Peds Externship: Week 6

So I'm now done with 3/4 of the peds externship. Wow. How summer has flown so far!! Many of my previous posts have been quite lengthy because they all span a week's worth of stuff. This one probably won't be much different . . .

Peds Externship: Week 6

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Monday

Along with Wednesdays, Mondays are primarily clinic days. So most of the day was spent in clinic seeing patients. It seems that there are 2 age groups of patients in peds rheum: little kids (younger than 6 or so) and teens. At one point, I did a joint exam with one of the interns. There are a lot of joints to examine! And I forgot to look at a few until we were through with almost all the joints. On this one kid, I wasn't sure if his knee was swollen or if it's just chubby from fat padding around it.

After clinic was over, we went to check up on the KotW from last week. He looked almost 100% better! Practically all his neurological symptoms were gone. Since Dr. W was off service and Dr. O was now on service, we saw him and his parents with her (we being the whole rheum posse). Dr. O gave him the okay to go home, but he still had to come back once a month or so to get treatment for the next few months, to make sure his symptoms don't return.

I must say, it's really good to see a patient that looked like he was going downhill make more or less a full recovery. I didn't even know you could almost fully recover from mini-strokes! Maybe that's just part of being a kid, the whole "reserve capacity" thing.

Tuesday

The day began with weekly teaching. The senior fellow, Dr. S, gave the lecture on differentiating between the different types of arthritis that kids can get. It was a long talk. Interesting, useful, but long. The talk could've been easily (and conveniently) broken into two parts. Oh well.

Partway through the lecture, the first-year fellow (Dr. K) got a page. She then returned with a huge patient file. At the end of the talk, Dr. S looks through the patient's records and goes, "Holy shit! This is a very complicated case! Are they sure they want to consult us?" This kid had been in the hospital since April and has seen so many teams - cardiology, critical care, GI, ID, pulmonology, and now us (and perhaps a few others). The fellows really didn't want to take this case because it looked like there wasn't anything we could do to help. So they dismissed us for lunch while they talked to the attending about whether or not to proceed. Just as I left, I saw the kid's name on the chart. It was one of the kids I saw while on peds ID about a month back! Same kid that had the 3-4 infected lines placed in him. Honestly . . . I was surprised he was still alive.

So after a few hours, we get a page to meet the fellows outside the kid's room. Apparently we took the case. Soon the attending, Dr. V, joined us. Even though Dr. O was on service, Dr. V was the best person to call because he's apparently double-boarded in peds rheum and immunology. We look at the kid's EMR (electronic medical records) for a while, and he was on so many drugs! As we scrolled down his list of drugs, one of the interns remarked, "Good God, is this a VA patient I'm looking at?!" Apparently, the old veterans at the VA are on a lot of drugs, lol.

We finally examine the kid. His liver was so enlarged that it grew down to his pelvis. Dr. V exclaimed, "If you can't palpate this liver, then you shouldn't be in medicine." He's right though, that liver was very easy to palpate. We then went back to a conference room to discuss his case. Dr. V kept asking all these immunology questions that I think none of us really knew the answers to, so we all kept quite while he talked. One thing I remember as we were walking to his lab to look at some flow cytometry data, is Dr. V saying, "And in toxic shock syndrome, almost all your T cells are activated. You don't want 90%+ of your T cells activated because then you die."

In the end, we were never able to come up with anything to help the kid (we were called because he had persistent fevers for over a week now) so we removed ourselves from the case. I'm not sure how long they can keep this kid alive, as he's waiting for a double heart and lung transplant.

Wednesday

Another clinic day. Pretty laid back, saw more kids. There was this one kid I saw who had multiple joint injuries in the last. He was a big kid. A football player. One who wants to eventually play for UM-Ann Arbor. ^_^ He weighs about twice as much as I do (if not more) and though he's about a decade younger than me, he's projected to grow taller than me by about a foot. o_O At any rate, he had no rheumatological problems.

There were a few rather shy/nervous little kids. Dr. N, who also happens to be the peds residency director, came in to take charge. I don't know what it is about him, but I swear he hypnotizes kids with his voice and calm facial expressions. They'll let him examine them when no one else was allowed to. Also, he has this nifty trick where he can guess what the kid had for breakfast when he examines their bellies. I must learn this trick, lol.

I thought that Wednesday might end early. Sadly, I jinxed myself. Just as I thought the afternoon patients were about done, 2 new patients showed up. Dr. N went to go see them and asked if I wanted to tag along. Of course I couldn't say no. He spent a long time with both patients. One of them didn't have anything rheumatological, the other had Raynaud's syndrome that I could've diagnosed from her chart. But Dr. N had such a fun time talking to her and her mom. Ah well.

Thursday

Similar to last Thursday. Just went through clinic patients for the following week. But instead of having a journal club, we had a demonstration instead. Dr. V knew an adult rheumatologist in another city who specializes in using ultrasound to do joint injections. So the rheumatologist came and gave us a demonstration using the ultrasound.

It was pretty cool, though I couldn't figure out what I was seeing on ultrasound most of the time. It does make sense to use ultrasound to guide needles into small joints, because they're hard to get to without doing at least some "collateral damage" along the way.

In the early afternoon, all the externs went to tour an inner city, grass-roots, non-profit organization. It was pretty amazing to see all the things going on there! As part of APAMSA (Asian Pacific American Med Student Association), we hosted a health fair there with other student groups several months ago. But even then I hadn't seen most of the place. Afterwards I got to talk to the person who gave us the tour about the possibility of continuing the health fair for this coming academic year. ::Crosses fingers::

Since there were no consults, I was given the okay to just go home.

Friday

I requested this Friday to be off, since it was Jim's (one of my labmates) wedding. I couldn't miss that! More on that in another post. :-P