Saturday, November 25, 2006

Days off

Nothing particularly exciting happened at my various pediatric clinics this week (though I did find an ear infection in a kid who came in for something totally different!). This rotation has been like a vacation—less than forty hours a week of being in clinic/lecture, weekends off, and a four day weekend for Thanksgiving—but I am ready for it to be over. I am discovering that there is such a thing as too much free time. I’ve tried to use a lot of the time to study, but since there is no stress this month I have very little motivation to study pediatrics—I have started going through some step 2 questions though. Tuesday I’ll start pediatric inpatient which should be quite a bit busier. I am missing the OR a bit.

Since I spent yesterday lying around doing nothing productive I decided to go to the Saturday Free Clinic this morning. It is much better as a third year than as a second. Usually it works by the M1 getting the patient and measuring vitals, then the M2 interviewing the patient, then the M3/M4 going and filling in any gaps and doing the physical, and coming up with a plan. Then the attending looks over everything, sees the patient, and signs the notes. Today, however, there were a lot of M3s, so I saw two patients by myself. The first patient, though, was reported to me by an M1 and M2. It was a young lady who wanted an annual pap smear and STD check, so there wasn’t much history to get. I basically just listened to her heart and lungs, then deferred the rest to an M3 who just finished OB/GYN. There weren’t any other M1/M2 teams in need of an M3 so I went ahead and got my own patient, a 35 year old man with type 2 diabetes and hypertension. He weighed 332 lbs, but had lost 40 pounds over the last two months with diet and exercise. I congratulated him and told him to keep it up. His blood pressure was still high though, so I told him we’d probably increase the dose. His hemoglobin A1c, a measure of long-term blood sugar control, was 9.2 (high). I reported to the attending, and he agreed with me as to increasing the blood pressure meds. He didn’t want to start diabetes meds though, since the patient was doing so well at losing weight.

The next patient was a man with rectal pain off and on for several years (he was diagnosed with hemorrhoids 7 years ago) worsening over the last two months. He described large, visible masses, but when we looked the attending could not detect any hemorrhoids. The man had been trying a lot of ointments and hot baths without success. From the patient’s description I thought he would need surgery—our exam was not really consistent with that, but we went ahead and referred him to a general surgeon for a second opinion anyway. Since this is a free clinic, the doctor who oversees it will have to approve the request.

This was the first time I have had any significant contact with the M1 class—I could not believe how young some of them looked. What’s scary is that I’m the same age most of them are—if I look that young I can definitely understand some of the comments I have gotten from patients!

Wednesday, November 15, 2006

Highlights of the Last Week

1) I went to the Global Health Missions Conference which was excellent. Very amazing and inspiring to hear of people who give up comfortable and lucrative lives to serve God in third world countries. Steve Saint was one of the speakers--I had never realized that he toured with one of the men (now a Christian) who murdered his father.

2) In my absence one of the local radio stations began playing nothing but Christmas music--you'd think they could at least wait until after Thanksgiving.

3) I was told by a four year old that I looked too young to be a doctor--I've often heard this from people two to three times my age, but from someone 1/5-1/6th? Give me a break kid.

4) I realized that I am terrified of little kids with fevers--I do my utmost to avoid touching them and acquiring any of their germs.

Tuesday, November 07, 2006


I had endocrine clinic all day today. I was with the attending and a fellow in the morning, and towards the end the attending let me see patients by myself—always better than merely shadowing. In the afternoon I just shadowed the nurse practitioner. One of the patients was a seven year old girl whose parents were concerned that she was beginning puberty. The father was an OB/GYN who turned out to be one of the doctors who had seen the fellow when she was pregnant with twins—she mentioned to me after the family left that it was stressful enough treating other physicians and their families let alone a physician she had gone to. The father was concerned about an adrenal or ovarian tumor, but the endocrinologist reassured them that those problems would cause different symptoms and the girl’s condition is most likely benign.

In the afternoon we saw a 14 year old boy with Crohn disease who has been 4’7” for the last three years. He looked like he was 11 or 12, but the father seemed to be a lot more concerned than he did. The NP saw him first and spoke to the parents about possible treatments, then the attending came to see him. He had normal growth hormone levels, but the bone age of an 11 year old—this is actually a good sign because it means that he will likely eventually gain back some of the inches he missed the last three years. The doctor recommended that he get testosterone injections for three months followed by monitoring for another three.

