The Peds Crisis

A few weeks ago, my good friend Lauren, who is a third-year medical student in Ohio, called me and informed me that she was having a crisis: "I love peds!"
"Me too!" I exclaimed. "And I don't know what to do!"

Both Lauren and I had entered medical school with a strong interest in women's health and had fully expected to pursue residencies in ob/gyn. Her love of pediatrics didn't surprise me as much as my own - she's phenomenal with kids. But I had never expected us - ok, especially me - to seriously consider this alternate career path.

Why has peds grown on me so much? It's a combination of factors. As they say, kids are not just little adults, and it is exciting and refreshing to study a whole different array of diseases, syndromes, and versions of "normal" than what I have experienced over and over again in adult medicine. (Another patient with hypertension? Yawn. A congenital heart defect or a case of precocious puberty? Now that's exciting!) The kids are mostly very sweet, and even when they're not well-behaved, hey, I don't have to bring them home. (And it's not like all adults are well-behaved and pleasant, either.) As one attending pointed out while explaining while he chose this career, kids are fixable. In most cases, this is true, whereas with adults, we often just put a temporary band-aid on their chronic condition, be it heart disease, pulmonary disease, or diabetes, that will hopefully hold them over for awhile until their next flare-up. Finally, the people have been spectacular. Never have I experienced so much teaching by attending physicians during rounds. And the residents, though tired, are enthusiastic and truly love what they do. In their words, "Why would anyone want to do anything else?"

To top it all off, I absolutely adored my week on the pediatric hematology/oncology floor. The kids I saw ran the gamut from the best possible prognosis to cases that renewed my passion for the importance of palliative, end-of-life care. In five days I wrote two poems; the atmosphere was so saturated with emotion that the words just sprang into my mind. The overall feel of the floor was special; parents took coffee breaks together and kids in neighboring rooms visited one another. Rather than each patient existing as an island on a impersonal ward, this was a community.

The teaching on heme/onc was phenomenal - the best I have yet experienced during medical school. On my first day, we took nearly five hours to round on five patients, and every minute spent standing before the attending trying to answer her questions was worth it. She asked questions in a manner that was not intimidating or aggressive, but that promoted learning. When I didn't know an answer, she backed up and asked me other questions that led me to put the facts together myself. It helped, of course, that I was absolutely fascinated by every detail we discussed. Others may not, but I certainly care about the side effects of various chemotherapies and the ways in which kids often describe them. Kidney function, which normally bores me, is enthralling in the context of a patient undergoing cancer treatment. I took copious notes, stopping only when I ran out of paper and energy, and even then listening with rapt attention.

The second attending I worked with challenged me in other ways, and especially helped me to improve my progress notes. "When you are writing a note, you are telling the patient's story," he said. And pitter-patter went my heart, out of love for telling these stories, for the patients whose stories they were, and for this celebration of humanism in medicine. And, truth be told, for my newfound love of pediatric oncology.