I leave my apartment, coffee in hand, around 7:40 a.m. I have a short commute to the University Hospital in Newark, New Jersey, and enjoy a 4-mile drive through the beautiful Branch Brook Park. On this autumn day, the leaves displaying their vibrant colors make my morning commute more serene. I relish the scenery and sip my coffee while mentally preparing for my day. I arrive at the Behavioral Health Science Building (BHSB) at 7:55 a.m.; parking was relatively easy today.

It is a Wednesday—this "hump day" is made more exciting by having a half-day of protected didactic time. First is our forensic seminar at eight o’clock. This second Wednesday of the month, I leave my resident colleagues and excuse myself from the psychotherapy seminar to attend the Resident Council Committee meeting.

This meeting is held biweekly with the bigwigs of the department. As the administrative chief resident, I represent the residents’ voice. On the agenda is the progress of several subcommittees including the curriculum, the research and recruitment subcommittees as well as other issues pertaining to residency training. The chief resident and I present the progress of our survey, which was sent via e-mail to other chief residents of university psychiatry residency programs in order to learn about the average number of didactic protected hours per week. Our program offers more didactic time than the average. This is a concern as our senior residents have little time during the week to see their long-term psychotherapy patients. Ideas are shared, but no decisions are finalized.

Grand rounds is next, and then it is bring your own lunch (BYOL) for our experiential group. I use this time to learn more about my colleagues and as an opportunity to observe group dynamics. Then, the fun is over, and it is back to the real world of work. I go to my office in the child and adolescent outpatient department, and after getting settled in, checking my messages and returning phone calls, there is a knock at my door. The child psychiatry resident introduces me to a fourth-year medical student taking a child psychiatry elective. She is in the process of applying to general psychiatry residency programs, and I am applying to child psychiatry fellowship programs. After talking briefly about approaches to interviewing children and families, we see several patients, present the cases to the attending and arrange for appropriate follow up. Beep-Beep-Beep, the pager shows the dreaded number, the pediatric emergency room.

After spending an hour in the pediatric emergency department with a 7-year-old boy and his aunt, counseling them on symptoms of depression and arranging outpatient follow up, I return to see my scheduled patients in the outpatient department. There is one message on the voice mail. It is from a representative from the journal Psychosomatics (finally!). I have been anxiously awaiting her call. She provides me with great news: my case report will be published in the July issue. It is the first publication that I have accomplished on my own! Earlier in the year, I read and reviewed a book with a supervisor for publication in the "orange journal" for child psychiatrists. Working with a supervisor increased my motivation, kept me focused and on top of deadlines. After numerous revisions, I see how he has helped me hone my writing, critiquing and editing skills. Now I await new challenges. I am excited! I e-mail my father the good news.

As I wait for my next patient, I have some downtime, which gives me a chance to prepare the on-call schedule for next month. As the administrative chief resident, I have this "pleasurable duty." We have 4 affiliated hospitals through which our 29 residents rotate. The University Hospital is short two residents who are out on medical leave. The task is to balance the schedule to accommodate both attendings and residents. I remember the phone call I received from an irate, out of control attending who was overwhelmed by the lack of resident coverage on the day he was scheduled to cover. I understand a new plan has to be formulated for the ER schedule. I play around with many blank calendars; a reasonable solution will come to me (I pray).

I get a page from the upstairs secretary telling me that my long-term adult psychotherapy patient is here. I cannot believe how the time flew; I did not even complete one schedule! I guess it will be homework.

The patient and I meet in the hallway and go to the float office for our session. The sessions are regularly videotaped and reviewed weekly with my psychotherapy supervisor. Today, the patient tells me she is pregnant. While we discuss her distress and her fears, I notice myself emulating cognitive behavioral techniques learned from my supervisor in certain circumstances. However, at other times, I am at a loss for words and I just simply nod and say "mmh hmm." It will be interesting when he watches the tape.

At around 6:00 in the evening, I begin my journey back home. I leave the ambulance sirens and the traffic behind me and turn into the park. The trees and winding roads greet me again. I feel good at the end of a busy yet enjoyable and productive day.