MEDMATES

Most people think that working in pediatrics is like this:

And it’s pretty true. But when it gets nasty, it gets really nasty.

 I started my rotation in the ED last week, and my second patient was a 4 week old with a finger fracture.

 Read that again.

 FOUR weeks old. Meaning that he can’t roll over, can’t crawl,  can only see about a foot in front of his face and can’t lift his head. So that fact that he reportedly just “woke up like that” sketched us all out.

So we got a skeletal survey, which is a series of x-rays of every bone in the body that we get on babies when we’re concerned that they’re being abused. And the results made me literally gasp out loud and feel like I was going to vomit.

12 fractures. 9 posterior rib fractures, which happen when adult hands squeeze a baby so hard that it breaks them. Two leg fractures, which happen when an adult picks a baby up and swings them by their leg. And then the finger, which I don’t even want to imagine. 

 It was then my job to go tell the parents what we had found and what was going to happen now. I took care of all of my other patients first and fiddled around on my computer for a few minutes. When I finally couldn’t put it off anymore, I walked towards their room, shaking so badly I wasn’t sure my voice would work. I was so afraid of what their reactions would be. Would they scream at me? Be physically violent? Take the baby and run (it happened to another resident earlier this month!)?

 "The x-rays came back and we found multiple rib fractures and two leg fractures. They are already healed and are older than the finger injury. At this point, we are required to contact CPS and admit him to the hospital to make sure that he will be safe at home before he can leave.”

 The mom was shocked beyond words and wanted to know how this could have happened. I thought “You tell me and we’ll both know,” but said “I can’t tell you how the fractures happened, I can just tell you that they’re there.” The dad had his face in his hands and… didn’t seem too surprised. I’ll never know the whole story.

 When we were in med school and all deciding which field to go into, people would often say, “I can’t go into Peds because seeing kids get sick with cancer is too sad.” I disagree. Our cancer patients are some of the strongest and pure-souled people on the planet. I am so honored to get to walk along side them on their journeys, and getting to know them is one of the best parts of my job.

But child abuse sucks. It keeps us up at night and makes us lock ourselves in the bathroom at the hospital to cry. It puts fire in the eyes of even the sweetest and gentlest pediatric nurses and doctors. It’s what I hate the most about my job.

Child abuse is one of, if not THE, worst thing that could ever happen to a child, and is 100% preventable. There are no excuses for hurting a child and there are no excuses for turning a blind eye when you see it. Everyone who works with children has to be on high alert and always trust their instincts.

If you want to learn more, check out:

MRI of the Fetal Brain

Advancements in MRI are giving us an unprecedented look at the fetal brain.

Until approximately a decade ago, what researchers knew about the developing prenatal brain came primarily from analyzing the brains of aborted or miscarried fetuses. But studying postmortem brains can be confounding because scientists can’t definitively pinpoint whether the injuries to the brain occurred before or during birth. 

Over the years, however, improvements to MRI are finally enabling researchers to study the developing brain in real time. With these advancements, researchers are just beginning to understand how normal brains develop, and how abnormalities can manifest over the course of development. Scientists cataloguing typical infant brain development with the mini-MRI hope to use it eventually to study the brains of premature babies, who have a high risk of brain damage. Ultimately, clinicians hope to intervene early with therapies, if available and approved, to prevent developmental disorders when there are signs of brain damage in utero or shortly after birth.

I love medicine, and I love being a doctor, most of the time.  But there is much that I do not like about medicine. After hearing that another one of our wonderful peers has lost their lives to suicide, I feel sad.

And I feel resentful. I am not a resentful person, but today is different.

I resent what medicine does to many of us. I resent how many of my kind, smart, wonderful friends are struggling to maintain their sanity and their sense of self. I resent that I can’t make it better for them. I resent how many of my peers become trapped in a cycle of self-doubt and feelings of worthlessness in a system set up to make them fail. I resent that our very humanity is sometimes treated like it is  unacceptable. I resent that we work on a knife edge; always close to something which could end a career or a life.

I resent that the system (any system, every system) is set up not to look after  patients, nor us. But to look after itself. I resent that politicians use our careers and lives as a football to advance their own careers. I resent that they have no idea what it’s like to work an understaffed on-call but think they can change laws and contracts governing how we work. I resent how the media paints us as martyrs one minute and greedy incompetent quacks the next. I resent how much this wears all of us down, and the way it’s eroding our cameraderie and goodwill.

Gerty Theresa Cori - 1947 Discovery of the course of the catalytic conversion of glycogen (also known as Cori Cycle)

Rosalyn Yalow - 1977 Development of radioimmunoassays of peptide hormones

Barbara McClintock - 1983 Discovery of mobile genetic elements

Rita Levi-Montalcini - 1986 Discoveries of growth factors

Gertrude B. Elion - 1988 Discoveries of important principles for drug treatment

Christiane Nüsslein-Volhard - 1995 Discoveries concerning the genetic control of early embryonic development

Linda B. Buck - 2004 Discoveries of odorant receptors and the organization of the olfactory system

Françoise Barré-Sinoussi - 2008 Discovery of human immunodeficiency virus

Carol W. Greider - 2009 Discovery of how chromosomes are protected by telomeres and the enzyme telomerase

Elizabeth H. Blackburn - 2009 Discovery of how chromosomes are protected by telomeres and the enzyme telomerase

May-Britt Moser - 2014 Discoveries of cells that constitute a positioning system in the brain

Back in the 1960s, the U.S. started vaccinating kids for measles. As expected, children stopped getting measles.

But something else happened.

Childhood deaths from all infectious diseases plummeted. Even deaths from diseases like pneumonia and diarrhea were cut by half.

“So it’s really been a mystery — why do children stop dying at such high rates from all these different infections following introduction of the measles vaccine,” says Michael Mina, a postdoc in biology at Princeton University and a medical student at Emory University.

“We found measles predisposes children to all other infectious diseases for up to a few years,” Mina says.

And the virus seems to do it in a sneaky way.

Like many viruses, measles is known to suppress the immune system for a few weeks after an infection. But previous studies in monkeys have suggested that measles takes this suppression to a whole new level: It erases immune protection to other diseases, Mina says.

Taken from the Declaration of Geneva

In the days and years to come, this oath recited at white coat ceremonies cannot be forgotten, regardless of unpredictable political pressures that may arise

The doctor supervising me yesterday : “You write way too many details in your notes! Cut it down.”

The doctor supervising me today : “You really need to write more details in your notes, more is always better than less.”

Me :