February 26, 2008

Connecting with kids

I raced back and forth, darting from exam room to exam room, following the brisk strides of my two peds attendings for the day. It was only a brief moment in time... a single afternoon for only three hours... and I had to meet with my study group right afterward, so I couldn't stay longer. If I could've, I would've.

I love pediatrics.

The first child came from the outer islands. She was a 1 weeker, 40 weeks gestation who got RSV bronchiolitis and she was here for a followup. My attending tried to elicite a few of the primitive reflexes for me, but she was a little fussy. She was a total cutie though!

The second kid I saw came in because the school "nurse" pulled her out of school because of a suspected case of pink eye. I learned that the public school nurses aren't nurses at all, actually.... they just have a bachelor's degree in something or other and then they get recruited to sit in the office and put ice bags and bandaids on kids without any real training! Here in my state, at least. The really interesting thing was that out of this false case of conjunctivitis came a true history of asthma! She was sent off to get a chest x-ray and was prescribed some albuterol and corticosteroids. She had a hard time listening to the directions for the correct way to take her medications... which got me thinking about some of the things I would have liked to do if I were in charge of the patient encounter. First, I'd put her in charge of her care. Give her all of the pieces, the two inhalers, the spacer and have her put it together. I'd have her recite the instructions out loud, practice once without actually using any medication and then again with the inhaler. Instead, it turned into a chaotic shouting match with the pediatrician and the mom telling her to listen. Yikes.

The third kid I saw was a teenager who sprained his wrist while skateboarding. The doctor took an x-ray and found a hairline fracture in the adjacent finger to the one he was complaining about! Turned out that it was dislocated and he reduced it on his own afterward which added to the swelling. The pediatrician buddy taped the two fingers together, his right pinky and ring finger together and splinted it. He didn't like the pink tape, so she went off to find an ace bandage. While she did that, he turned to me and said "good, at least I can still play the PS-II," wiggling his index and middle fingers. When she came back with the PURPLE ace wrap and covered up his entire hand, it didn't go over so well with him. She revised the wrapping to just the two fingers and all the nurses complimented his splint, saying that it looked really cute. The pediatrician recommended taking some NSAIDs for pain relief and he went "what? no, i don't take meds for pain." I chimed in "well, they also help reduce the swelling so your fingers won't be so uncomfortable." "Oh.... in that case, ok." The mom gave me a thumbs up and a knowing nod.

That really made my day.

1 comment:

  1. that's the difference between liking peds and not liking peds. the thing that would have made my day would be that the teenage boy got a purple ace wrap. :)