Peds Externship: Week 3

Week 3 marked the beginning of my second 2-week "mini-rotation": primary care pediatrics. I think it may be slightly rigged that all the externs are to do their time in primary care peds in an inner city clinic (that, or I just failed to hear that detail in the externship description).

Peds Externship: Week 3

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There's no real point in distinguishing each day from the next, as all the days were fairly similar. The pediatrician I'm working with is in the clinic from 8am until 8pm, Mondays through Wednesday (so I got Thursday and Friday off this week). However, I wasn't in clinic with him that entire time. During the mornings, he's at one clinic where there are very few pediatric patients; so, he often dismisses me and tells me to not bother coming in when there are no patients. In the late afternoon/evening, he goes to another clinic where there are a lot of pediatric patients, so it's a lot busier. There are a few things of note.

First, the pediatrician I'm working with is really young (late-30s to early-40s) and really into social media and networking. I mean, he has several Twitter accounts! He's also the only pediatrician at both clinics (both clinics are under the same company), everyone else are either family physicians or PAs (physician assistants). After this week, I get the feeling that most/all the doctors don't want to work there, but do so out of some obligation or some sense of "doing good" or "giving back." They just don't look that happy.

Second, being in inner city areas, the patient demographic is almost entirely African-American. Which is interesting, because it seems that the patient demographic in the suburbs is almost entirely Caucasian. I should expect this, but it's still rather contrasting. We did see some immigrant families from Nigeria and Liberia and such.

Third, being in inner city areas, almost all (if not all) the patients are on Medicare/Medicaid. The pediatrician held up 5 billing statements and said: "See these? These amount to about $600 because all these patients are on Medicare. If they all had private insurance, it'd be closer to $2000." That's pretty shocking, even though (again) I probably shouldn't be surprised.

Fourth, most of the kids I saw were babies or really young kids (less than 6-years-old or so). There was one day where we saw pretty much only 1-month-olds that were all born within a week of each other. o_O I've realized that I know next to nothing about babies. After almost every well-baby visit, I'd ask the pediatrician, "Is that normal?" Is that umbilical cord normal? Is there supposed to be stuff oozing out of it? Are they supposed to peel? Apparently, the answer to all those questions is: yes. One of the dads looked at me and said, "You don't have a kid, do you? You have that look on your face." Why yes, you'd be correct sir.

It's all just such a contrast. The suburban clinic was really nice. The hospital was even nicer (like, amazingly so). And these two inner city clinics . . . well, you can tell that they don't have much money invested into them. I wish things were different. As the pediatrician told me: while we'd like to think that everyone has a fair shot in the US, that everyone's born equal, the truth is that it's not. Doctors treat patients differently due to access to health care, even if they don't mean to.

It's just . . . unfair.

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Pink Glove Dance

So YouTube is a rather genius time-sink. There are a couple vids that I came across that I thought were cute and/or hilarious.

Pink Glove Dance

I've determined that people at my med school don't have enough fun. I particularly like this vid at about 0:58 minutes - the lone black male researcher in what appears to be an otherwise female lab. That's just precious. :-P

JK Divorce Entrance Dance

This is a spoof of sorts on this vid: JK Wedding Entrance Dance. Either way, quite amusing (particularly towards the end).

Muse - Time is Running Out

This song has been stuck in my head on and off for a few weeks now, especially various string arrangements of it. The Section Quartet has a really nice arrangement, but Vitamin String Quartet also has a good version. It almost makes me want to compose a version of this song too, lol.

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Peds Externship: Week 2

Well, Week 2 was nowhere near as "glamorous" as Week 1. But, I've seen many things that I can honestly appreciate, even if they're not the most . . . stimulating things out there. But I am glad that I witnessed/experienced them.

Anyway, Peds Externship: Week 2

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Monday

Rather than being on the wards like all of Week 1, this week started in clinic. I saw one HIV patient, with 2 HIV nurses and Dr. H. The patient was currently in transition from pediatric HIV care to adult HIV care. Dr. H and one of the nurses have had a long relationship with the patient that stretched back almost 10 years and it showed.

