Mar 23
Yikes!
pull up a chair Last week my partner had some skin cancer on his forehead removed at a downtown Toronto Clinic. Heād had this āspotā for sev
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Yikes!
pull up a chair Last week my partner had some skin cancer on his forehead removed at a downtown Toronto Clinic. Heād had this āspotā for sev
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entirely too much laughing
Hopefully this is slightly coherent because I'm on shift 3 out of 5 consecutive shifts in a row coming off of 3 night shifts in 1 week (with a few shifts in between) so I'm maybe a little delirious and actually that would probably explain all the word-finding difficulties I seem to be having recently at work (couldn't remember the word for sympathomimetic today on shift so literally turned to my colleague and was like, "Uh thing--heart rate, high? Big BP? Drugs?" which, to her credit, she responded, "Oh, like, stimulants? Sympathomimetics?" and we just both went back to charting like nothing happened).
Anyway, a 5-year-old kiddo came in today because his parent noticed he seemed to be tripping over his feet more than usual. Kiddo has a history of an acquired cardiac lesion (that has thankfully resolved since his last cardiology follow up!) but his parent was understandably stressed that it might be related to the heart function. While this didn't really fit any pathophysiologic explanation, I could tell that this parent's anxiety was probably not going to be easily assuaged, so I brought in the ultrasound machine when I went with my resident to assess him.
"This isn't as detailed as the--" I started to explain, when my new little friend piped up, "Oh, it's an echo!"
I laughed. "Well, these pictures aren't going to be as detailed as your echoes, little man, but they should be able to tell us if your heart is generally working well or not."
He eyed my gel bottle suspiciously. "Is that one warm?"
I tilted my head sympathetically. "Sorry my friend, it won't be as warm as the special jelly the echo people have. But you can touch it before we do your pictures if you want?"
He poked the gel and nodded.
"Okay. Echo time."
We got him positioned and he proceeded to laugh and giggle through the entire cardiac POCUS assessment. His parent was extremely relieved that his global cardiac function was normal, and was happy to follow up with his cardiology team. After all the giggling through the POCUS, I don't know why I thought the neurologic exam would be any more austere, but all I could think about as I proceeded to tickle the little guy through his sensory assessment was how the infant who was screeching and crying in the room next door was suddenly silent as my little friend squealed in laughter. (Maybe they were soothed by the giggles?)
We finished off the exam with a gait assessment during which we chased each other around in a very tiny little circle, first with regular walking, then on our tip toes, then on our heels, and made each other very dizzy, and laughed about this some more. There were no trips or falls, no ataxia, no gait abnormalities or foot drop or anything else that would signal a dangerous reason for the episodes of mechanical falls at home. As we concluded the exam, my little friend was very, very excited about his "go home" popsicle as he got his boots and jacket on.
As we exited the room, my resident turned to me and said, "We... just don't get that in the general emergency department. Seems like--"
"--entirely too much laughter for the grumpy adults?" I asked, waggling my eyebrows at her. She laughed.
"Entirely."
This is why we do pediatrics. Come join us--we have popsicles.
(Side note: one of the advice calls I received today was from a colleague assessing a child at one of the community EDs for poor oral intake secondary to significant oral lesions from hand-foot-mouth disease, and they were feeling distressed that they couldn't get the kiddo to drink. They'd only gotten acetaminophen and ketorolac into them so far, and still the little bean refused to drink. I suggested trying a topical analgesic like a tiny amount of viscous lidocaine, followed by a popsicle or a freezie, or even some ice chips. I was met by a brief silence on the other line. Then, my general emerg colleague, who works in an emergency department that sees mostly adults, said slowly, "We, uh, we don't have any popsicles OR freezies." I laughed sheepishly, "Oh, right, yeah, that's probably a peds thing, uh... sorry, yeah, what about the ice chips?" They chuckled. "Oh, yeah, we have those. Adults at least get ice chips." So... yeah, come to the peds side. We have popsicles. Oh! And stickers. We have stickers, too.)
San Diego Police Motors by D D Via Flickr: Daniel DeSart Ā© 2011
Ā«Ā Call the attending. I donāt need a med student or a junior resident... I need an adult.Ā Ā»
- Emerg Attending
the next step
My last patient I will ever see as a non-radiologist was a patient with second degree burns to his hand. He had accidentally put his hand on his wood stove when he wasnāt paying attention. There was a large blister. I ordered a tetanus shot, dabbed silver sulfadiazine and wrapped it with some gauze. After giving him a note for work (he was in construction and worked a lot with his hands), I sent him on his way.Ā
And with that, my clinical rotations are finished.Ā
Iāll miss it a lot, actually. It was such a privilege to work with patients every day- patients with all different types of problems, backgrounds, comorbidities, languages, expectations. It was a privilege to have patients trust you with the most intimate details of their life, their deepest fears or concerns, and having the ability to make them feel better- either with reassurance, or with extra testing if needed. Iāll miss talking to patients every day. Iāll miss examining the patients directly myself, sometimes from head-to-toe, to find the clinical pathology. It made interpreting imaging so much easier, when I had personally examined the patient myself and knew exactly where they were sore, knew exactly what their story was. And Iāll even miss their stories- no matter how circumstantial they were sometimes. Ā Ā
Onto the next chapter- radiology. I hope itās as fulfilling as these clinical rotations have been for me.Ā
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I had one of the weirdest calls into the emerg the other day. Our business clerk looks up from the phone with a perplexed expression and I happened to be writing a note, so I asked her what was going on. She said,Ā āThereās a pediatrician on the phone with a question Iām not sure how to answer.ā
Hm, thatās already odd. Usually if itās a definitely medical issue our clerks are really efficient at getting one of the doctors on the line to deal with it, and anything else theyāre awesome at connecting to the right places.
āOkay, would you like me to talk to them?ā
(Warning: under the cut is mostly just ranting and venting and an example of how our system is so thoroughly broken that doctors cannot even seem to help each other out or treat each other with common courtesy.)
Back in scrubs for my first week in emerg!!
We had some āon borardingā the first 3 days where we practiced resuscitations and management of common airway emergencies
Simulations are really fun, and you really learn what kind of person you are in those situations. I felt like I stayed pretty clear headed and made some good contributions
Thursday and Friday I had my first two shifts, it was h e c t i c
But I did get to put in an IV, stitched some lacerations and saw my first resuscitation.