EPT
so as you may know i recently retired from fulltime sc2/TL in order to focus a bit more on my studies. i'm currently a 5th year med student doing my paeds term! haha
but yeah, today (or yesterday, really) was quite a day :o quite possibly the most emotionally draining day i've had in a very long time (and it's difficult to drain me so) haha. i think i'm going to debrief myself a bit here to clear some air lol.
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paediatrics has been a really good experience so far! we started with 3 days of lectures (none of which i particularly paid intense attention to or really revised) and the first days on the ward were thursday and friday of week 1.
getting to hospital is not too difficult; i generally get driven there and back, which is mighty awesome of my parents. the average day lasts from about 8am to 5pm.
at 8am, there's morning handover, followed by a bit of handover teaching (on whichever topic is relevant at hand). pretty much the rest of the average day is spent on the wards, until afternoon handover at 4pm (which usually starts a little late, hence the 5pm end). sometimes there's rooms or follow-up clinics organised, but most of the days so far i've been spending a lot of time on the wards.
![[image loading]](http://1.bp.blogspot.com/_462vuuqpW2E/SSQU2Tn5XmI/AAAAAAAAAD8/5MxkHRdDUyc/s320/Ward+corridor.jpg)
the ward looks a bit like this
2F is the main paediatric ward, and they're happy to admit children under 16 (once you're 16 +1day, you cannot be admitted under the paediatric team unless there's some chronic paediatric condition like cerebral palsy and the team is familiar with you). upstairs, there's 3D (special care nursery) and 3E (postnatal ward) that we also spend some time in. the SCN isn't particularly epic like most NICUs, and they can't manage babies with TPN (they get transferred to another hospital) so most of the babies we see there aren't incredibly sick. postnatal ward, of course, is where most of the baby checks happen!
other than those places, the other place i've spent significant time in hospital has been ED ward. there's two special paediatric beds and one room for peadiatric procedures (the bed's this freaky dinosaur thingy that the paeds team doesn't like since the bed has a raised lip, which makes lumbar punctures quite difficult).
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so for the first two days, we were pretty much meant to acclimatise ourselves to the ward and get used to playing, taking obs and in general dealing with the kids on the wards. there's only two students assigned to paeds here, which is pretty good since we can both do quite a bit of stuff and it's not that intimidating when we're all together (rather than like, six students or something where patients get freaked). i found the first two days rather uneventful, and didn't really make that much effort to get to know the team well since the new rotation was coming on for monday.
the next monday was probably the slowest day out of the weeks so far, since we didn't have much to do. it was taken up a lot by the JMO tour around, and the students really didn't have much to do haha. tuesday did pick up a bit though, and one of the consultants gave us a nice rundown tutorial on hearing and vision screening, as well as developmental assessment of children. i started to get to know the other RMOs and registrars a bit; there's a team of four RMOs and registrars doing the different shifts.
in terms of shifts, there's the day shift (8am-5pm), afternoon (4pm-12 midnight) and night (11pm-9am). during the day, there's two RMOs and one registrar on (as well as 1 or 2 consultants). evening has one registrar and one RMO, while nights is either a registrar or RMO. pretty much the time we're rostered is for the day shift, but as you'll see soon i did two evening shifts as well for extra experience!
the RMOs for the new term are A, H, EJ and Y; the registrars are S, L and G. the consultants we had come around were E1, E2, D and C.
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so i guess i really got into the swing of things come wednesday in week 2. after a short handover teaching, i got a short tutorial on baby checks with dr C, along with EJ. i actually think for most of the next 3 days (wed-fri) i actually spent doing baby checks with EJ and getting to know the team better, haha. pretty much the days were handover -> handover teaching -> ward round (2F and SCN) -> baby checks -> lunch (usually 2pm ish) -> chase up orders/bloods/etc on wards -> handover -> home, often punctuated by the random tute or emergency caesarean or whatever.