There were moments where the patient broke down and just cried on Dr. H's shoulder. I was not prepared for all the psychosocial issues that Dr. H and his HIV nurses had to handle in addition to the disease itself. I sat by rather awkwardly. Most of the 1.5-hour long visit was not "medicine," strictly speaking. Most of that hour was trying to help the patient work out personal issues - with home situation conflicts, with relationship problems, etc - such that the patient could resume taking meds regularly and on time. Even after all this time, there was still a lot of coping.

After the clinic visit, I was dismissed for the remainder of the day. There was a 2nd patient that didn't show up. Dr. H told me to look up and read articles on drug adherence, particularly with HIV and other chronic illnesses. What I found surprised me. You can read a post about it here.

Tuesday

I met briefly with Dr. H first thing in the morning to discuss a little about what I had read. A memorable quote of his:

When a doctor or a student says, "The patient won't take his/her meds," change "won't" into "can't" in your mind. Think, "The patient can't take his/her meds."

In this way, we (health professionals) allow ourselves to enter the patient's mind and figure out what's going on and why he/she isn't take meds with "perfect compliance."

Then a lab manager came to fetch me and take me to a clinical diagnostics lab. This lab apparently takes patient samples from the hospitals and determines if the patients have some kind of respiratory virus (e.g. influenza A, influenza B, parainfluenza, hMPV, etc). It also diagnoses blood samples for Epstein-Barr virus (EBV) before transplants and such. I followed around one the lab techs and watched her run a parainfluenza sample. Most impressive was the sheer level of regulation that the lab must maintain to be certified. o_O It's good to know that they must adhere to such standards, as the treatment for a patient very well does depend on the accuracy of the tests.

It was particularly amusing listening to them reminisce about the H1N1 flu pandemic last year. The lab had just completed a H1N1 assay for that virus about a week before the pandemic hit (serendipitously), so it was actually ahead of the state and the CDC in diagnosing cases. Of course, this meant that the lab was inundated with samples and the lab techs were very very busy. Like one lab tech said, "There was much consumption of wine at the end of the day."

Wednesday

During the morning, I went to Children's Court Center with 3 other externs. A retired judge met us there and gave us a "brief" history on Children's Court. Then we walked over to the DA's (Defense Attorney's) office to see what hearings we could sit in on. It was kind of exciting.

We sat in on 2 court cases. The presiding judge seemed somewhat peeved at our presence. Children's Court deals with cases like child abuse, foster care, termination of parental rights, juvenile delinquency, etc. The "goal" of Children's Court is to reunite parent and child as best as possible - even if the parents clearly suck. Usually - and curiously - the alternative tends to be worse. Apparently kids don't do well in foster care and such.

At the end, I'm glad to say that I've sat in on a hearing like this that most people only see on TV. Also, I'm really glad I didn't go into law. All that procedural stuff is not for me.

In the afternoon, I transitioned to the basic science lab from the clinical lab. It was like a throw-back to my lab experiences in undergrad, hehe. I didn't see much - just a virus assay to quantify the number of flu "amplicons" in serial dilutions of a lab sample. Alas, the assay failed.

Thursday

The entire day was a continuation of the basic science lab, where they develop assays used by the clinical lab to diagnose patient samples. I watched several lab techs/grad students do various experiments. It is as with all lab stuff - interesting to talk about/discuss, mindless to do, and mind-numbingly boring to watch, lol. I did, however, amuse myself with the "octopette" - an 8-channel pipette - for a couple minutes.

I sat and had lunch with the lab group - it was all pretty chill. I picked up a book that the head of the PID department (Dr. C) wanted me to read (6 chapters' worth) before clinic on Friday. The book was on international adoption medicine. So chances are good I'd be heading to an adoption clinic.

Friday

As predicted, I went with Dr. C to an international adoption clinic (it was in the next city over). We met with 2 sets of parents and their adopted kids (both kids adopted from East Asia). Each clinic visit took about an hour.

