Last month’s rotation was pediatrics. Things went fine, with the exception that I don’t really like kids, particularly sick ones. This is unfortunate, since my medical specialty is family medicine…and maybe at least a little ironic since I’m the father of four kids.
But, who can blame me? Other than my grandma, I can’t think of many people who really like snotty, miserable, tired children with strange, goopy, painful-smelling substances coming (sometimes SHOOTING) out of most of their orifices (orifi?). Add to this the fact that many kids are too little to tell me anything helpful about what is going on. Either they don’t speak at all, or commonly, they just nod “yes” to any question about anything.
“Does this hurt?” I ask as I push on a girl’s abdomen.
Nod.
“Does your throat hurt?”
Nod.
“Head hurt?”
Nod.
“Toes hurt?”
Nod.
“How about your Ego, your Id and your super-ego? Do they hurt?”
Nod.
“Would you feel comfortable with a diagnosis of femoral head vascular necrosis?”
Nod.
As such, I was tempted more than once to put the least amount of effort into my hospital orders as possible:
Dr. Ankeney’s orders regarding Bed 1107:
Kid. Wheezing.
Albuterol nebs q 4.
Some form of steroid q 6.
Food if he’ll eat, water if he’ll drink, Shrek if he’ll watch the tube.
If condition worsens, call a pediatrician.
This is, incidentally, my problem with my own kids too. Until they can interact with me, I never really have too much interest in them. I feel a sense of obligation, of course, but in general, it has taken me about a year to warm up to each of my kids (William, our youngest, is currently “on the bubble” at 7 months). With Emma (our oldest, now 7), I was fine with housing and feeding her but not really in love with her for at least a year. This ambivalence changed on the day she threw her pacifier at me. Here was this this kid, who until now just sorta sat around, pooped, ate and pretty much constantly cried. Then one day she looked at me, grinned, and threw her pacifier right at my face…and laughed. Stole my heart, that kid.
The thing about taking care of children is that the stakes are higher. There always seems to be more people involved with care plans for kids, and somehow more people mourn the suffering of a child if things go badly. Even meth-heads with needle tracks all over their arms will hover around their sick children, suddenly more interested in the health of their child than their substance-addiction. Its an intimidating environment for a new doctor.
Through a strange collusion of events, I took care of a 4-year old kid in the hospital without the oversight of an attending for almost 2 days. While in general I like the autonomy and responsibility of residency, as I mentioned, with kids the whole thing is different. I would have liked a little guidance on this one.
The little guy was extremely short of breath, using all of his muscles in his upper body to breathe (worrisome sign of respiratory distress). The amount of oxygen in his blood was measured to be at a reasonably good level once we gave him oxygen through a nasal cannula. But the problem – with kids especially – is that they may APPEAR to be getting enough oxygen when in fact they are working so hard to breathe that they suddenly tire out and can’t breathe at all. We call it “crashing”.
Having no attending to oversee my plan for this kid, I found myself hovering around the peds floor much more than normal. I came in early, stayed late. Sat at the bedside. All that. The medical staff could tell I was “flying solo” on this case, and under the guise of being “helpful”, they began to prey on me like a pack of wolves.
“Hiiiigh. Janie, Respiratory Therapy. I just gave Joey the nebulizer treatment you ordered. He needs to be on steroids.”
“But he doesn’t have asthma,” I reply. “I think he has RSV.”
“Are you sure?”
“I’m an intern. I’m not SURE of anything except that I work all the time.”
Later, a nurse approaches. “Oh, so YOU’RE the resident for 14?, I’m Sarah from the night team. We were wondering if you should have started those fluids. And, I was just wondering if they’re being infused at the right rate.”
‘WE’? I think. Are you all just sitting around with all your pals talking about how I’m screwing this up?
“I’ve run the rate-to-body-weight equation 4 times, and I get the same answer. I’m pretty sure it’s right. His electrolyte profile is convincing for dehydration. Plus, he just looks thirsty.”
“Wellll. Ok. I guess you know what you’re doing.”
Thanks for the ‘I guess’ of confidence.
Just as I was really starting to fret, he woke up one morning asking for Popsicles and books – a sure sign that things were on the upswing. Around that time, he started talking to me.
“You’re in here a lot.”
“Yeah…well, I like the cartoons.”
“I have 23 movies at home,” he stated proudly.
Feigning ambivalence, I say “I guess that’s cool, but I have 2 cats and a canoe.”
“I got a cat, too, and my Dad lets me take him camping with us.”
Uh oh. Upstaged. Camping? With the cat? Really?
“I have a bike with a shock-absorber on the front-tire.”
“I have a stuffed Tigger that’s THIS BIG,” arms outstretched. “His name is…Tigger.”
“I have a surfboard and a BIG bag to carry it in, and wax that goes on it so my feet don’t slip off.”
“I got a rabbit, a turtle, a newt, a firebelly frog and can get to level 4 on…” some video game I’d never heard of.
Mayday. Mayday. The kid’s out-cooling me. COME UP WITH SOMETHING.
“Yeah? Well I got this STETHESCOPE. It lets me listen to your heart’s secrets.”
His big brown eyes widen. He looks down at his chest. “My heart tells secrets?”
“Only to me.”
Ahhh. Victory. Beat THAT, little man!
“Yeah,” I continue, “it murmurs and gallops and gurgles and thumps and….”
“Uh, Dr. Ankeney?”
I suddenly realize all the grown-ups are standing around watching me, politely waiting for me to become the doctor again. Right. *Ahem*. Joey’s mom approaches me, “Thank you so much for taking such good care of our son. We were really worried.”
Once I managed to find an attending, I was told that with some minor revisions, my plan for Joey had been ‘within the standard of care’ (attending-speak for “why, now that’s a durn good job, son”). It felt good to do something right. Especially with a kid. Especially a cute little guy who has 23 cartoon movies and a big stuffed tigger and black curly hair and spaces between each of his baby teeth.
“Glad I could help.” I say to his mother quietly.
Don’t get the wrong impression. I still don’t like kids. Of course, I eventually like my own kids. And now Joey’s on my “exempt from contempt” list. So are most of the kids on my clinic panel. Yeah, it’s a lot of kids. Someone out there might argue that, in fact, I totally love kids. That I only say I don’t like ‘em because I’m trying to act like a grown-up in a very serious world. That I myself am just a big kid, hoping to not get fired because I wandered off into the forest with a group of 6-year-olds to build a fort and conquer the evil elves of Northeshurry Castle.
Fine. Argue that. But I’ll never admit to it.