![[image loading]](http://farm5.static.flickr.com/4141/4915711686_8dfe21b119_m.jpg)
baby checks! we need to fill out this record, giving baby a quick one-over on day 2
for the first day (wednesday) EJ did all the baby checks herself while i was documenting, but for the next two days we split them pretty evenly (which was good, since there were like seven each day lol). there were a few interesting things we saw, including but not limited to a single palmar crease, sacral dimple, ridiculously-difficult-to-open eyes, and babies weeing on us (EJ's first official baby check, haha). doing the baby checks is pretty fun, and i'm learning how to change diapers and clothe babies, too :p they're pretty fun to hold and coo, especially if they're crying and you need to calm them.
![[image loading]](http://www.i-am-pregnant.com/images200/76597566.jpg)
sacral dimple
on the wards themselves, there were a few interesting presentations to see. quite a few were fairly straightforward managements of asthma, but there were also things like scarlett fever, hand/foot/mouth disease, cow's milk allergies, and quite a few cases of meningitis. some of them got fairly strange, too - we had this depressed mum who was being rather unreasonable about a bit of gastro, which was a bit strange.
there was this one incredibly cute baby (7 month) who had this strange episode of unresponsiveness too, query seizure. cutest baby i've seen so far! seriously haha just look at him and he smiles this epic smile lol. after 9-12months or so, though, they begin to develop stranger danger, so they're not nearly as much fun to examine and play with. after 4-5years they begin to get ok again, though, since you can reason with them.
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on friday afternoon there was a pretty funny event that happened :p around midday, the paeds team was called in for an emergency caesarean (needs to be there to check if baby is ok for all emergency caesars) and EJ, H and L went off to manage baby while i had a bit of a chill in the wards. EJ, a bit of time after changing out of theatre blues, left her ring in the top pocket! we had this rather amusing metaphorical tirade about ring=independance and her losing ring=not being independant woman=dependant woman now and all, haha.
but yeah, pretty much, after the afternoon handover, i went down with her to try and see if we could find it, after hearing some success stories about how others found their valuables by wading through all the linen. after tracking down where the linen goes from theatre, we found the loading dock (they're sent to liverpool for processing - which is kinda lazy lol). all we had to work with was that EJ was wearing a blue white-rimmed top that wasn't a dress, and was in a green sack. after wading through seven trolleys' worth of green sacks, we realised that that day's linen wasn't actually transported to the dock yet o.O
![[image loading]](http://www.scrubsuk.com/images/medical%20scrubs%201.jpg)
these things are theatre blues
so we then headed back to theatres, where was asked where that day's linen was held. pretty much we entered and found the storeroom. after diving into these sacks with renewed vigour, EJ miraculously found the ring in the first white-rimmed top of the first green sack we opened! and that was rather opportune as well, since she had pretty much given up hope at several stages of the process :p but no fear, i was as perky as ever and propped her along to get it :p
so that was pretty cool experience haha :p not really productive in medical way, but pretty much after that (or maybe a bit before then, already, hm) i tagged along with EJ most of the time :o favourite resident i've met so far! although to be fair i haven't met any
super secret tech for girls wanting to keep rings while changing in theatre - bring a safety pin and pin it to your bra (which is more difficult to misplace than a ring).
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but yeah, i guess most of the interesting experiences happened in the last two days. i've spent more than 32 of my last 40 hours at hospital, going on two shifts for the past two days (8am-12 midnight x2). the double shifts are pretty long (16 hours each) but actually don't feel all that long since you keep pretty occupied during the time, as there's always stuff to do (especially baby checks).
so yeah, i suppose the reason why i stayed back was that apparently most kids present after dinner, so there'd be more ED presentations to see. also, this week EJ and L were on evening shift as well (they were on day shift last week).
the first night i stayed back was pretty uneventful. there was this one baby check left over from day shift that we had to do - baby's eyes couldn't be opened (we need to check for red reflex). unsurprisingly, it was an asian baby :p ahaha. so i saw it first by myself - i could open one eye, but i didn't have enough limbs to use the opthalmoscope at the same time (one hand to open the eye, one to calm baby). so i brought EJ upstairs, and we got the left eye to open, but not the right one. aand it took a fourth visit (me+L) to finally get the right eye to open! there's a few tricks which can be tried but in the end we had to force the eye open (hence two people needed).
