Saturday, December 02, 2006

Inpatient Peds

I can’t believe it’s already December. I started pediatric inpatient on Tuesday—usually we would switch rotations at the first of the month, but with Christmas things got shaken up a bit. On peds each student is paired up with an intern, but the interns all switched on the first. The intern I had the first couple days is going to go into dermatology, but she is doing a pediatric internship. She was very nice and extremely smart and competent and it turns out we went to the same undergrad in California. The intern I just got yesterday is also very nice, but she is an ER resident who hasn’t done inpatient pediatrics since her third year of medical school (ER residents rotate through a bunch of different specialties in their intern year). One of the first things she told me was that she hates kids. I likely won’t learn as much (at least about pediatrics) from her, but the good thing is that I know I’m going to get a great evaluation from her—after we spent two hours going over a chart to transfer a patient to our floor she told me that anyone who has to deal with that [garbage] deserves a good eval. Since yesterday was her first day, she had no idea about how rounds/presentations work; one of the other students on the team told me it was the first time he felt like we knew more about what was going on than the intern did. I think she’ll be fine in a couple days, though she has not been shy about making it clear she really doesn’t care what any of the supervising residents think about her since she has no intention of having anything to do with kids after this month.

One of the first patients I saw on this floor was a 5 month old girl with mild holoprosencephaly, a cleft lip/palate, seizures, and central diabetes insipidus. She had been there for two weeks and will hopefully go home on Monday. The main problem is the dosing of her ddAVP—too much and her sodium drops, too little and it shoots up.

I was on call Thursday, and helped admit two kids. One was a 2 year old with a 4 day history of fever who developed a rash the day after being started on an antibiotic. The other was a 19 month old with a two week history of vomiting and diarrhea who presented to the ER with severe dehydration and hypoglycemia. The two year old we admitted for another team, so I don’t know what happened with him; but the 19 month old (after getting a lot of IV fluids) was feeling better yesterday and probably went home this morning.

The way this rotation works is that we are on call every four days (intern stays overnight, students leave at ten, then the next day the intern has to leave by noon [though they usually don’t] and the student stays to take care of loose ends). Weekends we have off unless we are on call or post call. Essentially, that means that I have three days off this month, and two of them are this weekend. Next week I will be on call Friday, so will have to be there on Saturday, then the next week I will be on call Saturday so will have to be there Sunday. Even given this, I still prefer inpatient to outpatient. I wouldn’t mind having an outpatient month once every six months or so though.


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