Kids are like puppies in a pet store, they are really cute and fun to play with at the store but I wouldn't want to take one home with me.
In the mist of the mundane activities of outpatient clinic, cute- well behaved kids just bring a big fat smile to me. Lately kids are coming in droves to squeeze in their school physical & shots before the start of school this Monday. There were all sorts of cute puppies, I mean kids this week. We had quiet ones who read books while waiting for me & the Dr., 4th grade girls who dressed like their moms, who dressed like they were 18, and then we had the kids who are completely nuts and can't sit still for a second for me to examine them ie ADHD kids. Trying to examine ADHD kids is like trying examine a kid at the jungle gym all the while chasing after them with with your otoscope and stethoscope. I would have one ADHD kid sitting on the table and 1 s later that get distracted by their parents or other siblings and are just bouncing from wall to wall. Mom later explained to me that during vacation, the kids are off the ADHD medicine. In the mist of this playground aka Peds clinic I also saw some sick babies. Yea babies are cute too but man they are just big fat petri dishes.
I examined 2 babies with URI [upper respiratory tract infections] using a tongue blade and they just laid a big cough right in my face. I felt like was just sprayed with 10^14 colonies of bacteria all on me. Well to no surprise I woke up the next day with a big headache and a sore throat. OH NO! I was getting sick. Luckily I take my vitamins regularly, supplemented with Extra Vitamin C when I feel like I coming down with some cold. So my minor cold lasted 2 days, but during those days I just felt dizzy and weak and massively sleepy--those darn cytokines & TNF were kicking in.
Kids also are super excited about stickers they get at the Dr.'s office. I mean I would be too. You guys should see these cool looking stickers the Dr.'s got. There's Shrek, Dora, Ratioulle, Spiderman, Barbie, Sponge Bob, I mean they're pretty big and some are really shiny and glittery,and even 2D looking. So a neat trick I like to use when I examine kids, is that I tell them if they don't behave they won't get stickers. Yea so some of you may think that's mean, but its really an empty threat, but really all Kids get stickers before they leave.
Another thing to be careful of when you examine them, is too be careful not to drop the "S-bomb." I mean "Shots" they totally freak out and some start crying even before the needles arrive if you even mention the word in front of them.
Well I'm heading to Costco this weekend to stock up on some more Vitamin C. It really works!!! Hope you guys who just took the shelf have a good weekend. :)
Friday, August 24, 2007
Wednesday, August 15, 2007
Suspicions Confirmed- R/O Pediatrics
So begins the Pediatric rotation on Monday. Hmm the past few days at PCC have been uneventful albeit kinda inching towards boredom. The most interesting part of Peds is visiting the specialty clinics at Cook Children's. Yesterday I saw sick little ones in the Ped Pulmonology Clinic with varieties of Asthma, Cystic Fibrosis, and some other breathing problems. I like the specialty clinic the mostly because the kids are way sick and that keeps them sitting still, laying in mom's lap, they don't run, open and slam doors, demand for stickers like the healthier kids at PCC.
Today I confirmed what I always suspected I hate Peds. Hmm you can say its a combination of the parents, the noisiness, the coughing in your face, the incessant crying, the I' can't tell what's wrong with me because I can't talk, when you exam them. To me it seems like all kids have ADHD despite if they are actually diagnosed. Today was a busy day we're running behind and parents complain b/c of the long wait. I'm sorry, I don't recall at time when I visit my doctor I did not have to wait. News Flash: Its a fact of medicine, going to the doctor means waiting. Well this mother was a little irritated and decides to lay it on the little innocent med student -ME.
Mother: My appt was at 4:00pm , its now 5:00pm, this is the last time I'm coming here. [in a huff]
Med-student: I apologize for the wait we've been hit with a lot very sick kids today.
Mother: [in a very annoyed tone] Yea you guys are getting too busy, I can't get my child in for well child visit until October and its past his birthday ( by like 1 mo.)
Onto the exam:
S: MOM: son has rashes with pus oozing out.