The first clinic visit went pretty smoothly. The adopted baby was adorable and seemed pretty well-adjusted. Dr. C seemed a little concerned about the kid's "hyper-geniality." In other words, the kid seemed a little too nice and too cooperative around strangers. In my reading, this was definitely an issue because if kids aren't well-attached to their care-givers, they're nice to everyone and easily walk away with strangers (not a good thing). The clinical psychologists decided it was worth monitoring over the next few years.

The second clinic visit was . . . interesting. The kid was 5-years-old and knew very little English. So a translator was called in. This kid had . . . many issues. Neurological problems (developmental delay), ophthalmologic problems (he was severely cross-eyed), and behavioral issues. The poor parents seemed at wit's end at times. On the way back, Dr. C stated that, while most parents mean well when they adopt such kids, they rarely think things entirely through. Often times internationally adopted kids are "damaged" in some way, either inherently or as a result of institutionalization in an orphanage and/or foster home. He foresaw potential disaster for this particular family.

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And that concludes my time with pediatric infectious disease. I must say I'm kind of sad to leave. There's still so much more to learn and experience!

I met with Dr. H briefly before heading out with Dr. C to receive and give feedback. According to Dr. H, I was "attentive on the wards, seemed interested, and was intellectually present." I'll take all that as good things; though I must say, I was particularly amused at his choice of words for "intellectually present." :-P

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Peds Externship: Week 1

On Monday I started my 8-week long pediatric externship. I begin with 2 weeks of pediatric infectious disease (PID), then 2 weeks of primary care pediatrics, and finally 4 weeks of pediatric rheumatology. I didn't even rank pediatric rheumatology on my list, so I'm not sure how/why I got it; but, everyone I've talked to - without fail - have emphatically told me how amazing/interesting it is and how much I'll enjoy it. So I'm curious as to what it's going to be like.

Anyway, back to PID. It was ranked #1 on my list, so I'm really happy I got it. I had shadowed adult ID twice a few months ago, and thoroughly enjoyed it. So I figured, "Why not? Let's do peds ID and see how it's similar/different." When I told Dr. P (in adult ID) that I'd be working with Dr. H for 2 weeks in PID, he was like, "Good. He's the guy to work with. I'll send him an email to recommend you."

Now, without further ado, Peds Externship: Week 1
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Monday
I arrived at a small conference room for the extern orientation. Soon, 3 other peds externs join me . . . but no one else was to be found. The meeting was supposed to start at 8:30am. Wondering where everyone else was, we wandered the building looking for the others. 10 minutes later, we found the other 4 externs and the coordinator in another conference room on the same floor - clearly, there was some miscommunication. The rest of the orientation was unremarkable.

At 1pm, I reported to the PID office. I eventually found my way to the 11th floor and met up with Dr. H and the resident on rotation with him this month. PID is mostly a "consult" specialty; that is, you're asked for a consultation when there's something that someone else doesn't know. So the only patients on his service were those from other doctors who asked him for a PID consult.

After 4 hours of near-constant standing, my feet wanted to separate themselves from me and walk away. And in those 4 hours, I learned that there are about 4-5 main antibiotics used in the hospital, that there are different kinds of MRSA, and that MRSA is a scarily common infection. I also learned how to interpret chest x-rays better.

Tuesday
The first thing I had to do was get my ID badge. After that, I found the resident and we rounded for a few minutes before I was recalled to the PID office, where Dr. H wanted me to sit in on a meeting. It was a pediatric HIV management meeting and it consisted of him, 2 HIV nurses, and a social worker. Basically, he reviewed several pediatric HIV cases across the Midwest and discussed with the team on how to manage them (medication changes, follow-up, etc).

After finishing, Dr. H and I rendezvoused with the resident on the wards. Lots of running all over the hospital. I think Dr. H had to leave for a meeting, so it was just me and the resident for a while. I went with the resident to the resident's noon conference. Afterwards, I followed him to the resident's lounge, where I pilfered some food, lol.

