhood, one final check-in with office voice mail. Tonight, I hear a concerning message from a 57-year-old man with a history of suicide attempts. He cancels his appointment for the following day. His voice sounds different and tense. I call him back, but he does not answer. Feeling uneasy, I call my caseload supervisor at home. We discuss options, including calling for a police welfare check. Fortunately, one final attempt to reach my patient succeeds. He admits that he had a plan to kill himself that night, but after a brief talk, agreed to go to the ER for admission to the hospital. Later, I confirm that the patient has arrived at the hospital, and at last I can go to sleep, feeling some relief that a potentially catastrophic outcome has been averted. I climb into bed, knowing one thing for sure—that in 7 hours, I’ll be feeling the cold, wet nose nudging me, and that each day ahead will continue to be unlike any before.