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