Rotation roundup: Pediatrics

Gaining rapport with peds patients (I’m on a Supernatural kick, don’t judge me.)

(Just wanna say – after talking to kids nearly exclusively for 2 months, it’s going to be awfully weird talking to adults again.  No more commenting on how much I like their Dora socks or what kind of sticker they want.)

It’s been two whole months with the focus entirely on children – it doesn’t feel like it, having spent only a few weeks in each place.  For those who aren’t familiar, our pediatrics rotation is split into a number of parts: Clinical Teaching Unit (CTU, i.e. inpatients), outpatient clinic, subspecialty clinic, CTU call, and pediatric ER, as well as a few half-days in neonatal intensive care (NICU).  They’re all very different, so it’s hard to review them all as a cohesive group, but I’ll do my darndest.

Working with kids is a pretty unique part of medicine; in very few other places is the family unit so essential to every meeting and every appointment.  Not only that, but your approach can be entirely different for exactly same presentation depending on the patient’s age.  It presents an interesting challenge and makes you really think broadly.

So peds.

The where: the Stollery, Misericordia pediatrics, Mis NICU

The good: Let’s face it.  Making googly faces and fooling around with kids is super fun.  Not only is it entertaining, it’s absolutely necessary to the trust you build from the moment you walk in the door.  Learning how to “pant like a puppy dog” to get you a good view of the back of the throat may get you that view that you otherwise might not.  And I’ve never smiled so much on a rotation – you can win a lot of favour from kids just with a smile and a wink.

And kids are great, not just because they’re kids.  From a medical perspective, they have all kinds of interesting pathologies you won’t see anywhere else.  Kawasaki disease, rheumatic fever, meconium aspiration… all things you might not see without a couple of kids in your practice.  Plus kids are amazing to treat!  They can be incredibly resilient and bounce back beautifully, even from very dire illnesses and infections.  There are kids in NICU that need intubation (a tube into the lungs to protect the airway and provide artificial breaths) that come off oxygen, go home, and lead healthy, happy lives.  It’s incredibly rewarding.

All praise to the staff.  Lovely people, as a general rule.  In hospital, in clinic, didn’t seem to matter – everyone was interested in whether I’d eaten, what I’d like to learn, and what my plans for residency are.  I made a mental note to carry around their great feedback and praise as I head towards gen surg…

More as a mental note, I loved peds ER.  I didn’t expect to, but I did.  The quick turnover, the acuity, the exposure to very interesting cases, the support from the staff… it was amazing and never felt like 8 hours.

The not-so-good:  Parents can be difficult.  And there’s nothing more frustrating than a parent that speaks for a child that can clearly speak for him/herself.  While often an amazing resource for information, parents have the power to enlighten and obstruct.  And God help me if I disagree with a parent’s diagnosis or choice to not vaccinate.  We both want to give the child the best chance – we’re on the same side! – but we believe the other’s methods are ineffective or even dangerous.  Not a good place to be.

In medicine, sometimes it’s “no pain, no gain.”  If you need that IV, we accept short-term discomfort for long-term healing.  In adults, it’s usually an easy sell.  Kids… not so much.  Especially the kids old enough to understand cause and effect (needle = pain) but don’t understand the abstract future (needle -> water + sugar -> feel better -> go home).  It’s just awful to hurt kids, even if we absolutely must.

I also solidified my distaste of hospital practice on this rotation.  2 weeks on inpatients was more than enough to know that the daily routine is rather tedious for me.  I felt like I practiced only a little medicine but did a hell of a lot of paperwork, consults, phone calls, and progress notes.  That inter-dependent, hospitalist kind of practice appeals to some people, but I don’t believe I’m one of them.

The verdict: Kids are awesome, full stop.  Though I don’t want to work in hospital, I feel way more comfortable involving them in my practice.  And who knows?  Maybe I’ll like adult ER, too…

Wish me luck on general surgery!

 – Atalanta

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