We then met up with Dr. H and rounded on almost all the patients on his consult service. Saw kids with MRSA, with staph/strep infections, with pneumonia, etc. The resident would often stop and teach/review stuff with me, which I really appreciated. He'd also give me tips on the USMLE Step 1 I'd be taking this time next year. The last patient we saw was at 4pm, but the interview with her and her parents took almost 2 hours! Dermatology suspected Munchausen's, but Dr. H suspected (made up?) a diagnosis of strep infection. Again, my feet wanted to assassinate me.

Wednesday
I met with the resident and we rounded on a few patients before meeting the rest of the PID department for PID patient rounds. It was interesting to see all the PID physicians discuss (argue) about various treatments and therapies for patients on their service in the hospital.

In the afternoon I was supposed to go with an HIV nurse on a home visit, but the patient was in surgery so that was canceled. Instead, I continued to round with the resident (Dr. H had meetings all day except for 15-20 minutes during which he could see patients). Basically just rounded on all the patients from the previous days and saw some new patients. Several patients were getting better on our service, so that was great to see. I was surprised how after only a day or two, I could recall the patients' names, why they were in the hospital, and why we were seeing them.

Thursday
Like the previous days, I first met up with the resident, and then we joined up with Dr. H as soon as he was available. The first new case I saw was a kid with tetralogy of Fallot and a brain abscess (of infectious origin). When I learned about tetralogy of Fallot in class, I thought I would never see a case and here it was right in front of me!! Also, the brain abscess was really interesting because I found myself recalling some of the things I learned in neuro, trying to localize the lesion. The poor kid had ipsilateral ptosis, downward gaze, and small pupil; and contralateral muscle weakness.

A few of the kids I saw were really improving (and were subsequently discharged the following day). It's great to see a kid recover from being super-miserable to practically normal again. Today was the day that I went with the HIV nurse to the home visit. But first we had to go to a HIV center in downtown for another HIV management meeting (this time for HIV+ women). After seeing all the psycho-social issues the patients often had to deal with, I'm glad that HIV nurses exist, but I do NOT envy their job.

The home visit took a surprisingly long time. I helped the HIV nurse sort and organize all the meds this woman was on. I think she was on more meds than I've been on in my entire life combined. o_O That's a lot of drugs to keep straight. It was one of those experiences that I could do without repeating, but really appreciate having to do it at least once just to see what's all involved.

The HIV nurse told me that many of the things that Dr. H does are unpaid. The HIV management meetings and all the other meetings he has are essentially done for free (because they can't be billed). Dr. H is thus forced to see enough patients in the hospital to make his salary - and he used to work in the ICU to make ends meet (but not anymore).

Friday
First went to grand rounds with the entire pediatrics department. People's pagers kept going off every few minutes, and that was sooo annoying. Afterwards, we rounded on patients until about noon. I felt some fontanelles on some babies! Babies are so cute. ^_^ Too bad they were sick (one of them had meningitis). At noon, the resident left for a meeting and I tagged along with Dr. H to a research presentation (it could've been better). Dr. H kept ducking out to answer pages, and I eventually "lost" him.

After I paged the resident, I met up with him and continued rounding. Basically, it's endless rounding where you visit all patients and see how they're doing and if anything needs to be changed. Also, there was a sudden increase in new patient consults for us. Dr. H joined us for the new consults. It's really something watching him explain things to parents. He always makes a point of making sure the parents know exactly what's going on, and walks them through radiology images and all that.

Speaking of radiology . . . I was down in radiology several times this week with the resident and/or Dr. H. I must say, it's really dark down there! It's almost like it's the land of vampires. o_O
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So that was Week 1. Week 2 continues with PID, but the resident's on vacation. I will miss him - it was great working with him. Perhaps we'll bump into each other some time. Funny thing about that, Dr. H was surprised that I knew a couple other doctors that we met. He was like, "Do you know everyone?" The following day, I ran into one of the faculty advisors for APAMSA (Asian Pacific American Medical Student Association) while with the resident, and even the resident was like "Wow, you do know everyone, don't you?"

