never a dull moment

So yesterday I finished inpatient Peds---on to the clinics! I did well-child exams today; and usually you're supposed to see one and do one, but the way the patients fell my preceptor said "Eeeehh, you're ready. The next check is on a 13 year old boy. You can't really mess it up. Go in there and then tell me how it goes; any questions?" And I said, "Well for genital exams, are we supposed to bring in a chaperon?" And he deferred to his female colleague who said "Well, sometimes I feel like bringing in a nurse = two women ganging up on a young boy. I find it better just to do it alone if they already decided they don't want mom in there with them."

So I go in and ask mom her major concerns, then kick her out and ask the boy his major concerns. And then I do my exam and get to the last part, the genital exam, and say, "Now, this next part can be kind of embarrassing for patients, but it's important for your health that we check everything." And so I get him up off the exam table and we get his pants down. And he promptly gets an erection.

So I'm down there like "ohmygoodnessnowwhat?" and feeling like laughing but of course NOT laughing because come on, how embarrassing is this whole ordeal for this poor kid?! So I basically mentally recover from the initial shock, do a sloppier version of what I'd normally do, brush it all off somehow, finish up, and report back to my preceptor. He says "Everything go OK?" And I just HAD to tell him. His response was: "Oh no! I'm sorry....well...uh...take it as a compliment!" But then when we BOTH went in, it happened again. "Well I guess it's just his reaction to being examined. And quite honestly, it doesn't happen that often."

To HIM maybe! First well child exam...check! My second was on a 4 month old. Not quite as shocking.

Then I was in at the tail-end of another visit, this time with 3 little kids in the room. And I'm herding these kids as they're trying to steal away through the door while my preceptor educates mom on a script when this angelic 3-year-old blondie says to me: "Why aren't you wearing SHOES?!" And I say "These ARE shoes." To which she retorts, "No they're not, they're slippers!" I say they're flats, and then we focus on brother's shoes a while. Then she asks me "Why is your hair fuzzy?" And I say "What???" So then I explain to this child with pin-straight hair and sibs just the same that it's CURLY. Not FUZZY. Thanks a lot kiddo.

The end of the day was the newborn exam in the newborn nursery. Which was just amazingly interesting of course. And of course the first thing I find when taking off her diaper is a big 'ol dark poop. And I learn that the rule is you find it, you change it.

So let's recap: I examined an excited 13 year old, was insulted by a 3 year old, and rounded out the day with a newborn diaper surprise.

Gotta love Peds =)

love it.

theme of the week...and year

So no one told us that the Pediatrics Ward A was going to have a string of similar cases. But on the floors, this seems to happen a lot---there are themes of the week. When I was on Medicine, it was obstructive jaundice and drug rashes. Oh and PRES, which I won't go into cuz it's supposed to be SO rare, but I saw 2 cases in like 4 days. So this week it is babies without brains.

Actually with malformed brains---no cerebrum, but yes brainstem. I think we have about 4 holoprosencephalic children. And then around the same time we had 3 cerebral palsy children too. So one night one of my residents said something like "over 60% of my census has no brains, and 80% have some sort of mental delay."

Now, if your baby does not have a brain you would assume that it cannot live very long---and that truly is the case. But end of life issues are rough no matter what age. We have a child, call him LM. When our teaching resident took us to listen to his breath sounds, he could not have prepared me for the sight; I was ashamed at my brief internal repulsion. He has no brain: his eyes are therefore pushed way out of their sockets; he has a total cleft lip and palate, and therefore no nose, just a bit of skin hanging over a mouth-nose-hole. His body cannot regulate his electrolytes---particularly his sodium. However, when his sodium gets really high, he does not seize...because you would need cerebral tissue to do that. He does have a brainstem though, so he breathes, his heart beats, the rest of his body is well formed. He's alive. His mother is a very young, and she is so devoted to him, which is why he's lived 8 months. She is at his bedside 24-7. But my Attending puts it best when she says "Oh, that baby just breaks my heart." Because if he goes on like this he will have to be intubated and ventilated. And it will be that much harder for mom to say "stop this machine" than to have her baby pass on with her at home comfortably. The nurses and some residents complain about it: "Just let that baby go to heaven!" But how do you say that to someone who carried him inside her body? To anyone who's loved him since the second his existence was known?

