Sunday, June 13, 2010

Infections Everywhere, Oh My

On Monday I started my peds externship, starting with 2 weeks of peds infectious disease (PID). I think I'll talk about particular people/events rather than detail my day-to-day, as doing the latter would make this post too long.
First a cast of characters for this week:

Resident. Resident is a 2nd-year med/peds (internal medicine and pediatrics) resident currently rotating through PID. I spent most of my week with Resident. Resident is amazing - cute, adorable hazel eyes, a great smile, very intelligent and conscientious, very nice, and loves to teach. I learned and reviewed a lot with him this week - stuff that I learned (and too often forgot), some stuff I feel like I should've learned, and some stuff that I probably won't learn until M3 year. He gave me some tips for the USMLE Step 1 that I'll be taking this time next year. Also, he told some things I hadn't yet learned (like Cushing's triad) so I could "impressive" Dr. H and say I learned something from Resident. At least when Dr. H pimps us, he pimps nicely (sorta). I think I had a mini-crush on Resident, too bad he's on vacation next week. :-/

Dr. H. When I told Dr. P that I'd be working with Dr. H for 2 weeks, Dr. P was like, "Good. He's the guy to work with. I'll send him an email and let him know about you." So Dr. P hyped me up for Dr. H and that's kind of amusing. Dr. H is a quirky guy, and brilliant (maybe that's why he's quirky). He's been super-busy most of the week, hence why I've been rounding with Resident a lot (not that I'm complaining - Resident is awesome). One of the things I love about Dr. H is how he always makes a point to explain things to parents so they can understand the full situation. He'll sit down and explain any lab values and any radiology images (x-ray, CT, MRI, etc) until the parents understand. And the parents always appreciate it, because rarely do anyone else explain things in such detail.

HIV Nurse. On Thursday, I went with HIV Nurse to the local HIV/AIDS resource center for a management meeting with other nurses. So the management meeting is where nurses (and doctors) manage HIV cases - by adjusting meds, dealing with follow-up care, dealing with psycho-social issues, etc. I sat in on a peds HIV management meeting and this one for HIV+ women in the area. Then I went on a home visit with the HIV nurse. This poor woman takes more drugs than I think I've taken in my entire life combined. HIV meds, hypertension meds, insulin, and more. I'm really glad that HIV nurses exist to help patients manage their meds (and other life issues), but I certainly do not envy their job.

Doctors often prescribe a bunch of meds, but there's no real way to know if patients are actually doing them. So these HIV nurses are like the "executors" of the doctors' orders - making sure patients actually take their meds regularly and such. It's hard work, and I think it was a really good experience for me so I can appreciate the difficulties involved "downstream" after the doctor's visit. And from the HIV nurse I also learned that all the HIV management Dr. H does is for free, since that service can't be billed. So Dr. H spends a lot of his time doing stuff for patients that he isn't getting paid for; but, he must still somehow see enough patients to meet his salary. That's rough, but I only have admiration for what he does.
So, because I'm on PID, all I see are infections. Infections everywhere!! By the end of the first day I learned that there are different kinds of MRSA and that there are 4-5 main antibiotics commonly used in the hospital. Also, by the end of the first and second day, my feet wanted to assassinate me and walk away - it hurt so much to stand for so many hours. But I got used to it by the third day.

PID is basically endless rounds and consults. You don't really have any patients of your own; all your patients are referred to you from another physician/team as they ask you for a consult. The number of patients you'd see is actually rather small, but you do a lot for them and you spend a lot of time with each patient. A few patients we hovered around for a good hour or so, and also spent a lot of time talking to the (very worried) parents. So as a PID doc, you're basically a consultant (that does a lot of work).

I also saw several kids with pneumonia, and I got better at reading chest x-rays. I spent a little bit down in peds radiology to look at images with Resident and Dr. H, so that was cool. I must say, the radiology offices are dark - vampires could probably comfortably live there, lol. The radiologists also have interesting-looking (and possibly ergonomic) chairs that they sit in. o_O

Most of the kids I saw were quite sick, and several of them were in the PICU (pediatric intensive care unit). This one poor kid was sedated almost the whole time I was there and had like, 4-5 lines in him that were all infected. And he had this really uncomfortable-looking rash over his entire body except for a patch on his left arm.

Another kid was in the HOT (hematology/oncology/transplant) unit, and he was so adorable. It sucked that he had cancer and was scheduled to get chemo, but he seemed otherwise healthy and fine. We were looking into a mystery lung thing that produced no noticeable symptoms. That was truly curious. Just as curious as the teen who came in whose only complaint was a fever that persisted for 2 weeks and no other symptoms. :-/

The most interesting case I saw was a kid with tetralogy of Fallot. When I learned about it first semester, I never thought I'd see a case of it and here it was!! Alas, when Dr. H asked me what 4 features define it, I could only list 2 and he gave me a disapproving look. I also couldn't list the 5 cyanotic heart defects (though I'm pretty sure we only learned 4 of them anyhow). This kid came in with a brain abscess (likely of infectious origin), and so I found the neuro exam really interesting. Ipsilateral ptosis, downward gaze, and small pupil; contralateral muscle weakness. Very interesting. Bonus points if you can guess the location of the brain abscess on the CT. :-P

I also touched some babies' fontanelles! Babies are so cute. ^_^ The fontanelle feels different depending on how old the kid is, and also can bulge out if there's intracranial pressure (that's kinda freaky). Alas, at least one of them was in with bacterial meningitis, but I think he'll make it out okay. He was already on his way to recovery. That's something I do like about PID. At the beginning of the week all I saw were sick kids, but by the end of the week, 2 of them left our service because they got better and were discharged to go home.

Lastly, a funny note. Dr. H asked me how I knew Dr. P, and I said I met him at some event held at the med school and I shadowed him twice a few months ago. On the first day, we ran into a pediatric hospitalist I knew while she was on service. Dr. H was like, "Do you know everyone?" The following day, I ran into one of the faculty advisors for APAMSA while walking down the hall with Resident, and even Resident commented, "Wow, you do know everyone don't you?!" I was amused.
Okay, this post was longer than I thought. Ah well. So filled with medicine/health stuff, but that's the whole point. Remember folks, wash your hands. Germs lurk everywhere, and infections aren't fun.


Biki said...

I loved how you ended this post! All you need is old fashioned soap and water to keep most germs at bay.
Did you see the Mythbusters show about how easily it is to spread mucus around without realizing it?

LOL! So you know everyone, huh?

I can see how being a PID would be fascinating, and rewarding work. But so hard to deal with if the kids didnt make it....

Awesome post!

Anonymous said...

Reminds me of the first time I saw the word fontanelle about a year ago. It was rummaging through the Chumash data, the word for fontanelle is 'oxwo. I didn't know what they heck that even was.

Mike said...

Sounds like you are having a great time, and the doctors you're working with sound awesome!