Okay, every time I go to publish this post, I keep forgetting something more I want to add. :-/ Alas, this post (long as it is), doesn't quite do justice to all I've experienced this week. But I think some of it I can't even go into anyhow, due to HIPAA reasons. Oh well. My feet have finally become accustomed to standing/walking for so many hours, so they no longer want to kill me. :-P

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Weekend Trip

Well, it's certainly been a while since I last posted (right before I began studying for finals). Finals were rough, rougher than I had expected. But now I'm done with my M1 year!! Huzzah for surviving. :-D

Since finishing with finals last Friday, this entire week up to now has been kind of a blur, with each day blending and merging into the next. Oh how time flies. Alas this is our last "true" summer.

Over the weekend right after finals, my roommate (Ang), and my friend (Howie) took a trip to Chicago. We crashed with a friend of Ang's, who is working and living in downtown Chicago. Surprisingly, he lives in the apartment complex right across the street from Shivani. o_O

So on Saturday morning, we (and by "we" I mean "I" drove) left at 8:30am and drove to the Metra station in Waukegan, where we proceeded to take the Metra train into Ogilvie Center in downtown Chicago. It was interesting driving through Waukegan, because it reminded me of shadowing an endocrinologist there a few years ago. In fact, I'm pretty sure I drove right past the building where his clinic office was situated in.

We decided to walk to Millennium Park. Fortunately, Ang remembered the way (otherwise, Howie and I would be kicking his ass). Of all the times I've been to Chicago, I've never been to Millennium Park or Grant Park, so we made a point of going there. The weather was absolutely beautiful.

Some of the things we saw in Millennium Park include:

A fountain with a digital face that changes, and spits water (Crown Fountain).

A T-rex statue from China (rawr).

The Bean!! (Apparently it's called the Cloud Gate.)

Jay Pritzker Pavilion.

And of course, a tree on top of a building over yonder. :-P

After finishing up with Millennium Park, we walked by the art museum (but alas, it wasn't free that day so we skipped it) and headed for Grant Park. All there was really at Grant Park was a huge fountain. And a nice view of Lake Michigan.

We then took a taxi to Ang's friend's apartment. We relaxed there for a couple hours before his friend took us to Navy Pier, just to walk around a bit.

Then we went to go see Prince of Persia, which was a better movie than I had anticipated. And finally, to top off the day, we took a cab to a Korean restaurant for Korean bbq. I've never really had Korean bbq before, so it was certainly an experience. Our Korean waitress must've been annoyed at us for not being Korean or something, lol. The food was good, but I don't think Korean food will still be in my top 5 favorite types of food. I still think kimchi is gross, though the bulgolgi beef was quite delicious.

We crashed pretty hard upon returning to Ang's friend's place. We watched Sherlock Holmes on DVD but I was dozing off from time to time. Ang was taking a nap during most of the movie, before heading to bed before the rest of us. We called it a night pretty soon after finishing the movie.

The next morning, Ang's friend left to meet a friend in downtown. The 3 of us left for Chinatown to have dim sum. It was rather difficult for me to order for us, as I don't speak - but I can understand - Cantonese (I knew the most Chinese of the 3 of us; Ang and Howie were born in China, how embarrassing). The dim sum was okay, but surprisingly overpriced; none of us were particularly pleased at that. Finishing dim sum, we walked around Chinatown for a little bit, to let the food digest. We all got bubble smoothies, which certainly didn't help the whole "feeling stuffed" bit. And then I bought half a duck at the same place my parents buy duck when we visit Chinatown. ^_^

Returning to the friend's apartment, I called Shivani and met her on the street corner. We chatted for a little bit, catching up and such. Alas, Shivani has been frantically studying for USMLE Step 1, and was unable to join us in anything. Oh well.

Lastly, to top off the weekend, we had sushi before heading back to Waukegan (where I then drove us all back).
P.S. Apparently, if I post pictures to Blogger in Firefox as opposed to Google Chrome, one can actually click on the pictures to enlarge them in another window/tab. Good to know.

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