![[image loading]](http://api.ning.com/files/lpFlekgl6fciG5un57unkHeBbMq6zS3k*Xw*KITO8i0cNjnWvfKsM9sCwCua2PEAedTISZjQ7Me-e4aorA3nE-evMYRfilBe/PRinc_photo_of_neonatal_jaundice.jpg)
neonatal jaundice - no, it's not your white balance, babies can actually get this yellow
otherwise, that night we saw a case of neonatal jaundice on day 5. the baby looked quite yellow, but SBR levels were below the treatment normogram, so we discharged her after taking some bloods. one thing we did notice was that baby had gynecomastia, which everyone did a double take at haha. there was also a rather irregular heart rhythm which was fine since she was sleeping at the time of examination.
![[image loading]](http://www.bethencourtgroup.com/images/img_minimally_invasive_repair_pectus_excavatum.jpg)
pectus excavatum looks like this (but we saw it in a baby)
we also saw a pretty interesting case of pectus excavatum. 12 day old baby presented with increased work of breathing and epigastric recession only recently noticed (was not picked up on discharge or baby check). it was pretty marked, being about 1/3rd of the chest deep. we ended up admitting this one to the ward, but he's probably going to be discharged soon. one really strange thing was that i discovered mum was 22 upon looking at the notes, which totally surprised me since she looked much older (and already had kids aged 3 and 4).
getting bloods from babies actually seems quite a difficult task. on the first night, we collected 3 sets of bloods, and all of them took quite a bit of work to get in. it was pretty fun to help out, though. i actually don't think i've done an IV line or collected blood from an adult, though, let alone a neonate :o
the 'tail' in the title was actually on one of the paeds reviews, where we saw what might have been the root of an early tail :o there was a wrinkle in the skin on one of the babies that maternity asked us to review (there was a family history of mitochondrial disorders; previously baby died at 8 months, was acidotic at 6.81). i didn't quite get to see it myself, but it did sound cool (although the consultant the next day shut that line of thought down, haha).
but yeah, evening one overall was not overly eventful, and i left at about 12:30 after midnight handover. it was pretty funny :o at the end, L and EJ commented on the way i act around babies, which is apparently quite amusing and good! ahaha. we also had a pretty cool chat about careers and having babies (our own) and all too :p
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but yeah, the other evening (i'm writing this up just after i finished the evening) was rather eventful :o
EJ had to pull out due to extenuating circumstances so pretty much i took the place of the resident :o one thing i've noted about the paeds RMOs was that they actually don't know all that much more about paeds that i did (all the RMOS were from my uni; EJ is actually from the same high school as me too lol and was totally indignant when i didn't remember her rofl). it's because you actually can't intern in paeds, so the last bit of paediatric teaching they had was actually in phase 3 paeds, which i'm doing now.
but yeah, even though maybe paediatric sciences they're not thatttt much better than i am at, it was still rather epic being the acting resident for the night :o usually if there's a resident around, the resident and i share the note-writing duties - but i had to do all the notes on day 2 by myself haha. getting a pager and learning how to use and answer pages was rather interesting :o i guess now i can use system at this hospital, which might be useful if i end up there at any time in the future. i was quite glad i didn't mess up paging/answering too much!
but yeah, after major event #1 (EJ having to bail), there was a series of a few more things to come :o i don't quite remember the order, but roughly;
L + i witnessed a rather large argument between the grandparents of a baby that was about to be born, which doesn't really happen normally :o pretty much mum was about to give birth, and paternal grandma walks in and apparently fails to acknowledge the presence of maternal grandparents, and some stupid altercation ensues about rudeness :o eventually mum gets so angry that she throws (verbally) everyone out, including poor dad :o i thought the whole affair was rather nonsensical, but the thing that stood out was that it all occurred in vietnamese :o vietnamese is actually an incredibly good language to know, and i've pretty much used it daily on wards/baby checks. the fact that this one was in vietnamese was a bit weird, since i fully understood the altercation while everyone else was clueless, and that sorta feels weird. i wasn't really involved in the actual breaking-up or security or whatever, but it was just weird to know what was going on (they were quite vocal). *shrug
we also saw an 11 year old boy who was scheduled for violence. pretty much, he bashed another boy up since that kid insulted this one's dad. he had quite a history of getting into fights (has presented to ED previously with a dislocated shoulder from a fight, but he said it was because he fell off his bike). talking to him was rather amusing, since he was pretty eloquent for an 11-year, often bantering around. when we suggested he should come to 2F from ED, he hinted that he might run off, which ensued a pretty strange conversation after about where he would go and how we would catch him o.O. strange, a bit peculiar and all, but not particularly confronting as he wasn't quite violent towards us.
