Ten for Ten

In the early afternoon, I walk out of the children’s hospital with the other student in the rotation, feeling tired but relieved. Now that the exam for pediatrics is behind us, what are we going to do?

First, a beer is essential. Then, I am just going to enjoy the sunny afternoon.

Next week is study week for the big exam: everything we have learned over the last four years will be fair game. The diploma is going to be hinged on whether we pass this exam. So, the pressure is on.

But for this afternoon, I’m not going to think about it. Maybe I’ll even go see that new Bond movie tonight.

All Studies and No Exercise

Ugh, I feel like my body is atrophying. This is the last week of the rotation, which means serious study time, which is encroaching on my exercise time. For a whole week now, the only exercise I have been getting is my bicycle commute to and from the hospital. At a measly seven kilometers roundtrip, the commute is long enough to make me break a sweat, but not long enough to make me feel like I got a workout from it. Well, it’s better that than nothing.

Downed by Germy Kids

Everyone else on the pediatric rotation has been getting sick. It seems that whatever virus the sick kids have been coming into hospital with, it is now being passed around our group of med students. A few of my compatriots have already been feeling miserable as of late. Amidst the constant sniffling, I have luckily avoided getting hit - until last weekend. A hint of a sore throat on Friday brewed over the weekend and, by today, has become a full-blown case of viral upper respiratory tract infection. This has got to be the worst time to be sick. There are only two weeks until the end-of-rotation exam and then another week until the final exam. I really can't afford to be sick this close to two important exams. I know it's probably viral and I just have to let it run its course. If it's caused by what the kids have been spreading around, I should be feeling pretty sick these couple of days but I will be fine come exam time. Let's hope it's that and nothing worse.

Playing House

During a teaching session with one of the pediatricians today, I felt like we were the characters on House.

We saw a thirteen-month-old baby girl who was admitted to the ward yesterday. Through her mother, we learned that the baby had a previous history of Hand, Foot and Mouth Disease, which is a viral infection that happens commonly in children. It ran its course and she got better. Then her mother noticed a rash and diffuse redness in the area covered by the diaper. The mother treated it like a diaper rash. After a couple of days, the baby had not passed any bowel motion and was crying incessantly. The mother thought she had constipation and gave her some enema. The baby opened her bowel but was still unwell. At this point, the mother noticed that one of the baby’s legs was swollen from the hip to ankle and that she was spiking fevers intermittently. The mother finally brought the baby in to the children’s hospital Emergency Department. After having five different doctors taking a history from her, the mother clued in to the fact that the doctors were suspecting a non-accidental injury – i.e., child abuse. After a skeletal survey of the baby turned out normal, more investigations revealed the final diagnosis: the baby had septic arthritis of the hip. Ok, so the diagnosis was not House-worthy, but the process just made me think of the show.

There we were, three med students taking turn asking the mother the history yet again. Each time we were lead down the garden path, only to find that each piece of new information made us do a complete U-turn and think about a different process. Sure, all we did was take the history, we didn’t do any of the crazy things on House like going to the patient’s home and digging up the sandbox (as if doctors really do that in real life). Unlike House, our clinical coach, the pediatrician, was actually very nice to us and to his patients. So maybe it wasn’t like House after all, but I really enjoyed the exercise.

Going into the rotation, I didn’t think I would like pediatrics that much. But I think it’s growing on me.

Baby Check

I enjoy going to the neonatal ward. With all those chubby newborns and happy parents around, you can’t help but smile and share their joy. Yesterday I followed a resident on the ward and did a few well baby checks, which is one of the skills we have to learn during this rotation. Before each newborn is discharged, they are given a once-over by a doctor to make sure they are normal beyond having ten fingers, ten toes, and no obvious deformities.

Like everything else in medicine, there is a system to doing a baby check. You literally go from head to toe and front to back to examine the baby. I especially enjoy doing the primitive reflexes like the grasp reflex in the hands and feet, a telltale sign of our arboreal ancestry, and the Moro reflex, which is believed to be the only unlearned fear in the newborn. Today we had our baby check skills assessed by the neonatal consultant. The way I interacted with the baby I checked must have looked really natural, the consultant asked me afterward if I have kids of my own. Well, besides the four babies I delivered during the O&G rotation, yesterday would have been the first time I handled newborns. So maybe I do have a knack for handling little babies.

Kids Emergency

This week I am rostered on at the Emergency Department. Over the last couple of years, I have been slowly developing a liking to emergency medicine. Even though it is not always the adrenaline-pumping full-resuscitation cases with patients bleeding profusely as doctors bark orders while jumping on the patients’ chests as the stretcher races down the hall – in fact, that’s rarely the case – I really like the variety of presentations that’s characteristic of the specialty. So, I really look forward to my week at the children’s emergency department at the hospital.

Today I am on from 3 pm to 9 pm. This being my first day, I am still trying to find my way around the department. The consultants and registrars are incredibly nice to us. I have noticed that all the pediatricians I have met so far have been good teachers and really pleasant to work with. It makes sense: in order to be able to get kids to cooperate, the doctors just have to be pleasant to work effectively. It is hard enough to get kids to cooperate during examinations, a grumpy doctor would basically make that an impossible proposition.

The kids around Brisbane must have had a rough weekend. Late in the afternoon, the waiting room is filled with kids with various injured joints. As a medical student, all I can really do to help out the registrars and residents is by seeing the subacute cases: a sprained ankle, a swollen thumb, a rugby-related knee injury… Before long, it’s nine o’clock – the end of my shift. I have not had dinner, but I don’t even feel hungry. Normally, by this time, my thought would be on nothing but food and I’d be gnawing on my pen already.

“You coming in tomorrow?” the registrar asks me. “Yeah, three to nine again.” “Good, I’ll be on in the evening again. See you then, I’ll get you to do some good work.” With that, I change into my cycling clothes, hop on my bike, and ride down the quiet road toward home.

The Beginning of the End

Yes, it’s the last rotation of medical school! But, sigh, it’s arguably also the toughest one – pediatrics. It’s like everything we learned in the last two years all rolled into one: internal medicine, surgery, psychiatry, emergency medicine, and all those subspecialties like nephrology, cardiology, radiology, and whatever-else-ology. I thought the O&G rotation was busy, but by the looks of it, this rotation is going to be full-on. Goodbye, weekends.