Peds Externship: Week 7

Second to last week of the externship, wow!

Peds Externship: Week 7

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Monday

As usual, Monday is a clinic-heavy day. I think by this week I had the opportunity to work with each of the 5 attending physicians. I must say, each attending is quite unique in his/her own way.

Dr. N is the residency director. He has such a soothing voice and very calm facial expressions. He has some weird ability to put almost any kid at ease. And he's very patient. Dr. O is perhaps the eldest attending of the group, and I think she's the program director. She's very grandmotherly and I just love working with her. Dr. W is rather jovial, kind of like a geeky kid meets Santa. He loves research and thinking about the interesting stuff. (There are 2 Dr. V's, so one's Dr. Ve and the other's Dr. Vo.) Dr. Ve, his counterpart in many ways, is very direct and to-the-point. He walks through his logic quite efficiently. And lastly, Dr. Vo is perhaps the most amusing (and youngest) attending of the five. She's a fast-talker, full of energy, and gives off this ADHD feel about her. She loves to go off on tangents and laugh, and she cracks us up a lot.

Tuesday

We meet up early in the day to round on this one patient (Patient 1) that was admitted over the weekend under Dr. O's service. She thought the kid was going to die overnight - everything was going wrong and things were so so complicated. She was so fragile in the PICU. The fellow and Dr. Vo (the attending now on inpatient service) went up to another floor to see, what was supposed to be, a short stay patient (Patient 2). Instead, symptoms appeared with that kid and they were away on that floor for 2 hours while we sat twiddling our thumbs in the PICU waiting for them.

They finally returned and we rounded on this girl together with the ICU team. After that, it was close to lunch. After lunch, we met up on the floor where Patient 2 was staying. Then we get a call from the emergency department (ED) that one of the patients under rheum was there with a stroke. So several of us went down to see her. While the M4 and I waited to see her, one of the senior residents had already seen her and had written up the note. So we went back up to the floor without having actually seen or talked to her. Grrr.

The day ended with much frustration between the M4 and I, because we both felt out of the loop and out of the decision-making with these 3 patients. We saw none of them, we weren't clear on what was going on with them, and we couldn't remember them. So our day ended rather disgruntled.

Wednesday

It was another clinic day, and it was a good clinic day. Towards the end of the day, I saw this one patient, a little girl, with the M4 and then Dr. O. The mom had brought her 15-month-old brother with them to the appointment. He was so full of energy, just bouncing around the room and climbing on everything he could. So adorable!

After the M4 and I did the interview and physical exam, we went to get Dr. O. One of the tests Dr. O had the patient do was to jump on one foot. The brother saw this and attempted to imitate her. Now, developmentally, kids aren't supposed to be able to balance on one foot until they're about 4-years-old. So obviously he failed, lol. But it was so funny watching him try! He just sort of cocked one of his legs and shifted his weight to the other leg, but he couldn't actually jump so just stood like that. The puzzled look on his face was priceless.

Thursday

Like Tuesday, it felt like a long and somewhat frustrating day. But it wasn't too bad. After going over the weekly review of clinic patients, the residents, the M4, and I were dismissed. The attendings and the fellows, along with the nurses, had their business meeting. So those of us who were dismissed hung around in the residents' lounge for the next 2 hours or so. Bleh.

We get the page to round, so off we went to meet the fellow and Dr. Vo. So we round on the patients and discussed at length what they might have (or might not have) and what exactly was the best course of treatment for all of them. We then went down to radiology (it feels like we do that a lot) to have them point out to us what they think might be CNS vasculitis. This time we were smart, because we headed straight for interventional neuroradiology instead of "normal" radiology, lol. Of course, CNS vasculitis is one of the most difficult diagnoses to give because it's so difficult to prove that it exists unless it's really bad.

Friday

More rounding on the same 3 patients! Actually, Patient 3 (the one from the ED) was transferred to the adult rheumatologists at the hospital next door and was discharged yesterday. At noon, the M4 and I went to a neurology case conference on Patient 2. I must say, they hold their case conferences in a really nice room on the administrative floor. But it was so boring. I learned nothing new concerning this patient, everything they said had already been said. By them.

Anyway, after that, we had lunch and then rounded some more. Patient 1 was stable and actually starting to get better! Patient 2 was off to radiology for more imaging, and then went home. Patient 3 was already gone. It was actually a pretty good day of rounding, and it's always good to know that patients bounce back and start to do better.