Sayonara kiddos

I am all finished with my pediatric rotation and all finished with my last winter semester ever! Overall peds went very well. I had a lot of uncertainties going into this rotation. I wasn't sure I was going to like it at first because of the drastic change from trauma to that but the kiddos grew on me a little more each week. Doing the rotation in my home town was also something I was unsure of. It was odd running into people that I went to high school with and played on sports teams with. I would like to know what some of them were thinking when I walked into the room to examine their child. Then again, judging by the looks on some of thier faces maybe it's best if I don't know. I was unsure of how working with my uncle was going to go too. Working with my uncle turned out to be a good decision. I learned a lot from him but we also had fun. It was nice to not be intimidated for once. He is a fantastic pediatrician and I can see why everyone wants him to treat their children.

There is one thing that keeps sticking in my mind about this rotation. While here I have seen that there is a real need for more medical practioners. As students we have all had the "underserved" lecture and most of us listen but then don't really think about it again. Nurses and patients kept asking me if I was going to be coming back to the area to practice. They all really wanted me to come back because I am familiar with the people and they need more practioners. I do not plan to come back to the area to practice, at least not right away. I really feel like scum for that. There is a true need and I am knowingly walking away. I do not see myself being content doing family practice in a small town though. Perhaps someday when I have a family and am looking for something more layed back I'll consider it.

So to sum up the last six weeks I'd say that I have learned a great deal of pediatric medicine, I have learned that I absolutely adore newborns, and I have gained a new found respect for the people of this area and for rural medicine in general.

In case you are wondering why there is a scenic lake picture on here that's Raystown Lake, the lake in my hometown.

I have learned something on this rotation that I doubt I will be seeing or doing on any other rotation, circumcision. Circumcising or as we affectionately call it in the office "whacking wienies" is actually a pretty cool procedure to see. I can say this because I am a female. I highly doubt there is a man alive that could watch this without wincing. The instruments used for the procedure even have cool names like the Gomco, "helmet" (bet you can't guess where that goes), kellys, probe, and the circumstraint. I think the "helmet" might actually be called a bell but we refer to it as the helmet because it's more fun. The whole procedure takes around 20 minutes and is pretty much blood free which is kind of amazing considering you are amputating skin. Most of the babies tolerate it pretty well too. They are given a few drops of a sugar based liquid then a pacifier is stuck in their mouth. The doctor I am with uses a local anesthetic as well. That sugar must be some good stuff because the babies don't seem to notice you sticking a needle into the bottom of their little peenies. A funny side note: I noticed that when we inject the lidocane it of course causes the base to swell making it look a lot like a tiny little elephant trunk.

The success of the procedure is dependent on correctly fitting tools and the doctor's ability to achieve hemostasis. This is done with hemostats and the Gomco clamp. Patience and precision are also key. I was watching the doctor do one the other day and I realized just how important it is that he get this perfect. He can't leave even a millimeter of skin because that millimeter of skin will grow with the rest of him. This little guy has to carry that penis around with him for the rest of his life! You can't have one that looks like the result of a drunken lovefest between a turtle, an elephant, and a grub. Some girl will take one look at that and run the other way! The doctor I'm with is very good at them so rest assured Huntingdon county you will remain well populated in the future.

The after care is pretty easy as well. You just put Vaseline on it for a few days until it heals. End of story. The procedure seems to be well tolerated by the little ones and makes taking care of them a little easier on the parents. Even after watching this I would still want my future sons to have it done.

"Babies are such a nice way to start people" -Don Herrold

So far my favorite part of peds is the babies. I'm talking the really young little babies, 4 weeks and under. In the practice that I am in we see them within 24 hours of birth and then again at 1-2 weeks and again at 4 weeks. So I've been getting to see a lot of little ones. When we see them in the hospital within 24 hours they are brand spankin' new. It makes getting up an hour and a half early worth it. I love almost everything about them at this age. I love how they are still always warm when you hold them. I love the fresh clean baby smell. I love their onsies and tiny socks. I love the way they get raging mad and scream at you when you undress them and examine them with your freezing cold hands. I love playing with their reflexes. I love how their eyes look so fresh and shiny when they open them. I love their soft baby hair. I love the little grunting noises they make. I love to watch them as they discover new things, like their hand. This list could keep going and going but I'm sure I've already lost over half of your interest already so I'll stop. I haven't seen any super sick newborns yet. I saw one with Tetralogy of Fallot but she was stable and doing well for now. If I were in a different setting like a NICU I might change my mind. I can't imagine how difficult that would be.

Like OB, this specialty is making me excited at the prospect of having little babies in the house. I'm not in any position to be having children right now so someone in my family needs to have a baby soon so I can get this out of my system!!!! Sorry for the lack of medical things in this post. Next time I'll try to find an interesting case instead of just rambling on and on about my love for newborns. I promise!