Monday, November 06, 2006

Community peds

Today I did not have to go to clinic until 2:00pm:). I could get used to this. I went to a community pediatrician's office today. It was fast paced, so I didn't get bored (plus, I was only there for 2.75 hours!). We saw several patients, ranging from asthmatics to regular check-ups. Fortunately the children were all well-behaved, I didn't get spit on like one of my friends did last week.

I have a feeling that the pediatrician might be a homeschool dad--the pictures of his family in his office show that he has six young children, but I didn't get a chance to ask. He greatly raised my opinion of him when he encouraged the patients' parents to vote "yes" tomorrow on the gay marriage ban (in a non-confrontational way)--the liberal doctors at school would have thrown a fit to hear that--it was great.

Tomorrow I have to go to endocrine clinic all day, which seems an incredible hardship after the last week's schedule. I am going to be so spoiled by the end of this rotation, reality is going to strike hard next month.

Friday, November 03, 2006


Today was rather painful, but I can’t complain about getting out at 3:00. We had to go to pediatrics grand rounds at 8:30—a child psychiatrist who was triple board certified in peds, peds psych, and something else (psych?) from New Orleans spoke on various issues, I think mainly child abuse and the foster care system, but to be perfectly honest I was fading in and out the whole time. Unfortunately the auditorium was stadium seating so I didn’t feel comfortable playing Bejeweled on my PDA. It is really funny to see how people with different personalities react to different things—a student who also wants to be a surgeon verbalized my sentiments by telling me this rotation is killing her and that being a child psychiatrist is her worst nightmare, the student I was on CT with went up and spoke to the psych guy after because she thinks being a pediatrician+child psychiatrist would be the most fun job on the planet.

After grand rounds we returned to the nursery to present H&Ps. However, first we had to give a 5 minute talk on the process of fatty acid catabolism and how one would diagnose long chain acyl dehydrogenase deficiency in a child since yesterday none of us could remember how fatty acids were metabolized in cells. It went well, and fortunately only one of us (not me!!!) had to present an H&P. We were done by 11:00, so had two and a half hours off before going to our hour and a half lecture on (drumroll) altruism. The lecture ended up being (surprise, surprise) somewhat pointless. The problem is that they always pick the nicest, most likeable people to give these pointless talks, so one feels really bad complaining about it. Very sneaky.

I got spoiled for the last three months by leaving the house before most people are up. These last two days I have left right in the peak of traffic, so what used to be a blissful cruise straight down the highway for 30 minutes is now a frustrating 45-50 minute start-stop session that is making me want to tear my hair out.

Thursday, November 02, 2006


CT surgery is now over—I have bittersweet feelings about that. Monday I saw a minimally invasive repair of an atrial septal defect. It was quite amazing, the surgeon did the entire surgery through a 2-2.5 inch incision in the inframammary fold. Much superior to having a footlong scar down one’s chest, especially when the patient is a 21 year old woman.

Tuesday was the surgical exam, which was nowhere near as hard as the medicine exam, but I think I could have done better had I had more time to study. Wednesday was pediatrics orientation which was the typical orientation spiel. The girl who was on CT surgery with me has the exact opposite taste as me—she hated surgery, and almost started crying with joy at peds orientation when she heard about the clinics we would be going to, I really liked surgery and don’t care for clinics.

Today I went and basically just shadowed two nurse practitioners at an endocrine clinic. The first patient was an 11 year old girl who was very overweight and has high cholesterol. She’ll be getting a number of tests to check for various metabolic disorders and will continue to see her nutritionist. The second patient was 17 year old girl with a hormonal disorder due to unknown causes. The last patient was a one year old girl who is getting growth hormone. The patients were interesting, but altogether it was rather boring. I do not think I am cut out to see patients in the office all day long.

This afternoon I went to the nursery and had to do an H&P on a newborn. I had to get the details for the history entirely from the chart, so I had to spend what seemed like hours going over it, and tonight I have to write it all out and be ready to present it tomorrow.

I can’t say that I’m not going to appreciate the weekends off this month (and four—day—weekend on Thanksgiving!!!), but I think I can safely say pediatrics is not for me. In all fairness I think I would probably enjoy clinic as an attending, having my own patients instead of just observing other people’s. Also, this is the first day of the rotation and I usually hate the first week of any rotation.