[Album: The Truth About Love (2012)]
"clenched shut jaw, I've got another headache tonight."
Finally a chance to mull over the sights and sounds of a Pediatric Service.
3 weeks out of 8 total finished. Who would've thought Rounds would start at 6am everyday and last for 6+ hours? I expected them to be much longer than on a Surgical or other Sub-specialty...but 6+ hours everyday? Perhaps I didn't quite expect it to be THAT long. Oh well.
"I will breathe, I will breathe, I won't worry at all."
We do 3 weeks on an Inpatient Service and spend the remaining 5 on various Outpatient Services. I have had the unique opportunity to get assigned to the Pediatric Infectious Disease team and if I've learned one thing it's that Infectious Disease might be the only specialty I could live with if I were to go into something non-Surgical.
For all the impatient people. For all the obsessive-compulsive wrecks out there. This is the specialty for you -- without a doubt. A large part of the appeal that Surgical specialties have, in my opinion, is the unique situation where a problem has been identified and (hopefully) there is a definite procedure to solve that problem. Appendicitis? Take out the Appendix. Subdural Hematoma? Make a burr hole and drain it. Infant born without a biliary system? Re-route the jejunum of the small intestine and connect it to the liver to establish bile flow (hepaticojejunostomy a.k.a. Kasai procedure).
It's gratifying. It's the hopeless romantic scenario of Medicine: find a problem and fix it. Sick patient becomes a healthy patient. Save a life. Provide Hope where before there was none. What other reason could one have to enter this profession than to do just that? Over and over and over again until you've justified your existence on this Earth or simply until you just can't anymore. That's Medicine.
"You think I'm just too serious, I think you're full of sh*t."
Infectious Disease, surprisingly, works in exactly that fashion. Every patient that gets admitted to our service has some kind of infection....some particular mix of bacteria, virus, fungus, and/or parasite that we must identify. We have to gather all the clues. Look at the greater clinical picture. Order appropriate exams and assign the correct procedures in the correct order. Once we find the bug(s) what do we do? We eradicate it. We fix the problem. In just the past 3 weeks I've seen the sickest and most miserable patients transform into the bright, youthful innocence that all children deserve to express and thrive on. The great majority of infections have a distinct cure and that's all ID cares about -- the Cure.
Nothing is more exhilarating than knowing you gave everything to one person and, in doing so, positively impacted their life so that they can go on and do amazing things -- a sentiment that is magnified in light of the limitless potential of sick kids that you high-five on the day of discharge as they hop and skip out those hospital doors to change the world.
That's Medicine and Infectious Disease has been a good intro to Pediatrics.
"Blow me one last Kiss."
the crate --
Ignorance Ain't Bliss
In Infectious Disease, you're pretty much Sherlock...and I guess Dr. Watson all in one.
Patients are admitted to ID and consults are sent to ID when the pathogens, if any, are elusive and the diagnosis is a mystery. It's an event, a 6+ hour one in fact, watching the Residents and especially the Attendings come up with a massive list of Differential Diagnoses with another dozen etiologies and obscure variants -- taking everything possible into account. We've gone as far as asking if patients ever bleached their tubs. Or if they have somehow bit their upper arm. Or even if the patient's dog licked them in the eyeball recently. They've not only memorized all the possible diagnoses but they have inadvertently internalized all the ludicrous situations that might have occurred to give rise to what we are seeing clinically.
The Crates -- the shear breadth of knowledge -- that Infectious Disease specialists have on hand is ridic. I'm essentially spending most of my time googling every other thing that is mentioned, whether it's a bug and illness I've never heard before or one of a thousand different treatment/research protocols that suggest the best possible approach to the problem...I'm always huffing and puffing and trying to catch up. Literally, figuratively, and everything in between.
Patients are admitted to ID and consults are sent to ID when the pathogens, if any, are elusive and the diagnosis is a mystery. It's an event, a 6+ hour one in fact, watching the Residents and especially the Attendings come up with a massive list of Differential Diagnoses with another dozen etiologies and obscure variants -- taking everything possible into account. We've gone as far as asking if patients ever bleached their tubs. Or if they have somehow bit their upper arm. Or even if the patient's dog licked them in the eyeball recently. They've not only memorized all the possible diagnoses but they have inadvertently internalized all the ludicrous situations that might have occurred to give rise to what we are seeing clinically.
The Crates -- the shear breadth of knowledge -- that Infectious Disease specialists have on hand is ridic. I'm essentially spending most of my time googling every other thing that is mentioned, whether it's a bug and illness I've never heard before or one of a thousand different treatment/research protocols that suggest the best possible approach to the problem...I'm always huffing and puffing and trying to catch up. Literally, figuratively, and everything in between.
"Tie a knot in the rope, tryin' to hold, tryin' to hold."
Some of the most common diagnoses?