O: Afebrile, VS stable:
PE: Her son has these erythematous (red) , pruitic (itchy), infected lesions on his legs that he scratches and salivates on. He looks dirty and and boogers hanging out. [These pts are my favorite :) ]
A: Son: dirty- infected excoriations
Mother: Over reacting, and angry,
P: Recommend bathing your son regularly + abtx for the infection
Mother: needs a chill pill
Well for starters mom lets bathe your kid and stop him from licking those scratches. Then possibly those scratches won't get infected and subsequently you won't have to come to the Dr. and most importantly you won't to take your anger and frustration on the innocent med student who already hates PEDS, and finally the med student can go home a happy camper.
Not to say its all bad: the fun people are the nice parents and the chubby kids. I can't resist poking at chubby kids' cheeks, and tickling them to make them laugh like the Pillsbury Dough Boy.
Tomorrow: genetics clinic.
Shout out: I saw a DE at the library today with books and computer in stow, looking all cool with her Sunglasses at top her head and getting in some serious studying. Its cool to know people actually read this blog.
Today I confirmed what I always suspected I hate Peds. Hmm you can say its a combination of the parents, the noisiness, the coughing in your face, the incessant crying, the I' can't tell what's wrong with me because I can't talk, when you exam them. To me it seems like all kids have ADHD despite if they are actually diagnosed. Today was a busy day we're running behind and parents complain b/c of the long wait. I'm sorry, I don't recall at time when I visit my doctor I did not have to wait. News Flash: Its a fact of medicine, going to the doctor means waiting. Well this mother was a little irritated and decides to lay it on the little innocent med student -ME.
Mother: My appt was at 4:00pm , its now 5:00pm, this is the last time I'm coming here. [in a huff]
Med-student: I apologize for the wait we've been hit with a lot very sick kids today.
Mother: [in a very annoyed tone] Yea you guys are getting too busy, I can't get my child in for well child visit until October and its past his birthday ( by like 1 mo.)
Onto the exam:
S: MOM: son has rashes with pus oozing out.
O: Afebrile, VS stable:
PE: Her son has these erythematous (red) , pruitic (itchy), infected lesions on his legs that he scratches and salivates on. He looks dirty and and boogers hanging out. [These pts are my favorite :) ]
A: Son: dirty- infected excoriations
Mother: Over reacting, and angry,
P: Recommend bathing your son regularly + abtx for the infection
Mother: needs a chill pill
Well for starters mom lets bathe your kid and stop him from licking those scratches. Then possibly those scratches won't get infected and subsequently you won't have to come to the Dr. and most importantly you won't to take your anger and frustration on the innocent med student who already hates PEDS, and finally the med student can go home a happy camper.
Not to say its all bad: the fun people are the nice parents and the chubby kids. I can't resist poking at chubby kids' cheeks, and tickling them to make them laugh like the Pillsbury Dough Boy.
Tomorrow: genetics clinic.
Shout out: I saw a DE at the library today with books and computer in stow, looking all cool with her Sunglasses at top her head and getting in some serious studying. Its cool to know people actually read this blog.
Sunday, August 5, 2007
Last Night of Ob Call~~~the Most fun Call Night Ever.
Sat. was my last Ob call night for the rest the rotation. It was the best call night I have had the entire rotation. Oh Let me count the ways:
1. My senior and junior resident let me stay in the call room after morning report finished & rounding finished at 10am until pretty much 7:30pm!! This left me ample time to surf the internet and finish so some uncompleted reading. Although it was a lot of time, I never could really settle down and read with concentration b/c I felt like at some point there were going to page me soon like previous call nights where I only sat in the room for 1 or 2hr. Why did I get called back at 7:30 ~~~ have you guys heard of NIGHT ROUNDS~~~ well only with a certain Dr. here we do morning and night rounds. We review our pts that we have on L&D [labor and delivery] and those on the floor recovering after delivery, then we go by and visit them. After night rounding we sat around while the attending with nothing better to do than to begin pimping. Pimping was actually fun, b/c he made it very educational and unintimidating.
