Thursday, September 12, 2013

The Young: The beginning of pediatrics

My first two weeks of peds have been bittersweet! I love pediatrics. I love working with the kids and the parents. The residents are amazing and the attendings are awesome. Talk about a hospital full of super nice people. I get daily feedback and lots of help along the way. More importantly there is a lot of encouragement for growth and everyone's excitement and enthusiam for learning is refreshing. The other hand, the more bitter piece is that the kids are sick and on the service I am on now, they are normally very sick. I have been rounding with the Nephrology(kidney) and Endocrine(hormones) specialities for 2 weeks and though I have learned a ton, each patient has their own stories and will have their own struggles. These kids are mostly new onset diabetics, renal transplants, or otherwise sick in some long-term way. We have only had one little guy on service who went home healthy and wouldn't require chronic(long-term) care for a lifelong condition and even he spent 27 days in the hospital. We all like to picture kids as well taken care of, healthy and super active/happy, but unfortunately that isn't true for all kids. 
When my baby brother(who is most definitely no longer a baby anymore-he is like 6 feet tall) was young, he was diagnosed with type 1 diabetes. Talking to our dad about his feeling when it come to my brother's chronic illness gave me some insight on what some of these parents must be feeling and thinking. My brother was diagnosed almost 10 years ago and our father still wonders if he had dealt with things differently if things wouldn't have turned out this way. The answer of course is no. One of the things I love about the fellow I've been working with on the endocrine team is he always starts his first discussion with the family with the same speech. "You didn't do anything wrong. There was nothing you ate, nothing you fed your child, nothing you exposed them to that caused this. It was just something that was going to happen." Though the team deals with diabetic children every single day, for the family and the child this is new. It is life changing. These kids were harder for me, because of my brother. A lot of them were very sick and spent several days in the ICU before coming up to the regular floor where I saw them. Some of them were teenagers and others were tiny 5 year olds. One of my other favorite statements the endocrine team liked to make was, "you have to make diabetes part of your life, but you don't have to make your life diabetes." A good way to say that this is not the end of the line. Life will keep going even though right now it might seem overwhelming. I have definitely gotten pretty good at adjusting insulin doses and being able to evaluate DKA. I also have a great appreciation for the diabetic educators who play a HUGE role in helping these families get ready to go home and deal with this on their own. 
The nephrology patients for the most part were kids who came in after having a kidney transplant with various compliants. They were known to the system and were just special case patients who needed extra kidney attention when dealing with other issues like infections. However, the hardest patient for me to see was a new renal patient. She came in complaining of no real symptoms except occasional headaches for several months. She really only came in because her primary doctor told her that one of her lab results were abnormal and she needed to be seen by an inpatient doctor for evaluation. After lots of poking and tests and finally a renal biopsy, she got a diagnosis of IgA nephropathy. Basically some of the proteins created by her immune system were depositing in the kidney and causing inflammation and scarring. Her kidneys were slowing losing function. Her headaches were from high blood pressure. She went from being a happy teenager who just made the cheerleading squad to a teenager with stage 4 chronic kidney failure who would need long term treatment and would eventually progress to end stage renal disease and require dialysis or transplant. She is in the "this is not fair" stage and I couldn't agree with her more. If I could wave a magic wand and make it all better, I definitely would. But instead we will depend on science, research, and hope for a good response. For now however, she will get to return to life, get to be a teenager. At least for a little while. I hope it is much longer than expected.
I only have one afternoon and another full day left with the endocrine/nephrology inpatient team, but I feel like I have made a ton of progress! I have really enjoyed the residents and attendings I have worked with over the last week and a half. Part of this makes me want to do pediatrics first and then specialize in pediatric ER through that route, but for now I'm sticking with ER first. I am excited about finishing out this portion strong, learning everything I can possibly learn in a couple of days, and moving forward to general pediatrics come Sunday. I just hope next week's experience is just as valuable as the last couple weeks.

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