Kids

Orientation for Pediatrics was on Monday. The orientation lasted about 8 hours - some of which was useful, a lot of which was a waste of time. One particular funny moment (funny as in 'uncomfortable' rather than 'humorous') was during the Introduction to Pediatrics video, which explained to us that the physical exam on young patients can sometimes be difficult. They tend to perceive medical instruments as invasive and will react accordingly. It's easy to see how the otoscope can be scary, but the stethoscope itself can apparently evoke screams of horror. In the video, one pediatrician said that it was almost impossible to properly examine the oropharynx of the pediatric patient without the use of a tongue blade (I prefer to use the term "tongue depressor", but to each his own). "It is essential for you to master the proper use of the tongue blade," she said. "First, slide the blade down the gumline. Now twist...and now....GAG!" (emphasis, mine). We look askance at one another - "Did she just say what I think she said?"

Then, they brought in a lawyer. I snuck a picture:

Just kidding, Kinjo (serves you right for punking me). The lawyer was actually there to explain to us our role in looking for signs of neglect or abuse in the pediatric population. It can be a bit stressful, I suppose, because the way she put it was: "If you miss it, you're liable for malpractice" or something like that. But, she then pointed out all the resources that were available for us to contact if - no, when - we suspect that something is amiss. I'll refer you to Kinjo's blog, which has some links to organizations which deal with child protection. Pretty depressing stuff.

But, to make it all better, they handed us toys!!!!

Unfortunately, the toys are for our patients. Dang. Anyway, I hit the toy store and got some more toys to hand out. I'm thinking I'm going to enjoy this rotation.

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I start off on the Pediatric Inpatient Wards - I'm not just looking at ear infections and sore throats here. Here are two of the first two patients I hear about - I'll just give vague details to give you an idea of what I'm talking about, while protecting the kids from any sort of identification:

1. 2-year old boy with failure-to-thrive - DSS is trying to get custody, but can't find his mom to let her know when the hearing is scheduled. He's bounced around several foster homes, and he sleeps in a strange position. There may be bruises on his back. In contrast to the other beds and cribs on the ward, there are no balloons or toys or candy - his crib is bare. He's scared of all of these older people staring at him. We order a full skeletal survey to check for old fractures. It's nice to hear the attending physician tell the nurse to dig through some of the Christmas toy donations to see if there's anything that the boy would play with. Trust me that this kid was treated like a superstar while he was on the wards.
2. A 4-day old girl with a broken arm. It's not uncommon that arms can be dislocated or broken during birth. But the radiologist has never seen a fracture like this in his 50 years of practice from such a circumstance. X-ray shows a compound fracture in the middle of the arm - one may imagine how stress fractures or microfractures could occur, but how this break occurred is unfathomable. The case has now been labeled with "NAT." (I'm seeing too many "NAT's" on my patient list.) DSS refuses to let her parents in to see her unless they themselves are supervised.

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They don't hand those difficult social cases to third year medical students. I've followed two patients so far, and both they and their families have been wonderful to deal with. Thank goodness.