2. Both residents let me stay in my room and said not to sweat the small stuff, and if there was a delivery they would let me primary deliverer. Awesome huh, other times I followed the intern around doing orders and reading them over her shoulder.
3. I found Bomb-sticks at the hospital cafeteria!!~~ I realize I only like the banana part and I scraped the chocolate away. I haven't had one since College ~3 yrs ago.
So after a slow start, all the sudden BAM !! everyone decides to do a drive-by the L&D. First a 13yo who is about 36/40 wks pregnant. Whose mother just recently found out that she was pregnant at 7mo [28wks], came in for early contractions and pain. She was going into the 8th grade mind you.
Second, 21yo deaf pt 21 wks GA [gestational age] comes in for abdominal pain and UTI.
Third, a 23 yo G3P1011 at 39 wks for suprapubic pain and contractions after intercourse. So what is the mechanism of intercourse and contractions? Well sperm carries prostaglandins and intercourse causes deposition of prostaglandins around the cervix and causes uterine contractions like actually giving pitocin. So we frequently see pts come in after intercourse with CC of Vaginal bleeding. We went ahead and did a C-section on her but Oh no her:
Hgb: 7.o
HCT: 29
Platelets 33K
She was at sever risk of bleeding and she had suprapubic pain right over her previous uterine scar~~ Risk of rupture high!!! So C-section was a must even though she may be a bleeder
The plan:
1. give her general anesthesia. No epidural in fear of bleeding complications of hematoma
2. Do the C/s in a max of 20 mins and the get the baby out quick~ b/c if mom is not breathing under gen. anesthesia neither is baby.
3. Minimize bleeding as much as possible by cauterizing everything us see bloody.
Plan in action
1. Total C/s time 1hr 30mins.
2. Everyone is double gloved~ a specific requirment by on Dr. for all residents and students.
3. Incision is made, cutting is started,baby delivered pretty fast Oh maybe 15 mins into the action.
4. Confirmed~ uterus had a whole in it she was leaking amniotic fluid with meconium.
5. next 1hr and 15mins is spent A) removing 1st pair of gloves. B) attending being nit picky about how the Senior resident should suture and making extra sure he cauterizes every leaky BV.
Attending to Chief resident: not enough myometrium, ok too much myometrium, now be sure to get enough serosa, ok make sure its very tight... this went on for another hour.
6. Junior resident contaminates his gown by rubbing it against the attendings head--> he gets a new arm shield. --> Junior resident making faces at me b/c Dr. going into a 1hr procedure that normally takes 30mins from skin open to skin closure.
7. Finally she is sewed up and post op-lab shows lab mistake:
Hbg 10.1
HCT 36
Platelets 231 K !!!
We also take phone calls when pts call at night for the outpt clinic. So a pt calls cc of vaginal bleeding and contractions. Here is the phone call conv from what I could hear the junior resident over the phone:
R: So you are having contractions morning, afternoon, and at night.
R: Any bleeding, Leakage of fluids, and pain?
R: Have you been drinking enough water, or doing any vigorous activity, or have intercourse
PT: well now come to think of it: I had sex after breakfast, in the afternoon, and at night.
R: Uncontrolled Bursts of laughter while on the phone.
R: Please excuse me, I have a cough here. Handset is placed on the desk where he starts laughing some more.
R: Ok' I'm back I just have some allergies here.
R: Well now Ms. X maybe you should take a break from Sex tonight and tomorrow night.
R: If you have any more bleeding or its getting more painful let us know~~
End of conversation.
Basically we were all in the call room listening to his converation and everyone was laughing.
Fun night!!! Bye Bye Pregnant ladies.