From my experience I have to say the vast majority of cases (especially with it being one of the worst winters in Detroit history) are viral Upper Respiratory Infections (URIs)...usually due to Respiratory Syncytial Virus (RSV). A close second, and one we'd often have to rule out when diagnosing URI secondary to RSV is Pertussis or 'Whooping Cough.' Aside from those some notable contenders are your standard Strep Throat infections due to Streptococcus Pyogenes and an uncommon vasculitis I thought I would not see beyond textbooks -- Kawasaki's Disease (we probably had 3-5 cases of this).
In any case of acute or chronic infection the work-up was always tense. There aren't many other things out there that are scarier than the unknown -- part of the reason why a good number of Pediatric Patients are started on Broad-Spectrum Antibiotics that cover a plethora of likely organisms before we even know what's going on. Better to be safe than sorry.
From my experience I have to say the vast majority of cases (especially with it being one of the worst winters in Detroit history) are viral Upper Respiratory Infections (URIs)...usually due to Respiratory Syncytial Virus (RSV). A close second, and one we'd often have to rule out when diagnosing URI secondary to RSV is Pertussis or 'Whooping Cough.' Aside from those some notable contenders are your standard Strep Throat infections due to Streptococcus Pyogenes and an uncommon vasculitis I thought I would not see beyond textbooks -- Kawasaki's Disease (we probably had 3-5 cases of this).
In any case of acute or chronic infection the work-up was always tense. There aren't many other things out there that are scarier than the unknown -- part of the reason why a good number of Pediatric Patients are started on Broad-Spectrum Antibiotics that cover a plethora of likely organisms before we even know what's going on. Better to be safe than sorry.
"But there's nothing to grasp, so I let go."
It's natural to feel helpless when you have no idea what's going on. For that reason, perhaps the most useful Crate I've learned on this service is to keep our patients -- especially and most importantly the Parents -- informed about what's going on. We have to explain every lab test and imaging modality down to every nitty gritty detail. We have to explain the dosing schedule and coverage of every antibiotic. We have to justify the amount and location of every IV, PICC line, gastric tube, and why/why we are not providing food and/or maintenance fluids. It'a a festering marathon...and all the while we are trying to find out what is wrong and how to fix it....for multiple unique patients.
but You Only Live Once....and we wouldn't have it any other way.
On Infectious Disease we don't like Unknowns and we know our Patients don't either.
When you're sick you think of the Doctor. Doctor is supposed to handle the rest.
This is Medicine.
the hippo --
Ignorance is Pissed
Parents are also Doctors. Especially in this age.
They, however, can go from the well-meaning and mild-mannered Dr. Jekyll to the less pleasurable Mr./Mrs. Hydes...and you can't blame them.
"I think I've finally had enough, I think I probably think too much."
On more than one occasion we may have been the 3rd, 4th, and in one case the 7th set of Doctors that the Patient and Parents have seen regarding a difficult and amorphous illness. The spectre of the Unknown grows with time and every 'inconclusive' or 'indeterminate' test/exam.
Are we not Doctors?
Aren't we supposed to be the ones that Heal and Revive and Cure?
What some Patients and Parents don't realize is that we are just as frustrated and stressed out. That we are also losing sleep, appetites, and integrity within our personal relationships. Although we are all on the same team, until the Diagnosis is made and the pathogen identified it's common for the medical team to be viewed on the same side of the fence as the disease. It's a difficult position to be in, but when I think about it I would probably be just as Hulk fierce as any Parent were it my child in the same predicament.
"I think this might be it for us."
That's why the ID Hippo is identical to the Crate -- keeping everyone informed is the best weapon with which to slay the Unknown, the Unsure, and the "I thinks." Ignorance is, frankly, not bliss. It's a temporary state of falling and numbness with no end in sight. Although every Patient is unique and may have a different pathophysiological process going on there is always this one common ailment that Doctors have to manage and cure as well.
"My head is spinning so, blow me one last kiss."
We give Broad-Spectrum Antibiotics to fight the literal/tangible disease when we don't know what we are fighting. Similarly, I've realized theres a need for Broad-Spectrum Patience and Anti-Unknown...ics.
Overall, the best thing we can do is be as real and as straight-up as possible. No one likes hedging. No one likes guessing. No one likes assumptions or passive-aggressive tactics. I admit to being the biggest perpetrator of all the above which is why it's one of the things I'm working hardest on...to be painfully candid, truthful, and upfront no matter how difficult it is -- because it's the right thing to do.
At least this way we can all be pissed off together. We can be frustrated and scared together. No one gets left in the dark because at bare minimum everyone is on the same page and a common goal is in sight. Let's freakin' do this.
More than Bugs and more than Drugs.
Doctors need to give more Hugs.
This is Medicine.
Just when it can't get worse, I've had a sh*t day.
You've had a sh*t day?
We've had a sh*t day!
I think that life's too short for this.
So blow me one last Kiss.
