Peds ER in Oakland

Hi All,

This November I did a rotation at Oakland Children’s Hospital in Pediatric Emergency Medicine. It was a really incredible experience!

I drove from San Jose everyday (about 1 hour without traffic, but coming home was always at peak traffic times, so it could take up to 2 hours) and was scheduled almost every day of the month. The commute was tough (got into an accident on my first day), but I really liked being home with my family, so I stuck it out.

The rotation itself was intense–I think any ER rotation will be–we saw traumas, sickle cell crises (the hospital is known for treating this), lacerations, viral/bacterial infections (a lot of these) and asthma exacerbations.

One of the patients I triaged was a teenager with tingling and numbness in her feet and hands. She had difficulty walking too. She had gone to her pediatrician and was told that she couldn’t get an MRI for a few weeks, but her symptoms just kept getting worse, which is why her mom brought her to the ER. It didn’t sound like an infection or Lyme disease… so we did an MRI and ended up finding giant mass on her cervical spine. It was such a heartbreaking experience.

Another patient was really young and had gotten her fingers crushed in a door. She was autistic and this happened at school. The moment I saw her face, my heart melted. She was so good and so quiet, didn’t even cry, even though her fingers were crushed and bleeding. It wasn’t until her mother came (hours later) and she thought it was time to go home (but we didn’t let her leave just yet) that she finally started crying in frustration. Yet another heart breaking experience.

We had two traumas come in around the same time one day. The first was a Black child who was sitting in the back seat of a car without a seat belt. The car hit a semi in front of it and the glass shattered everywhere. The second was a White child who was riding a bike and got hit by a car. This child was wearing a helmet. I remember the parents of both these children rushing into the hospital. The Black child’s mother came in and this little boy kept apologizing to his mother, saying that he had messed up and that it was his fault for not wearing a seat belt. The White child’s mother and father came in together and their son just kept repeating that he was ok. Both families are from Oakland. They may live a few miles apart. But what a stark difference in their experiences, behaviors, and support systems. Why can’t we provide all our children with the same opportunities? With the same knowledge?

We also had cases of non-accidental trauma (child abuse) that shook me to my core. We had several suicidal and depressed children as well. I couldn’t wrap my head around this. One of the patients I was working with had been passed from foster home to foster home and her parents were drug addicts. Many children were malnourished but most were obese, eating what they could, just trying to survive. I grew up with parents who sacrificed everything to raise us, who always (to this day) put us first and it is so unthinkable to me that parents would harm their children. To have it in the back of your head as a provider that maybe a parent isn’t telling you the entire truth is so hard to wrap my head around.

All in all, this experience really brought to light many of the social issues that come with raising children. Honestly, when you are dealt a crappy hand, sometimes all you can do is just try to survive and raise your kids the best you can. But as much as I loved my outpatient third year pediatrics rotation in the small town of Walla Walla which had a lot of loving, supportive, mostly White families focused on raising their children and providing them with opportunities, not every child is getting the love and support that they need and deserve. Sometimes the situation just isn’t great at home. Coming from a single-parent household, I absolutely see the benefits of a middle-class, two parent home (and there are days that I wish I had that). I guess what I am rambling about led me to the conclusion that I am not strong enough to handle pediatrics. I think I went home crying more often than not during this rotation. Kids are more than just their broken arm or their 4-day cold or their cervical mass–they are the epitome of purity–creatures that need love, guidance, patience, and support. It broke my heart when they did not receive these things. And as providers–in every specialty–it’s our job to ensure that the children in our communities are getting those things. It truly takes a village to raise a child–I can absolutely speak to that–I grew up with aunties from our spiritual group driving me home from school everyday, cooking for our family every week, taking us to doctor’s appointments, babysitting my sister, and teaching me how to cook and clean. Without my support system, my village, I wouldn’t have the opportunities I have today.