1. My senior and junior resident let me stay in the call room after morning report finished & rounding finished at 10am until pretty much 7:30pm!! This left me ample time to surf the internet and finish so some uncompleted reading. Although it was a lot of time, I never could really settle down and read with concentration b/c I felt like at some point there were going to page me soon like previous call nights where I only sat in the room for 1 or 2hr. Why did I get called back at 7:30 ~~~ have you guys heard of NIGHT ROUNDS~~~ well only with a certain Dr. here we do morning and night rounds. We review our pts that we have on L&D [labor and delivery] and those on the floor recovering after delivery, then we go by and visit them. After night rounding we sat around while the attending with nothing better to do than to begin pimping. Pimping was actually fun, b/c he made it very educational and unintimidating.
2. Both residents let me stay in my room and said not to sweat the small stuff, and if there was a delivery they would let me primary deliverer. Awesome huh, other times I followed the intern around doing orders and reading them over her shoulder.
3. I found Bomb-sticks at the hospital cafeteria!!~~ I realize I only like the banana part and I scraped the chocolate away. I haven't had one since College ~3 yrs ago.
So after a slow start, all the sudden BAM !! everyone decides to do a drive-by the L&D. First a 13yo who is about 36/40 wks pregnant. Whose mother just recently found out that she was pregnant at 7mo [28wks], came in for early contractions and pain. She was going into the 8th grade mind you.
Second, 21yo deaf pt 21 wks GA [gestational age] comes in for abdominal pain and UTI.
Third, a 23 yo G3P1011 at 39 wks for suprapubic pain and contractions after intercourse. So what is the mechanism of intercourse and contractions? Well sperm carries prostaglandins and intercourse causes deposition of prostaglandins around the cervix and causes uterine contractions like actually giving pitocin. So we frequently see pts come in after intercourse with CC of Vaginal bleeding. We went ahead and did a C-section on her but Oh no her:
Hgb: 7.o
HCT: 29
Platelets 33K
She was at sever risk of bleeding and she had suprapubic pain right over her previous uterine scar~~ Risk of rupture high!!! So C-section was a must even though she may be a bleeder
The plan:
1. give her general anesthesia. No epidural in fear of bleeding complications of hematoma
2. Do the C/s in a max of 20 mins and the get the baby out quick~ b/c if mom is not breathing under gen. anesthesia neither is baby.
3. Minimize bleeding as much as possible by cauterizing everything us see bloody.
Plan in action
1. Total C/s time 1hr 30mins.
2. Everyone is double gloved~ a specific requirment by on Dr. for all residents and students.
3. Incision is made, cutting is started,baby delivered pretty fast Oh maybe 15 mins into the action.
4. Confirmed~ uterus had a whole in it she was leaking amniotic fluid with meconium.
5. next 1hr and 15mins is spent A) removing 1st pair of gloves. B) attending being nit picky about how the Senior resident should suture and making extra sure he cauterizes every leaky BV.
Attending to Chief resident: not enough myometrium, ok too much myometrium, now be sure to get enough serosa, ok make sure its very tight... this went on for another hour.
6. Junior resident contaminates his gown by rubbing it against the attendings head--> he gets a new arm shield. --> Junior resident making faces at me b/c Dr. going into a 1hr procedure that normally takes 30mins from skin open to skin closure.
7. Finally she is sewed up and post op-lab shows lab mistake:
Hbg 10.1
HCT 36
Platelets 231 K !!!
We also take phone calls when pts call at night for the outpt clinic. So a pt calls cc of vaginal bleeding and contractions. Here is the phone call conv from what I could hear the junior resident over the phone:
R: So you are having contractions morning, afternoon, and at night.
R: Any bleeding, Leakage of fluids, and pain?
R: Have you been drinking enough water, or doing any vigorous activity, or have intercourse
PT: well now come to think of it: I had sex after breakfast, in the afternoon, and at night.
R: Uncontrolled Bursts of laughter while on the phone.
R: Please excuse me, I have a cough here. Handset is placed on the desk where he starts laughing some more.
R: Ok' I'm back I just have some allergies here.
R: Well now Ms. X maybe you should take a break from Sex tonight and tomorrow night.
R: If you have any more bleeding or its getting more painful let us know~~
End of conversation.
Basically we were all in the call room listening to his converation and everyone was laughing.
Fun night!!! Bye Bye Pregnant ladies.
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