So it’s been an interesting last three months and now that I’m on my vacation I’ve got a little bit more time. I’ll just start out with talking about my rotations. I believe the last post I did wrapped up psych and since then I’ve done neurology, inpatient and outpatient pediatrics. Here it goes.
Neurology wasn’t as terrifying as I thought it would be, though it would only happen to me that the day before we started our neuro rotation I would sleep on the couch wrong and develop a neuropathy in my left arm. I had numbness and pain down my arm that gave me a new appreciation for people with these types of issues chronically. Thankfully mine got a lot better with rehab therapy and a course of steroids. The steroids though weren’t without their own side effects and shot my INR up to 5.0. I only realized this after I missed a day of peds neuro clinic with bad flank pain and bright red hematuria. Everything resolved after a few days and a CT scan showed there weren’t any stones or kidney damage, but it was a real wake up call that I needed to be better about checking my INR when anything changed. Lesson learned, back to my neuro rotation. Turns out for all the dermatomes, innervations and spinal cord levels they try to teach us, they’re not overly practical as anything more than a basis for understanding the field. I did two weeks at the VA and then two weeks in the peds neurology outpatient clinic and surprisingly enough never had to say which dermatome or spinal cord was involved, though when I gave a talk about one and a half syndrome I did have to highlight the pathways of horizontal eye movement. The sad thing that I started to realize the further I got in neurology was that even when you can identify the lesion there’s little you can actually do. I had stroke patients at the VA and unfortunately at Riley in the outpatient pediatric stroke clinic as well. They always showed up too late for us to do any thrombolytic therapy to try and break up the clot, so we kept them until they were stable and we had imaging to show the extent of the lesion and then sent them to rehab. We also saw the frequently tested myasthenia gravis, cluster headaches, migraines, back pain, neurofibromatosis, mitochondrial disorders, Parkinson’s, benign essential tremor, seizures, and hearing loss. I wasn’t really a fan of working at the VA. I had some good patients, but I also had some bad ones that really frustrated me. I get the feeling it’s going to be a recurring theme in medicine constantly harping on people about losing weight and exercising, eating right, smoking, drinking, and drug use. Unfortunately there’s only so much pestering we can do and it oftentimes feels like a waste of time to tell these patients the lifestyle changes will make them feel better, because that’s not the answer they want. Frequently people have the misconception that we can just give them a pill and they will instantly feel better and there will be no side effects, no tolerance, and they’ll be able to keep the same habits that got them to this point. The reality isn’t even close and there’s a lot of issues we still don’t have real answers too. The most frustrated patients I saw during my outpatient days at the VA were the headache patients who had tried so many different medications and either got no relief or couldn’t tolerate the side effects.
I really enjoyed the pediatric neurology clinic though at Riley. I saw a lot of sad cases but it was inspiring how resilient some of these kids were. I’m not sure if it was just the naturally happy disposition of some children or because they didn’t really remember a time where they weren’t having some of these issues. It was great though because that was the first time I got to talk with children as patients. I was nervous but it was actually really easy for me to recognize the situation, try to get the child to open up and realize when I was better off getting the majority of the story from the parents. They’ve tried to teach us that certain age groups are better at this than others and that’s fine if that’s how you judge your approach to a situation but I found that it was really just a kid by kid basis and I could get a good enough assessment in the first few minutes of the interview to determine my approach. Some kids love to talk to you, especially if you joke around with them and don’t act like it’s all business and others are just incredibly shy and nervous (terrified that they are going to get a shot as I learned on outpatient peds) or just outright not feeling well. I had grade school kids that initiated the conversation and were more aware of their health than some teenagers/young adults who would soon be in charge of their own healthcare. I really enjoyed these interactions with kids and on top of that I got to work with Dr. Walsh the pediatric neurogeneticist. This just rekindled my interest in genetics and was a nice transition to my complex care pediatric inpatient month.
I had so much fun on both of my pediatric months. I’ve got to give a huge thanks to Deb Brakel for really pushing me to do Complex care despite all the negative reviews it had gotten over the years. While I must confess there were some sad social cases while I was there, the kids were so much fun to work with. I held babies, I played with little kids, I tried to help teach the nursing students, I got a teddy bear named after me, and a very nice card made especially for me by one of my patients. I handed out muppet band-aids, I sang silly children’s TV show songs that I had listened to with my niece Madison, I got smiles every morning from some of the sweetest patients in the world. It was such a fantastic month it made it easy to forget that I was there from 7-5 Monday through Friday and 7-2 or 3 at least one weekend day a week. The kids were so much fun to play with and the parents were so nice to me as a student because I was able to put in the time to really explain and discuss things with them that the attendings didn’t always have time for. And sometimes the parents really just needed someone to sit and listen to them because they were there alone away from their normal support group. I did struggle at first finding my role on the team especially when I was only there a few days before the residents changed and the staff were only on for a week at a time, and I didn’t really like asking families to evaluate me because I didn’t want them to think for a moment that anything I had done in connecting with them or their children was about getting a nice evaluation though I had a number of them who would have probably written a very nice one. It was also interesting in that this was the first time Kilah and I worked in the same hospital together. I worked on the floor below her and occasionally had patients on her floor. It wasn’t as weird as we thought it would be but I think a majority of that came from the fact that she never had to take orders from me or had any of my patients. Her co-workers are apparently still talking about the time she kissed one of the “doctors” though. It really was a great month though and a nice reminder why I got into medicine.
