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.
Sunday, December 19, 2010
Tuesday, December 7, 2010
Little People
(written halfway through Pediatrics)
I was not excited about starting Peds. On my first day, my first patient – a 1-year-old at the height of his stranger-anxiety - screamed the whole time. I looked at him empathetically. You and me both, buddy. By the end of the first week I had concluded that peds was not for me because I cannot work in a field in which:
A) I have to use falsetto every day
B) I have to utter the phrase “poopy diaper”
C) In the first week, I catch a stomach virus that makes me throw up for the first time in 13 years
But get this: pediatrics is growing on me. It turns out that most of the kids don’t scream, and I’m really pretty good with them. The parents – the reason many people give for not pursuing the specialty – aren’t that bad, either. I seem to get along pretty well with them, and a few of them have even complimented me on how I handle their kids. It’s even interesting academically; there’s a whole set of different disorders that happen in kids, so there’s plenty new to learn, which is exciting. I actually enjoying reading my review books at night and then shouting, “Hey! That’s so cool – I saw that in a kid today!” (I don’t know if Tay enjoys that part.) And of course the timing of my rotation schedule was perfect, giving me a week working in the newborn nursery immediately following my bout of illness, and the adorable, itty-bitty little babies completely made me forget about being sick the week before.
What about the sad stuff, the kids who can't be fixed up or cured? Well, I don’t know yet. My first four weeks have been outpatient, so I haven’t seen any seriously ill kids yet. Starting the week of Thanksgiving, I will do four weeks on the inpatient floor, including one in oncology. I’ll let you know how it goes.
I was not excited about starting Peds. On my first day, my first patient – a 1-year-old at the height of his stranger-anxiety - screamed the whole time. I looked at him empathetically. You and me both, buddy. By the end of the first week I had concluded that peds was not for me because I cannot work in a field in which:
A) I have to use falsetto every day
B) I have to utter the phrase “poopy diaper”
C) In the first week, I catch a stomach virus that makes me throw up for the first time in 13 years
But get this: pediatrics is growing on me. It turns out that most of the kids don’t scream, and I’m really pretty good with them. The parents – the reason many people give for not pursuing the specialty – aren’t that bad, either. I seem to get along pretty well with them, and a few of them have even complimented me on how I handle their kids. It’s even interesting academically; there’s a whole set of different disorders that happen in kids, so there’s plenty new to learn, which is exciting. I actually enjoying reading my review books at night and then shouting, “Hey! That’s so cool – I saw that in a kid today!” (I don’t know if Tay enjoys that part.) And of course the timing of my rotation schedule was perfect, giving me a week working in the newborn nursery immediately following my bout of illness, and the adorable, itty-bitty little babies completely made me forget about being sick the week before.
What about the sad stuff, the kids who can't be fixed up or cured? Well, I don’t know yet. My first four weeks have been outpatient, so I haven’t seen any seriously ill kids yet. Starting the week of Thanksgiving, I will do four weeks on the inpatient floor, including one in oncology. I’ll let you know how it goes.
Sunday, December 5, 2010
The Third Time's the Charm
During October, on my third rotation of my third year, I fell back in love with medicine. I was assigned to a private family medicine practice about 30 minutes away. The doctor has one PA working for him, and between the two of them they keep the practice open seven days per week. He takes in students from several medical and PA programs, so I got to work with other students as well. Everything about this practice was exactly what I was looking for and had not yet encountered:
-He gives students quite a bit of autonomy to not only see and examine patients on our own, but to draw blood, give shots, and do EKGs.
-As a student, you bring the patients in and do a full history and physical, then tell the doctor your findings, what you think is wrong, and what you want to do about it. He then sees the patient with you and makes the final decisions, and you write up the chart note.
-Students have space to leave their stuff and to sit to write their notes, to eat lunch, and to study in the [rare] down time.
-Everyone on staff is incredibly friendly, and most of the patients are, too.
And most importantly: he is an amazing teacher and mentor! He quizzed me on a lot of topics, and taught me both clinical pearls and tactics for caring for patients. I literally wrote down phrases that he used with patients. It probably helped that we had very compatible senses of humor, because we joked around a lot. The days were jam-packed, so the time flew by… even that stretch where I [voluntarily] worked 14 days in a row. He challenged me to develop my own diagnoses and treatment plans – “Someday you’re going to be in my position, kid, and you won’t have someone else to turn to,” he told me one day when I wavered in my decision.
As terribly sad as I was when the short four-week rotation came to an end, I left feeling rejuvenated, even considering a career in family medicine, and beginning to feel some real confidence in my clinical skills.
-He gives students quite a bit of autonomy to not only see and examine patients on our own, but to draw blood, give shots, and do EKGs.
-As a student, you bring the patients in and do a full history and physical, then tell the doctor your findings, what you think is wrong, and what you want to do about it. He then sees the patient with you and makes the final decisions, and you write up the chart note.
-Students have space to leave their stuff and to sit to write their notes, to eat lunch, and to study in the [rare] down time.
-Everyone on staff is incredibly friendly, and most of the patients are, too.
And most importantly: he is an amazing teacher and mentor! He quizzed me on a lot of topics, and taught me both clinical pearls and tactics for caring for patients. I literally wrote down phrases that he used with patients. It probably helped that we had very compatible senses of humor, because we joked around a lot. The days were jam-packed, so the time flew by… even that stretch where I [voluntarily] worked 14 days in a row. He challenged me to develop my own diagnoses and treatment plans – “Someday you’re going to be in my position, kid, and you won’t have someone else to turn to,” he told me one day when I wavered in my decision.
As terribly sad as I was when the short four-week rotation came to an end, I left feeling rejuvenated, even considering a career in family medicine, and beginning to feel some real confidence in my clinical skills.
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