My only patient at the moment, TL, also has no brain. Every morning I come in and her head is ginormous---she also has hydrocephalus; her brain fluid was obstructed and so was just collecting, giving her a big 'ol head. She was given a shunt and hopefully it will go down. She too has a salt problem. And she too has a cleft lip and palate; so feeding her is insane and she's getting a tube placed into her stomach soon. And it makes me feel awful to think it, but I do; what is the end point? How long can she live like this? But she has very devoted parents who want everything done for her.

My roommate had a different perspective this past week. She is on OB/GYN and has had a lot of fun helping deliver babies, but last Thursday saw a baby die. The situation was very emergent, and they did all they could, but when the baby was delivered she crashed and could not be resuscitated. Now I've seen a lot of implied soon-til-death, and one patient already dead---but I've never seen someone be alive and then be suddenly gone. So later that Thursday night I'd gotten off the phone with a friend to find G WEEPING to Grey's Anatomy. I'd missed yep, all of it, and she was watching the end (and G never watches Grey's). Apparently George's father died, but what got her most was that HE KNEW the prognosis. Only he understood what was going to happen to him; his relative said "He's going to be alright, though, right?" So G turns to me with her eyes all red and says "Katie, what on earth are we going to do? What are we going to do when our parents are going to die, and we know the truth and no one else understands it like we do?"

Which reminded me of Psych class last year. We learned about the milestones of each med school year. Year one was dealing with a new workload and dissecting a cadaver. Year two was a time for hypochondriasis---studying diseases causes you to believe you have all of them. Year three is dealing with mortality.

This year has taught me that death is a part of life. Sounds simple and cliche, but if you understand me, I'm saying that after a lifetime of thinking it cruel and unfair, I eventually realized that sometimes it's OK to die. We don't really treat death like that as a society. It's never very happy, but it's just...there, waiting. But dying comfortably can be more important than drastic measures taken for a severely limited life.

It's a very hard lesson to learn. It's still getting mixed reviews here in H-town.

clap hands!

So I had myself a wonderful break---got to eat dinners with the family, visit the Field Museum with a hilarious boy (AND buy mold-o-ramas!), rock out at a concert/laser light show, fly to Minneapolis for a wedding shower and drive back in the same day (yeah Ya-Ya road trips!), make scarves, play with my dog, celebrate birthdays, go on dates, laugh heartily with old friends, party-hop for New Year's, and, of course, get tipsy in bars with cherished people I see not often enough. Heck, I even got to compare feet with three of my best girl friends! I had myself quite a time.

Oh but what I did NOT do over break, such as truly work on my MSR proposal. Which is what I'm attempting at the moment and have been attempting all the livelong day. To make things just a tad more hilarious than they are right now, this proposal's deadline is Friday, and if I don't make deadline, I can't apply for next year's classes. And if life wasn't funny enough, it turns out I will have to attempt to fill out even more forms for the submission of my project to the Institutional Review Board....something I found out TODAY! Woot!

I think my current treatment of this state of affaris has to do with my having about 4 hours of formal sleep (my own doing---I just can't stop hanging out) before taking one of the bumpiest flights I've ever taken. I "slept" through most of it (I bet I got a bunch of stage 2); but I remember seeing a blurred, no-glasses vision of the back of a panicky elderly lady sitting bolt-upright, two rows ahead of me. She should have followed my stupendous method of anxiety control: pretend you're on a really bumpy car-ride and drift back to sleep! Seriously though, at one point I was shaken awake enough to be groggily thinking "I should've worn a sports bra." And if you know me, that IS a feat.

So life over here is just silly. And here all I want to do is skip on over to the Fitness Center for a week of Team-Based Learning (another adventure! Let's get all 136 of us separated into groups of 5-6 based on our complimentary learning styles and compete for answers AS a learning-game! ) and relax before starting up Pediatrics. Oooooo I cannot wait for this week to be over!