Skip to main content

Healing Children in Pediatrics

Since the beginning of August I've been working on my pediatrics rotation. It started mundanely enough with 8 am - 5 pm clinic hours, and by the beginning of September picked up in worktime, with 6 am - 5 pm the norm for a day's work, Monday through Saturday. Still, despite peaking with 75 - 80 hours each week not including time spent studying, pediatrics is the most enjoyable thing I have encountered in medicine thus far, and the largest reason for that is the children.

Early on in the first week of the rotation Dr. Groshong, the head of the pediatrics department, spoke to us about what he wanted us to get out of the next two months. He said the primary goal is for us to enjoy learning to care for children and have fun doing the work we do at the same time. That I enjoyed working in pediatrics is an understatement; there was no house officer or attending physician who was ever unpleasant to be around or ever was in so poor a mood it was intolerable.

Clinic duties consisted of me seeing a patient first, followed by a senior resident. It was through this process that I honed my skills in interviewing and examing patients. It was also through this process that I learned how fun it is to engage children. One very memorable moment was when a 6 year old girl with a rash hopped off the exam table, pulled up her shirt to show off her belly and yelled "Wanna see it?!" Children are so excited to have an adult's attention, and I was perpetually eager to dispense as much attention that was needed to make the visit pleasant for the kid.

A few times in clinic there were patients that elicited fear of serious concern from me as a budding clinician. The time I was most concerned was when I approached the exam room to see a 2 month old boy and read the nurses note on the chart stating "coughing up blood" as the reason for visiting. My first concern was whether it truly was blood, or something less serious, and I truly hoped in my mind it was a mistake. The family was young; the mother only 17 at best and a father who was of similar age, living with the mom's grandparents. The father described that the child had started to cough, began to be frothy at the mouth, and when he wiped away the spit noted that it was tinged with blood about an hour earlier. Later during my exam, with the baby on his back on the table, he began to cough and gurgle again. I grabbed a few paper towels and stopped my exam and just waited. I waited long enough until I noticed pinkish frothy sputum at the child's mouth, and wiped a large portion away only to see it was thick with blood. I set it aside as my evidence for true hemoptysis (coughing up blood) and began meticulously inspecting the inside of the child's nose and mouth for a source of the bleed other than the lungs. There was no discernable source, and a more ominous sign was the sound of wet crackles coming from the child's lungs through my stethescope. A chest x-ray performed in the clinic showed a diffuse clouding of the lower right lung, and the 2 month old was rapidly admitted and treated with antibiotics for a possible unknown infection. Other concerns were a possible tumor or foreign object in the lung.

I finished my outpatient weeks at the Green Meadows General Pediatrics clinic and moved on to inpatient pediatrics service. It was an adjustment to have to start the day before sunrise, but the plus side was there was little to any traffic to deal with on the drive to the hospital. The atmosphere of the ward was one of running an efficient machine; a day consisted of a systematic hand-off of information on patients from the night float physicians to the day team, a pre-rounding and data calculating period, determining the quantity of fluid and caloric intake versus fluid output a patient had, the days and dose of antibiotics or medications, lab results as well as those pending, attending rounds with the head physician where the treatment plan was discussed and adjusted, afternoon "power hours" where all the work needed was done for the day and progress notes were recorded. Phone calls would be made to receive lab results or schedule consults or follow up appointments, follow up visits with the patients would be performed, reporting to the intern or resident about changes in patients occurred, and new patients would be admitted by the intern and student on call that day. At the end of the regular work day the night float team would arrive, and the info on patients would be relayed systematically to the physicians and hand-off would once again occur. Patient management was, in short, a careful process of adjusting the vital signs and symptoms of a patient to a point of better health, be it by symptom control until the illness passed or disease process control to provide better baseline health.

Despite the many similarities to auto mechanics inpatient medicine had in my head, it was not without attention to the psychosocial aspects of the care of the patient. One patient who taught me a great deal about the importance of caring for non-medical needs was my little refuge from Gabon, Africa, who I will call Edward (not his real name, though). Edward was a 9 year old boy who came to the US with his family as refugees and spoke only French. I admitted Edward on a Tuesday evening in the ER, at the end of what had been a rather blue day as I ruminated over several things that had been on my mind as of late. For the past 4 days his knees and ankles had begun to swell and become painful, and a day after arriving in the US was so painful and weak he could not support his own weight. He was accompanied in the ER by his father and the refuge service case worker of the Jefferson City Diocese.

Edward was scared, quiet, and in obvious pain and discomfort. He was a very slender 9 year old child with little muscle mass, and although not emaciated, did not have much cutaneous fat. He and his father had arrived in the US the day before and had not slept since the previous morning. They were exhausted and earnestly desired to go home, however the father wanted to do whatever the doctors deemed necessary for the child's health. A tap of the left knee joint to draw off fluid showed a large amount of white blood cells and a lot of inflammation. It was also learned that the boy was HIV positive, and being highly concerned about the possibility of joint infection that could devastate the child's knees, we admitted him to begin treatment that would last 18 days. In those 18 days Edward and I would develop a patient-physician connection that demonstrated love and hope in a way that surpassed the language and cultural barriers present between us.

To be continued...

Popular posts from this blog

The $2000 monkey on my back, deferred

It’s been more than a week, and I think an update is due. Plus, I can give updates on my own status with my heart murmur, having seen the doctor this past Friday. The only thing that has kept me from updating until now is simply laziness (in other words, I was far too busy studying/eating/cleaning/sleeping to actually relax and write). This past Friday I went to the Student Health Center to see my doctor about the previously mentioned murmur recently discovered. My doctor presumed it was most likely an innocent flow murmur, which occurs if a heart valve doesn’t close all the way or in time when the heart beats, allowing blood to flow back the opposite way, and the blood causes turbulence heard as noise. If you’ve ever heard turbulent water flowing over and through rocks and back upstream in eddies in a river, you should get the idea of what a murmur is. It was recommended that I have an echocardiography done, or an ultrasound picture of my heart. This would allow us to see exactly how ...

My first place, technology and humanity

This past Friday I signed the lease on my own apartment. No roommates, just myself. It is both exciting and scary at the same time. It feels grown up to do the signing myself, and being the one person responsible for everything. In any case, it is a milestone in my life to have my first place. Being a type of person that enjoys having a peaceful repose to retreat to when I need recharging, it was overwhelmingly calming to wake up this morning to the sound of rain and rolling thunder, and to sit on the couch with a bowl of cereal after a time of quiet devotion and journaling. It is highly rewarding to now be sitting here publicly journaling while some relaxing music plays from my office. I look forward to slowly building a home out of my apartment, through decorating and spreading out of my belongings, and that will be a great feeling of comfort to come to after a hard day's work or to end a good evening. If there's any one thing I am nervous about in my own place, it is dealing...

School, Shaving, Serpentine Belts, and Sex

It's been all about the S the last few days. On Saturday (ironic, it starts with an 'S' day), my battery in my Jeep completely died a sudden death. There was a plastic sleeve attached to the battery that contained the purchase receipt. Purchased in 2002, well that explains it. It took about 10 - 15 phone calls to actually find someone available to take me to O'Reily's (I was trying to work out in concentric circles from my house), but I finally got a new battery. The guy testing the old one simply said, "Yup, it's dead," with a total resignation telling me that there was no hope in rejuvenating it. New battery, check. Now I'm mobile again... Fast forward to where I'm headed west on Stadium. A loud thunk followed by an instantaneous loss of power steering control, coupled with a drop in battery voltage from 14 V to barely 10 V, and a slowly rising engine thermometer told me something was wrong with the Jeep. I drove to HyVee's parking lot, p...