I heart pediatrics

It's Friday afternoon of a long weekend and I've been told to sit tight and wait until 5 PM before I leave for Montreal so I don't hit crazy traffic on the way in. Let me tell you, this is a hard thing for me to do (sit still). So, just in case you were thinking "boy, is she the biggest geek for writing on her blog on a Friday afternoon" this is my reason why.


At any rate I wanted to write about the experiences I've had while on the pediatrics ward. I don't really want to forget them, because it has been an amazing time! I had the great fortune of working with great residents who are genuinely nice, like to teach, will answer questions and yet not make you feel small for doing so. It's also very humbling to see residents and staff explain procedures and prognoses to parents in an empathetic, easy-to-understand and honest manner. I wonder if I'll ever be good at that.


My very first patient on the ward was a beautiful 9-month-old girl who had vomiting and diarrhea. She was an angel. Usually kids freak out during physical exams but she was calm and very cooperative. She was admitted for fluid replacement and I followed her each day and really got a chance to be involved in her management. She didn't get better after day 1 and much to my worry she didn't get ready after day 2 either. The team and I decided it was time for imaging after much debate. (I find this a curiosity in pediatrics - often we don't do blood work and defer further work-up to avoid inflicting unnecessary trauma to kids - health resource management to the max). By this point I already found myself really really liking pediatrics and feeling all torn up inside since I have already tailored my entire future career towards radiology. The imaging came back and the poor girl had an intussusception. I was freaking out - what now? When I found out it was the radiologist who could fix the problem, I was thinking to myself... that's pretty awesome amazing. I would love to be the one to be able to perform a life-saving procedure. I also thought, radiologists can do a heck of a lot more than most people think. And so the internal turmoil continued.


Thankfully my patient recovered but after the proecdure she still was having fevers on and off so we sent off urine and blood cultures to rule out infection. Cultures take several days so the results hadn't come back before my patient had done better and was discharged home. Several days later the cultures came back negative and I had another big internal debate about whether or not to call the parents and let them know. Generally speaking, physicians do not have the time to call all their patients back about negative test results. The parents were told that we'd call them if anything came back positive, but I still thought it would be nice to let them know. Also, I really wanted to know if my first pediatric patient had fully recovered. I finally decided it would be a nice thing to do, although probably unnecessary and unorthodox. I picked up the phone, dialed and... got the machine! Then I thought - uh oh - if I hang up and the parents have call display, they might freak out that the hospital called. But then I thought, if I leave a message I might be breaking patient confidentiality, since somebody else could possibly hear the message. It's a #1 rule that you never call a patient and leave information on their machine. Imagine if you were a teenager living with your parents and had to get a test for chlamydia done and your doctor called and left a message for all the world to hear. But then I figured, this was an 9-month old child and again it would be nice for the parents to know about the culture results. So I left a message and broke the rules. And I assume she's better.

I began thinking that 9-month old children are my most favourite age group in the world but I love interacting with the teens too. I admitted a 14-year-old boy who was coming in for another round of chemotherapy. It was well known that he hated these hospital admissions. The drugs made him sick and it meant he had to be far away from home, as he was from a community up north (while most people make fun of pediatrics in Kingston, I think it's great that they care for a very unique Native population). I really wanted to help make this stay better for him. Sure enough, by the next day he was up and about, poking his head by the nursing station and chatting with the volunteers. In the end, I don't think he really wanted to leave. When I said bye he asked if I would be there for his next chemo treatment and I said no, because I would only spend three weeks on the ward. I think he was kind of sad, and I was too... but his thoughtfulness really made my day.

Another memorable moment was when I got to deliver good news to a little girl and her mother who had been in hospital for over almost two weeks - they could go home!! Just in time for the start of school. However, this meant I had to pull her PICC line. [A peripherally inserted central catheter or PICC can be used for IV access when long-term antibiotics or other form of treatment is needed, in order to avoid poking a patient a thousand times. These lines are placed by interventional radiologists :) .] After being a scut monkey in general surgery at McGill where I pulled a gajillion lines and drains all day, no problem, I thought why not, I'll pull this line too. Little did I know that this normally 5 second procedure would turn into an hour ordeal. Usually PICCs are covered by many bandages at the insertion site to prevent it from moving. Of course, we all know taking sticky bandages off skin can be painful... especially for kids. The patient insisted on taking the bandages herself, millimeter by millimeter... I sat and waited... it took an hour... and in the end, just as I thought, the PICC was pulled in 5 seconds.

Today was my last day on the ward and I felt a real sense of sadness. I have two more weeks in pediatric clinics and then I start on internal medicine again. Blah. How I dread working on the adult wards, where there are no stickers and fun, only bad smells and grumpiness.

Well it's past 5 PM so I better run... more thoughts after I savour my last moments of summer.