I thought nothing could top my inpatient month, until I had my outpatient month at Epler Park. A huge shoutout to the attendings and nursing staff who made it such an awesome month. They were even nice enough to get a cookie cake to celebrate my last day there on Thursday. It was really nice working in the outpatient office. I was kind of worried it would get boring, but it was actually a lot of fun talking to well patients from time to time and I actually got pretty confident in my ENT exams thanks to Dr. Porter and Dr. Wilson. The last few days I was there I didn’t miss a single ear infection, which may not sound like much but really is an accomplishment because they are surprisingly difficult to determine a normal ear from a fluid filled ear from an infected ear. It was really great getting to work at one office the whole month instead of bouncing around. One because it was nice and close to our house anyway, and two because Dr. Porter was really able to point out and help me with areas of diagnosis and physical exam that I needed to work on. It will come in real handy during residency even if it didn’t help that much on the exam because the questions and medicine they asked were so random and vague it was one of the hardest tests I’ve taken and didn’t really broach the topics I thought it would like milestones, COMMON pediatric illnesses, criteria for treatment, and any of the other things I saw regularly in clinic. It was very random and tested a lot more rare things that I hadn’t even seen working with the genetics and metabolism team. Hopefully I still did alright, the fact that I haven’t heard from Dr. Harris telling me I need to retake the test during my vacation is a good sign. It turns out I really just enjoyed my pediatrics rotation as a whole.
I’m glad pediatrics was everything I had hoped it would be. I was kind of on the fence about doing med-peds and guess I still am just a little, because I like the idea of doing transitional care for people with complex genetic problems, but after doing my peds rotation I really think I want to just work with kids. I’ve met a couple of med-peds docs who make a convincing argument about transitional care and the growing need in this country, but I’m afraid rather than having the patient census I want of primarily peds with some adults, I would see mostly adults with only a few pediatric patients. There’s still time for me to change my mind, but it doesn’t seem all that likely at this point. I think I’ve found my calling and the numerous parents that asked me “Do you want to do pediatrics? Because you’d be really good at it.” just helped affirm that point.
So now that I’ve caught you up on all that, I guess I should catch you up on family matters. My brother in law is continuing to have medical issues and had major surgery to place an LVAD to help alleviate the symptoms of his heart failure. He’s home and doing better but I don’t think it was the instantaneous feel-better procedure that he thought/had been told it would be. The recovery just from the procedure itself has been a little hard on him. All the prayers sent his way have been greatly appreciated. My niece went to see Dr. Escobar, the developmental/genetic pediatrician I worked with two summers ago, and he is going to make sure she gets the assistance she may need when she starts preschool. She’s come a long way and is racing all around, talking up a storm when she wants to, but he thinks she may have some issues with learning and is willing to help them get her the right assistance when her First Steps ends at 3 years old. Mom has healed well from her surgery and is enjoying chasing Madison all around, helping Michelle with her and Jon when she can. She and Michelle are both still looking for jobs, but with everything going on with Jon and Madison, it seems like a blessing in disguise that they are both off and free right now. Dad has been working for the last month or two now which is nice, here’s hoping the weather doesn’t get much worse and he’s able to keep up with his streak.
We actually just got back from visiting my wife’s family this past weekend in Rising Sun. Lucian is growing like a weed and was fussy as all get out while he’s trying to cut his first teeth at 7 months. He’s nearly caught Madison in weight and is wearing 12 month clothes. He stands with assistance, but is still working on the crawling motion.We enjoyed hanging out with her brother and sister-in-law at their house and then we met up with her dad and had a great dinner at a Japanese steakhouse to celebrate her sister-in-laws birthday. And we got to watch my younger brother-in-law play in a baseball tourney and catch up with her cousin/maid of honor who moved back to their home town to be closer to her family. It was a really nice weekend, but we had to cut it a little short because of the impending snowstorms and didn’t get everything done that we had hoped. It was so weird though that I got a little sunburnt at her brother’s baseball game on Saturday and then had to drive her to work in the snow yesterday morning because the roads were terrible. I guess that’s just Indiana weather and I should be used to it by this point. I am taking my vacation this month despite my previous post to the contrary so we’ll hopefully have time to go back soon.
I decided to just take the vacation because the genetics elective I wanted to do this year was all full this month and before I found out from Dr. Lah, one of the geneticists I worked with on inpatient pediatrics, that I could probably petition my way in, my wife and I set up a vacation to Boyne Falls, Michigan up near Traverse City. I also figured it would be good to study and get Step 2 CK out of the way early so I’m studying now to take it in June or July depending on what my schedule looks like, whenever it’s finally released.
Anyways, I’ve got dinner to cook. Hopefully I’ll remember to update you guys more as this month goes along.