I'm nearly done with two weeks of third year, but have yet to post on this here blog.
Week 1 was spent in the healthy newborn nursery at one of our sister hospitals here. The day started at 0630 and lasted until 3-4 if we weren't on call, or until 9 if we were on call. We would do exams on any babies that had been born during the night, write up the H&P, and write progress notes on any babies that we were following from previous days. At 0830 we would round with the attending, giving him a brief synopsis of the infant's pre-natal history, any significant physical findings, and discharge plans. I have to admit, we were pretty spoiled because our intern had a sheet that spelled all this out in the order in which our attending wanted to hear it. The one night of call I had I spent in the NICU. There was an infant born at 29 weeks gestation who weighed about 2 lbs, and there was another infant born with hypoplastic left heart syndrome.
This is a relatively rare congenital heart defect in which there is almost no left ventricular tissue. In lay terms, that means the heart is not really able to pump blood to the systemic (as opposed to pulmonic) circuit. As a result, the child can only receive blood from the right ventricle via remnant of fetal circulation. In the fetus, there is a connection between the left and right atria, known as the foramen ovale as well as between the pulmonary artery and the aorta, known as the ductus arteriosus. In this infant with a hypoplastic left heart, we keep these open with a substance called prostaglandin E2 (PGE2), until such time as the infant is able to survive the three open heart surgeries necessary to enable life. Without the PGE2, the ductus arteriosus will close in a matter of days and the infant will die.
As an MS3, my role was simply to stand in the background, ask questions, and not contaminate anything. We resuscitated these infants right outside the C-section room, and prepared them for a brief trip down the hall to the NICU. It was pretty hard for me to see the dad of the hypoplastic heart baby because he was filming his brand new baby with his iPhone because I knew we were both aware of the fact that those seconds of video could very well be the only keepsake these parents get to have of their baby. Being in the NICU in general was challenging emotionally because I mentally place Gunner in the little isolettes and had little daymares of terrible illnesses that could have befallen him. I don't know why we were blessed with a baby who didn't have any problems, but I am grateful.
Week 2:
I've been in outpatient pediatrics this week. Outpatient clinic is a combination of general pediatrics as well as specialty clinics. I've spent about half the week in U Peds, our general peds clinic, and about half in specialty clinics. I've been in the cystic fibrosis (CF), asthma, diabetes, and allergy clinics. Generally I enjoy the specialty clinics more, since there seems to be greater emphasis on the patient's disease and its management, rather than in Upeds where there are a lot more social issues in addition to any pathology. I don't consider myself to be anti-social, I do enjoy being with patients and talking with them. I just don't relish trying to fix all that is wrong with their lives that is not health related. I realize that there are social workers who can bear most of this burden, but trying to find a car seat for someone or help them get WIC or TANF (welfare) isn't very gratifying. Thus far, actually, I haven't seen very much pathology, at least that is grossly visible, our work has mostly been well-child visits and maintenance checkups for chronic conditions.
In other news, I got my board scores back yesterday and I was very pleased with the result. There should be no difficulty, from a scores standpoint anyway, pursuing whatever it is I choose to do.
