Peds Externship: Week 1
>> Saturday, June 12, 2010
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
-----
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
-----
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
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
-----
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
-----
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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2 comments:
Your externship sounds so cool! :P I'm glad you're getting to see lots of different and interesting things.
Also, Dr. H sounds like a very good doctor. I like doctors who take the time to talk to patients/parents (unlike the fellows on my peds surgery rotation, who used to discuss strategies for getting through rounds faster and talking to families less so they could have breakfast before surgery...)
I must admit, Dr. H is a pretty amazing fellow. :-)
Also, almost intimidatingly brilliant. o_O
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