This week I reached the half-way point of my pediatric rotation, which marks a switch from inpatient service to outpatient ambulatory care. I felt reluctant about this change, since I was just starting to feel comfortable with my role with the inpatient team. I had a good experience, besides fainting on the floor (even that turned out to be not SO bad).
My memories from the inpatient weeks revolve mostly around the people. Medical students who begin 3rd year especially remember their first patients. It wasn’t until my second day working with the pediatrics inpatient team that I was assigned to a new admission. I felt excited and nervous as I went to meet him.
He was a toddler “with history of CHF (Chronic Heart Failure), admitted for 2 days of worsening fever and respiratory distress.” What I wasn’t prepared for was that mom spoke only a little English. She understood Spanish, but spoke primarily Portuguese. Along with an intern and the head resident, we took a history of his illness from mom, asking questions in Spanish and deciphering answers in Portuguese and English.
I was expecting him to cry when we examined him, but he was quiet and still. I moved my stethoscope along his torso, listening to his heart, lungs and abdomen while he was quiet. Then, I examined his ears, eyes, head and throat. We determined he probably had a viral infection, most likely to be “RSV” (Respiratory Syncitial Virus). This case was “bread and butter” (common) for pediatrics. In fact, there was not much we could do for him besides monitor his respiratory and cardiovascular status and treat his symptoms.
I wanted to do more. I came home and read journal articles on RSV treatments. Asthma medications weren’t recommended because the respiratory obstruction was due to mucus, not inflamed airways. Saline nebulizers could be used to reduce the mucus, but the evidence was still “inconclusive.” Heliox (helium and oxygen) was useful in extreme cases, but it is extremely expensive. There weren’t any easy solutions, and this is the case with many patients.
As the week went on, his story blended with others. Coincidentally my second patient was another boy with a probable RSV infection and a history of heart problems. This time I learned about WPW (Wolff-Parkinson-White Syndrome), a type of “SVT,” (Supraventricular Tachycardia), especially common in children.
As the days passed, my patients’ diagnoses broadened to include asthma, cellulitis, dacryocystocele and febrile seizures. During rounds, I heard the stories of other patients: dermatitis herpeticus, functional constipation with encopresis, bilious vomiting, bloody diarrhea, accidentally cut gastric-tube, fever of unknown origin, mysterious ALTE’s (Apparent Life Threatening Events), and a child who had been in a mysterious coma for a month.
Everyday we discussed the “assessment and plan,” how we would care for each patient. I felt my medical knowledge, the roughly piled structure of facts, start to form itself into something more concrete. It was like I had been studying another language, and suddenly I was in the country, surrounded by people who spoke only that language. I was overwhelmed, clueless at times. I started scribbling words that I heard often, like: MRCP, VCUG, KUB, NCAT. The everyday language was different from what I had studied.
From my first patient to my second, third and fourth, I already started to feel a huge difference. I learned the order of notes and presentations. I used some of those previously foreign acronyms myself, and I entered patients’ rooms with more joy and less trepidation. My performance has been far from perfect, but these first patient memories are the best learning experiences in medicine that I have had so far.
