Being back in the ED again, and being sincerely happy about it, definitely makes me a bit more confident about the whole EM/Peds thing again--cuz I have to say---there are days that I very much miss the OR. And being on the Peds side for the past few months got me thinking that maybe Peds was more my thing, but after one shift downstairs, I realized my heart is totally into the ED thing too.
I am currently doing my first, and only, away rotation. It is pretty interesting to see how the ED works here compared to back home. Firstly, for all lacerations: the nurses numb up and scrub them out for you. This lets me get other work done like calling surgery or pediatrics, or discharging someone. Secondly, I never have to look up a single number to page someone---I just tell one of the three secretaries that I need to talk to Dr. C and they take care of it---within ten minutes I'm getting paged overhead that he is on the line waiting. Lastly, people here are ridiculously friendly.
Last night I had a sick kiddo. In the ED the main purpose is to decide who is "sick" and who is "not sick." I have to say as a second year I thought everyone was considered "sick"---I mean why else would they have gone to the ED?? Now I think I finally have it down. So this kidddo had a fever of 104, hadn't eaten/drank anything all day, was tachycardic and tachypnic and just looked out of it. I was worried. So we started an IV, got cultures from her urine and blood and gave her Tylenol and Motrin. She perked up after the second bolus and I felt much better. Her urine came back with a UTI and we decided we were gonna send her home, but my attending really wanted me to talk to her pediatrician prior to sending her home. Of course the parents had no idea which Dr. F it was in town (there were 3 by the same last name) so I had to do some serious searching.
Around 10:30pm I was pretty sure that I narrowed it down to the correct doc. I was nervous to page this doc late at night just to do a "let you know" conversation, but it was important. So I dialed away. She responded about 10 minutes later and was amazing. She was completely appreciative that I informed her. I couldn't believe it. I hung up the phone with a smile on my face. And that's when I started thinking---I hadn't called a single consult so far that resulted in someone getting nasty or being rude---people here were happy to help out! What an amazing concept---we were all on the same side --trying to do best by the patient. And that's when I started thinking, maybe I could live here.
I finished my rotation and at PICU--- I know I didn't report much on it, ok like nothing really on it, so I am gonna sum it up here!
It was intense. And as a close peds mentor told me---you have to be deranged to like it. Call me deranged!
Because I liked it enough that I actually applied to a pediatric program. Who woulda thought?!?! I was able to cardiovert a stable arrhythmia twice, I did my first LP on a kid, and I saw more central lines placed that I believe I could now do one on my own. I took care of a ventilated congenital cardiac kiddo---balancing lasix and fluids carefully. I took care of a very sad head bleed teenager---she was in the bed of the truck when it rolled over. I managed a very dehydrated kiddo (sodium=170!) and normalized her sodium carefully. All in all--I learned a ton but I also experienced awful things.
My second to last day we had 3 children die. It was probably one of the worst days of my medical school career. (I had a hanging death of a college student while on trauma which now is in second place) The first death occurred around 9am: it was a previously healthy 6 year old who had a T&A (tonsil and adenoid removal) the previous day. At 4am, mom gave him hydrocodone and by 8am he was blue and not breathing. We coded him for 90 minutes. And just before we were about to call it, someone found a pulse. So we put him on a epinephrine drip to allow mom & dad to say goodbye. It was so sad. By the time it was all settled it was around noon. I grabbed a quick lunch and then was told there was a 2 month old boy coming in coding. He was sleeping on the couch with dad and dad woke up and he wasn't breathing. We coded him for 60 minutes, but he did not make it. The final death was a cardiac kid who went to surgery. I came up from the ED after the 2 month old didn't make it to find out that the cardiac kid died while in surgery.
I pretty much cried all day. But it got me thinking which is "better"---having a sudden situation, where your child passed away suddenly and out of the blue, or having a chronically sick child and them passing away in a high risk situation---aka surgery---but a situation that you believe will save their life. I am not sure which one "wins."
So I recently (aka Monday) started my rotation in the PICU -Pediatric Intensive Care Unit- and let me tell you---its intense! More on that later....
We had about a 10 minute break the other day and started looking up kids on the floor that might come up to to the unit. At one point the peds resident recognized a kiddo there and started telling me their story: Its a 10 month old kiddo who has had chronic diarrhea since birth. They've done all kinds of tests to figure out the cause. They found out the kid is unable to digest both proteins AND sugars. This is actually quite rare. Apparently kiddos usually just have one problem or the other, but not both at the same time---this is a good thing because if you cannot digest proteins, then we give the kid sugars to eat, and if you cannot digest sugars, we give them proteins. For this kid they are playing a fine line in feeding him.