![[image loading]](http://www.uihealthcare.org/uploadedImages/UIHealthcare/Content/Education/Graduate_Medical_Education/Residencies/Family_Medicine-Psychiatry/About_the_Program/residents-and-lynch-in-birthing-suite-practicing-neonatal-resuscitation.jpg)
neonatal resuscitation looks a bit like this
however, there were two main events that stood out during the night. one of them was an emergency caesarean that we got called off to (i answered the page correctly yay). baby had a bit of problem on CTG but nothing major, and we just had to get ready to assess baby and resus if necessary :o since it was my first time setting up the machine and getting ready and all, it was a bit stressful and all. even though history was ok and there were no major red flags, we still had to prepare for the worst. baby came out and was pretty much ok, except for a bit of cyanosis in the extremities. but yeah, the baby still came into SCN for assessment after we caught it, and there it seemed all ok.
the most draining bit of the night was probably the admission of a 15yo anorexic girl representing to hospital for failure to stick to discharge plans. pretty much, she was in here for a few days prior for some problems including the anorexia nervosa and was discharged the day before. she was instructed to take a week off school and try to stick to the plan, and follow up with SCH. however, she actually ended up running off to school and not sticking to the plan as advised, and mum brought her into hospital.
what followed to try and convince her that admitting her was in her best interests took an incredibly long time. it was pretty much 90 minutes of going around and around in circles. a few days prior to this, actually, dr C gave us a tute on refeeding syndrome and anorexia, and there he also mentioned how good these anorexics were at bargaining.
this girl was particularly adept at it :o trying to strike compromises and deals and promises for ages across all the different staff, it took L a very solid amount of persistence and insistence to get her to accept staying. it was a pretty complex history and management overall but suffice to say i was pretty dead after sitting in on it (and i wasn't even doing anything!)
so yeah, that was pretty much the crux of the night :o i suppose looking back, it wasn't particularly epic. i guess just the large number of emotionally-draining experience plus the added responsibility of all the resident duties sort of surprised me (especially after a fairly lax night before). but yes, nice vent haha even though i hope it's not too vent-y.
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i'm pretty wiped and probably will take friday off lol, but that's fine since the registrars are all mightily impressed by me anyway lol. i probably won't run into EJ anymore (she's actually on relief) but i should still see everyone else next week when i return!
still need to sort out mini-cex, but i think L is more than happy to sign off the learning plan. just gonna chill and sleep in on friday, which is great since i've had little sleep with the 2x double shifts.
i've learned quite a bit on this term so far, though i've done little in terms of self-directed reading outside of hospital. i'm not sure how much of it will actually stay with me, or how good i actually am at managing patients. pretty much i just pick up a lot of tidbits with the team, and am learning some intern-y skills, which should be useful later on.
i'm having fun, and the days aren't too tiring since there's always a lot to do (strange, aye, but more free time = you feel tired since bored). i haven't run into many epically stressful situations, but some of the JMOs have, and it can get pretty intense (although thurs evening was pretty intense as far as most shifts go). apparently they recommend that i consider paeds, and i think it wouldn't be a bad idea. hrmmm.
apparently my next paeds term (genetics) at SCH is pretty lame lol, according to one of the ED RMOs. but meh, gotta see how it goes. next week i'll try and sort the assessment-paperwork and spend some more time in clinics, woop.
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this was probably far too long and esoteric lol tl;dr - paeds is fun
all photos used are from google images and not of actual events or patients
keep looking after those babies!!!
