December was the end of my pediatrics rotation, and for some reason I have had more inquiries as to how I liked it than my prior rotations. Briefly, I liked it! It was fun to work with kids ranging from premies to young adults. However, I will not be going into Peds. This is another case of a specialty that I did not dislike at all, it just wasn't as good as surgery.
I spent four weeks on one of the general pediatric teams at LeBonheur Children's Hospital. As Erin can attest, I hardly saw the light of day. We were only given two days off the entire month, and were on call about twice each week. Each call lasted 30 hours, and they were very busy since I decided to do Peds during sick kid season. Each day started at 6 a.m. by waking up patients and their parents to see how they were feeling and if everything went well overnight. Any of you who ever stay at a teaching hospital, please take pity on the med student that has to wake you up before dawn. I assure you we feel just as bad about having to wake you up at such awful hours! I had between four and six patients to see every morning, and we were supposed to have our daily notes in the computer before the interns. Mornings were stressful.
At 10 a.m. we would have rounds with the attending to discuss all of the patients, including any important new findings or lab values, and our daily plan as well as the big picture for each patient. This would take up to two hours, but at the end we would have a plan for the rest of the day. During rounds a running list is made of what needs to be done; med changes, discharge paperwork, consults, etc. After finishing the list, we would split up responsibilities and the team would divide and conquer. When the day's work was completed we would meet up and check-out to the intern on call about any patients they needed to keep a close eye on. Then we would go home, rest, and start over the next day. It was the most exhausting month of my life thus far.
Lebonheur was the first hospital I have worked where every aspect of the patient's chart was computerized. Every hospital in the city has some form of electronic medical record, but at LeBonheur every bit of it is online, the paper charts have nothing in them save for a sheet of labels with patient information on them. There were a lot of quirks to be found in the system, but overall I think that it makes patients safer and allows everyone who cares for them to easily and efficiently access information. Honestly, the best part of EMR is that we are no longer at the mercy of terrible handwriting. I can't tell you how much time I spend at some of the other facilities trying to decipher several pages of scrawl that someone left on the chart. The frustration it has caused is responsible for a few of my grey hairs.
After leaving the halls of the hospital and rejoining society I spent the next month in a smorgasbord of pediatric outpatient clinics. Cardiology, neurology, pulmonology, GI, rheumatology, genetics, etc. Some were better than others, and a few were excellent. It generally depended on the attending and how involved we were. I won't go into the detail of each one but I was able to see a spectrum of problems from runny noses to cystic fibrosis, and that made it a decent learning experience.
I spent one week in the neonatal ICU at the Med. In my recap of OB/GYN I shared about the hardly-contained insanity of labor and delivery at the Med, all of the sick and/or premature babies were whisked upstairs by the Peds teams never to be seen again (by the OB/GYN people anyway). The week of NICU work helped close the book, as I got to be one of the people whisking the kids upstairs. There is a special phone in the NICU, very much like the bat phone, that rings when there is a baby being delivered and they suspect that it may be in trouble. There is a staircase directly from the NICU to labor and delivery to allow quick access. I went for three deliveries throughout the week, and walking back into a delivery suite made me realize just how much I did not miss OB/GYN. All three of the kids ended up being just fine, and we brought them upstairs just to be watched.
That is not to say that all of the patients in the NICU did well. There were two on our team that had support withdrawn the week that I was there. We had two other babies who were born at 25 weeks (full term is 37 weeks), and weighed about a pound each. They could have been in the pictures you've seen of babies with wedding bands over their arms, unimaginably tiny. The staff there was incredible. For the two kids who didn't make it, they had a professional photographer there to take some pictures beforehand for the family. There was as much support and care as can be afforded, and although it is of little solace at the time the families tend to be appreciative of such small mementos of their child.
Last but certainly not least was St. Jude. I know that many of you contribute to St. Jude, and it is a unique place. The campus is interesting because as a hospital it is actually quite small. In general they attempt to provide as much care as they can on an outpatient basis, so that the kids don't have to stay in the hospital. For those who do, they could not be in a more child friendly environment. There is a Wii and DVD player in every room, with a library of games and movies on each floor. Every aspect of the place has been designed to put kids and their families at ease. The vast majority of the campus is dedicated to research space, which if of course why St. Jude is so famous. 60 years ago childhood leukemia was almost universally fatal, and thanks mostly to work at St. Jude it now has a 96% survival rate. That being said there is certainly still work to be done. Some of the stories that parents shared with me quite simply made my soul ache, knowing that their children were not going to make it, but participating in experimental treatments in the hope that one day a cure may be found for someone else's child. It was very powerful, and I am glad to have been able to spend some time there.
Next on the list is family medicine, where I get to spend two months on the frontline of primary care. As a bonus, the rotation has a reputation for allowing the most time off!
No comments:
Post a Comment