So for every child that is part of my community, I promise to be part of your village. I promise to stand up for you, to work with your schools to teach you about your health, to work with your parents and to pay as much attention as I can to you and your needs, regardless of what specialty I go into. May you all be loved, supported, and taken care of. May you grow up to be happy, healthy, whole individuals. May you grow to leave this world in a better state than what you found it in. May you do good and great things.

-P

 

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Rotating with the Sniffles

‘Ellow All!

I completed my Pediatrics rotation last week and oh man, was it a doooozy. Aside from seeing and treating snot-nosed, chunky-monkey style kids, I was exposed to a very different type of physician. Aside from the doctor, the rotation was interesting overall as I was able to act as an Intern and see patients independently and diagnose and treat. We had a couple of cool cases like Prader-Willi, HSV encephalitis, and an Inguinal hernia on a 6 month old female. But most of peds was seeing kids for well-child check-ups and cough/cold symptoms. As you can maybe tell, I lost a little bit of my rose-colored vision during this rotation. The hues of gray and black started edging into the background and I felt pretty jaded towards a medical society that accepts and negotiates with doctors that treat their patients and staff poorly.

When I was 25 and freshly returned to Seattle, I worked for an Ophthalmologist that was the epitome of an old-school asshole. Please excuse the language. He was a selfish tyrant and the staff and his patients basically feared him. It was a toxic environment to work in and since leaving that clinic I promised myself to 1) never become a tyrant, 2) be nice to my staff & pay them PTO and provide health insurance, and 3) never patronize the patrons. It is truly a bad sign when your patient’s are afraid of you. Peds rotation provided a similarly toxic environment. From the minute I stepped into this clinic I felt the weight of negativity emanating from the staff, quiet fear of the children when the doctor entered the exam room, and hushed discussions throughout the office. It was and stayed an eerie place to work. I am glad it is over, but still disturbed by the thought that so many patients are treated by this doctor and that the staff continues to work for him.

Let that be a lesson to us all: do not be a terrible person in any aspect of your life. Also, when you’re on peds, be sure to wash your hands a lot! I think this was, ironically, one of the rotations I did not get sick on, but my hands were dried and cracked by the end.

Now off to Inpatient Internal Med! 🙂

Munchkins!

Hello All!

My last rotation for 2015 was Pediatrics. This was probably one of the best rotations I’ve had–my preceptor was not only engaging and enthusiastic about having a student–he was also calm and thoughtful. He asked me tons of questions throughout the rotation, he even wrote up a dermatology quiz just for me! He also invited me to join his family for Thanksgiving and it was wonderful.

Peds is awesome. The kids are sweet, parents are (mostly) easy to work with, and the doctors are all unbelievably compassionate. I’ve also seen some interesting pathology–Trisomy 21, hypospadias, holoprosencephaly, scabies, seizures, Rubinstein-Taybi, the list goes on… There have also been some really tough cases. We had a patient come in for a sexual assault workup a week ago, she was only five years old. 😦

I guess with the good comes the bad and it’s up to us what we choose to focus on. I will walk away from this rotation remembering that five year old girl forever; but I will also remember the child who came in for an ADHD work up and gave me a huge hug, the adopted 21 month old from Asia who blew me a kiss to say goodbye, the parent who came back to clinic the day after her son’s appoint to thank me for making him feel comfortable, and the preceptor who treated me like a daughter.

Last week, two foster sisters (1 Caucasian, 1 African American) came into clinic and were so intrigued to see a dark-skinned female greeting them (their foster mother pointed this out to me). As I got to know them and their history, I shared a little about myself and my journey. I told them that they can do anything they set their mind to, no matter what their home life is like. We talked about loving ourselves and accepting our flaws and having the courage to reach our potential. It was a good lesson for me, because it is so easy for me to tell myself that I’m not good enough or that I’m not going to succeed. I guess when we love ourselves, we can be our best selves and help others feel loved too. So, in honor of them and all children (at heart) everywhere, a quote from the most famous doctor of all time:

Remember, you’ll move mountains and YOU are worth it!

Have a great holiday season!

Priya