Sunday, July 21, 2013

First Impressions: Pediatrics/Peds ER


I changed the title of this post probably 5 times because so much has happened in the past three weeks that it's hard to categorize what I've been doing. I've spent my past three weeks in my Pediatrics rotation (a total of 6 weeks), but on the outpatient (clinic) portion of it, and have also worked a couple of shifts in the Peds ED (Pediatric Emergency Department). But some of my best memories have come from the ED, so that'll be the topic of most of my post. I'm going to try to blog about my initial impressions of every rotation that I do this year -- mostly so I remember what the heck I did and to try to narrow down what I want to do with my life, but also fill you in on my crazy schedule which seems to change every 4-6 weeks or so. Think of rotations like a trial period for your future job. We spend 4-6 weeks rotating through all the different departments of the hospital all throughout our third year -- Pediatrics, OB/GYN (including Labor and Delivery), Internal Medicine, Surgery, Psychiatry, Family Medicine, Neurology, and an elective (for me, Radiation Oncology). So at any point, you could ask me, "What rotation are you on?" And I'd know you were semi-clued in to what I am doing at that time. Today, I am on Peds, but am switching over to the inpatient (sicker patients staying "in" the hospital overnight) side of things tomorrow at 7 am. In fact, I get to do a week in the newborn nursery! And then do my last two weeks in Peds on the "floors" or the "wards" in the general pediatric inpatient department.

But I just wanted to brag a little about my awesome day in the Peds ER today. I actually started out with a not so great experience in the ER. However, after a couple of shifts, I turned a corner and am now actually kind of bummed I don't get anymore shifts there. Today, it was slow but steady day (as weekends tend to be in the ED), and the residents were awesome about teaching, so I got to irrigate and dress a wound, help with stitching up a 5 year old's busted knee, and then staple a girl's scalp closed after she cut her head while having a seizure! I'll probably look back on this entry in a couple months and scoff because "irrigating" a wound literally means washing it out with saline/sterile water and "dressing" a wound means putting antibacterial cream on it and covering it with gauze and tape, but there's a first time for everything and today was my first time doing procedures, so I am pretty damn excited about it right now. I've gotten to know some of the residents/attendings better too, and for the most part, they all seem like great people and people I would be glad to have as my doctors, which I think is an important sign of confidence in your own institution.

In my other outpatient clinics, I've also been learning a lot about normal childhood development. In our PATH clinic, we were responsible for doing histories and physicals (H&P's) for well-child visit as well as acute care visits and presenting to the attending, so it was great to be involved in direct patient care there. Attendings would trust our H&P's, writing down what we said into their notes, and then ask us for our assessment and plans and then oftentimes would just do what we told them even though hello, I'm just a third year medical student! I still can't believe how much they trust us, so if you are worried about that in the least, don't go to a teaching hospital. (You think I told the girl who's head I stapled today that it was my first time? Heck no! Meanwhile, my resident was reassuring her, "She's done this loads of times!") Pediatrics is interesting because you always hear "children are not little adults," meaning you can't just apply everything you know about adults, including vitals, diseases, epidemiology, treatment, to kids because they are physiologically different and are susceptible to different diseases and need different doses of medication. One of the things I like about it is that when a kid gets sick, it's not really their fault. Hate me for saying this, but I personally find it harder to treat adults with diseases they have clearly brought on by themselves, like obesity or Type 2 diabetes (like Paula Deen). With kids, it's usually not their fault with they are diagnosed with Type 1 diabetes or god forbid, aplastic anemia, like one boy I saw in Heme/Onc clinic. And when you see them so young, you actually have a good chance of altering their disease course! I've shadowed quite a few times in the Peds GI clinic, and for kids with food allergies or inflammatory bowel disease, it's all about patient education because they will have to deal with it for the rest of the their lives. So if you educate them well about their disease early on, they can establish good practices from the beginning and go on to enjoy a better quality of life than an adult who has to change all of her established habits and may not be so complaint. Also, pediatric patients tend not to have long problem lists, and any past medical history they have is usually pertinent to why they're being seen that day (e.g. asthma or allergies), so it is relatively easier to manage than a drug-addicted, homeless alcoholic who has pancreatitis and cirrhosis of the liver who just got diagnosed with a brain tumor. See what I mean? So those are some tidbits from Peds outpatient. Starting inpatient (and an earlier start) tomorrow!

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