Living there:

Your address is 310 E. 71st Street (between 1st and 2nd Ave.) Apt 3F New York, NY 10021 phone (212)288-5246

There are two sets of keys to the apt that will go back and forth between Baltimore and NYC.

Move in after noon on the Sunday before you start.

You get a one bedroom studio about two blocks from work in the Upper East Side of Manhattan. 71st, between 1st and 2nd. There's a 24 hour person at the front door, and I think they take packages if you need them to. Apartment comes with a full bed, a few lamps, table, chairs, sheets, towels, t.v. with some cable, some pots, pans and cooking utensils, microwave, fridge, gas range, some plates and bowls, phone (no answering machine). Here are some photos:

It's air conditioned, and it has central heat for the winter time. The walls are a bit bare, so be creative with your decorating!

The water pressure in the bathroom is great! Trash chutes for small stuff on each floor; you can take bigger bags out yourself to the trash cans on the first floor. Laundry is down stairs on the first floor, toward the western half of the building. $1.25 to wash, $0.50 to dry

The housekeeper will be in once midway through your rotation to clean the bathroom, kitchen, etc and will pick up any linen/towel laundry to do. If you need additional linen or towels, please let Mary Hargett know.

Please leave your pager (212 606-1644 #338), anesthesia cart key, and any other department items in the apartment for the next rotating resident.

The nearest subway stop is the #6, on 68th and Lexington, about three blocks south and three blocks west of the apt. This line will get you up and down Manhattan quite nicely. Metrocards are available in the subway stations.

Our ID badges get us into the Cornell Library, which is in the building on 69th and York. Computers, journals, etc. for your enjoyment.

Library on the 8th floor of HSS is available, but hours are not so convenient for us (8AM-5PM) as the Cornell library.

There are restaurants, florists, grocery stores, movie theaters, etc. all within a few blocks of the apt. The best thing to do is just walk around and explore your neighborhood, because there's something for everyone. Too many restaurants, too little time . . .

Working arrangements: Contact person is Mary Hargett email: hargettm@hss.edu

To get to HSS, turn right as you leave your apt. building, and walk down 71st. Half a block after you pass York Ave there will be a sign that says HSS and a small driveway to your right. Go there.

Don't bring scrubs, you can bring a white coat if you want, and a stethoscope is always good to have.

Laryngoscopes are supplied by attendings, bring music, because we are the OR DJ's. Many attendings have sweet music set-ups, with cd's, iPOds, etc.

You will probably go to see Mary a little before 700 AM the Monday that you start. Her office is on the 6th floor. Take the "west" elevators which are right in front of you as you enter the hospital.

You'll meet some of the attendings that day, get your ID badge made, and get your password to the Omnicell, which is their version of our Pyxis machines. Everything is quite flexible on the first day. I made it a point to see

1)both sets of OR's on the 1st and 4th floors, 2)the preop and recovery rooms on both floors 3)the call room, (4th floor) 4)the drawers with the nerve stimulators, needles, and LMA's (4th flr.) 5)the 4th floor lounge (with a dangerously limitless supply of cookies, juice, and milk) 6)there's a very small anesthesia office near the 4th floor lounge where you can check email 7)locker rooms on both floors

It's handy just to walk around a bit on both floors. Both East and West elevators have front and rear doors, and it took me a while to get used to the lay out.

We don't have to transport patients to the OR's. The "Unit Assistants" will do this. They also help with everything from positioning, running for warming blankets, pillows, etc.

1st floor is our JHOC, and 4th is like our GOR.

OR's start 8:00 MTuW, and 8:30 ThuF Some sort of teaching in various locations happens at 700AM Mon, Thu, and Fri.

If your day goes late, attendings will get you out around 6:00PM.

No preop phone calls are needed! Patients need "medical clearance" just to be admitted to HSS.

Set up is minimal compared to ours. Propofol infusion, sux syringe ready to draw up, atropine drawn up, 1 mg epi in 250 cc NS, and ephedrine. Also draw up your local anesthetic mix specific to the block you will do.

There are sweet pyxis like machines in EACH ROOM. They have all the drugs (narcotics included) you would ever need or want to give except clindamycin which is only rarely given, and must be ordered from pharmacy. These machines are also supply carts with central line and cordis kits, pressure transducers, epidural and spinal kits, very nice arm boards for the a-lines, wires, pressure bags, etc.

Tech support (courtesy of Walter, Junior and Raymond during the day) is amazing. I have never run out of anything.

There are Spacelabs monitors, like the old ones Bayview had. There are some REALLY old Ohmeda machines, and some newer Ohmedas in the rooms that are more likely to have general anesthetics administered.

You will do: interscalenes with the parethesia technique that come on seconds to minutes after injection transarterial axillary blocks, femoral, popliteal, sciatic, ankle, infraclavicular or coracoid, a handful of psoas compartment, lot's of CSE's, (often paramedian approach, lateral position) spinals, a couple plexus or femoral catheters are possible

After two weeks, you will meet with Dr. Liguori, who will let you tell him your needs and desires and voice compliants and kudos. He almost always does the schedule, and it's quite an impressive case mix you will get.

You will take one saturday call towards the end of your rotation. You cover the recovery room/ICU and the acute pain pager. There is no formal ICU, people just have extended stays in recovery. If patients are very sick with multisystem organ failure, they will likely get sent to New York Hospital. There is a very low threshold for ruling patients out for MI's

You present one article at journal club.

Case tips: Propofol usually dosed cc/hour, not mcg/kg/min. Once you get used to it, it's much faster than having to always program the person's weight in the pump.

Nasal cannulae are used much more often than face masks.

They don't use on the ETCO2 monitor to monitor spontaneous ventilation. You just gotta watch the patient. (always a good idea!)

Hip replacements often get an a-line, central line, epidural or CSE, and epi infusion. There are no three way transducers, if you need to transduce 2 pressures (CVP and arterial), use a 250cc bag of NS and spike it with two single pressure transducer sets.

Knee replacements will often get a-lines, CSE or epidural, and femoral nerve block. Some may get sciatics also. Consider nipride or epi drips, depending on attending. We usually control the tourniquets.

Shoulder patients often get a bean bag to keep them in place. There are about 3 different set ups with and without bean bags and various head holders. Use minimal to no sedation before your interscalene. (mix up two sets of 30 cc mepivicaine, 1.5 cc bicarb, and about 0.1 cc epi to give you 1:300k epinephrine, some will also add 10 cc 0.75 bupivicaine with epi.) These patients will often get prophylactic metoprolol to help prevent the badness associated with the Bezold-Jarisch reflex. Be ready to use various agents such as metop, labetalol, and hydralazine to control BP in the patients who are getting subacromial decompressions.

Look at the surgery for orthopedics chapter in Miller, and you will get an idea of practice here. Dr. Sharrock is one of the attendings here.

This place is great fun, with very enthusiastic attendings, friendly staff, excellent anesthesia/surgery relationships, good case mix, and an apt in a great location.