Kids kids kids

First let me apologize for not updating this for a week and a half. A lot has happened since I last posted, I moved back home and started my next rotation. I am now doing pediatrics in my hometown with my uncle at his office. It has been an interesting transition. I haven't lived at home for this long in 9 years. I'm still getting used to the daily phone calls asking what time I'm coming home and the occasional visit from our golden retriever in the middle of the night but overall it's going well. I especially like coming home to home cooked meals everyday and parking in a garage!

Going from a level one trauma center to outpatient pediatrics is quite the adjustment as well. In fact I don't think you can compare them in any way. It's a welcome change of pace though. Working with my uncle is very different too. For once I'm not intimidated out of my mind. That may sound bad but I mean it in a positive kind of way. I am still learning something everyday and being challenged. Examining children is completely different from examining an adult. We take things for granted with adults. Adults aren't terrified of a simple thing like a stethescope, well the "normal" ones aren't anyways. With an adult you just jump right in and do the exam, end of story. With little kids you have to explain everything you're going to do and let them touch everything first to prove to them it doesn't hurt. You have to earn their trust. You also have to earn the parents trust. All this has to be done in under 25 minutes! Talk about a challenge. I've only been doing peds for two weeks but I have found that these 5 things are necessary to successfully exam a kid:

5. A friendly face
4. A knowledge of current cartoons
3. A plethora of different noises and voices
2. A love for children
1. PATIENCE PATIENCE PATIENCE

I'm sure this list will grow weekly and I am looking forward to figuring out all of the secret little tricks of pediatrics.

I did it!!!! I made it through six weeks of trauma surgery at Hershey! Looking back on the whole thing I cannot believe I made it. Even falling asleep at night was difficult because I knew what I was going to have to face the next day- a butt kicking beyond anything I had experienced. There was no real way to prepare for the next day. You never knew what kind of traumas would roll through the doors. And you never knew what random topic you were going to be quizzed incessantly on that day. And when I say quiz I don't just mean "asked a question and if you don't know the answer big deal just look it up". I mean if you don't know the answer that's license to get in your face and rapid fire more and more questions until you have been reduced to a shapeless blob of pond scum. Some days by the time they were done with me I didn't even know my own name. Strangely this form of so called teaching actually worked for me. I think it worked because I was absolutely terrified of the humiliation that came from not knowing the answers.

The traumas themselves were challenging as well. From a medical standpoint it wasn't too bad because you just follow a specific algorithm that has been beat into your brain. The difficultly arose when you let your mind wonder from it's preprogrammed path to allowing it to process what exactly is going on from the human standpoint. In other words I got into trouble when I let myself feel. I only did trauma for six weeks so I never developed the ability to be unaffected by the events that had just unfolded in front of me. Many of the trauma attendings, PAs, and nurses have developed this. I don't think I ever want to get to the point where the loss of a life is routine. During my time at Hershey I saw at least a dozen level one traumas and a whole lot more level twos. There are three that stick out in my mind. I remember everything about them; the smells, sounds, injuries, and outcomes. I even remember the feeling after it's all over. It didn't matter what time of the day the trauma came in. When they were bad I always walked away in a state of numbness. I walked through the remainder of the day just going through the motions. I was afraid to allow myself to process the trauma in it's entirety until I was home in the comfort of my room and usually talking it out on the phone with a friend.

It may sound like it but I don't regret doing trauma surgery. I have come out on the other side a stronger person with tougher skin. I've learned how to take a beating and still hold my head up. I've matured as a PA was well. I feel more in control now in situations that seem out of control than I ever before. And finally I've learned that you can do well in any situation if you are willing to work hard enough for it. The best things in life are the things you sacrifice for.

Tragedy Strikes Again

Friday started out like any other day. At 6am I'm checking in on my assigned patient followed by signout at 6:30 and case studies at 7:30. We were just finishing up our case studies when the trauma pagers went off. It said "Level 1 trauma. Response STAT. Multiple adult and pediatric traumas." This was the first time I had seen a page like this. The most I've ever seen at once was 2. As usual we all stopped everything and ran downstairs to the ER. We got there and learned that there was a car accident and five teenagers were traumatically injured. All of these kids were in the same car and were on there way to school when they collided head on with another driver. Four of the five victims were unconscious and had to be extricated from the car. They were being flown in. A trauma of this nature required that every ATLS trained person in the entire hospital respond. I would guesstimate that around 50 people were involved directly in these traumas. It sounds like complete chaos but it went amazingly smooth. I was super impressed with how well orchestrated everything was. Every room had someone in charge and also had someone responsible for communicating with the other rooms about who's patient was the sickest and needed CT scanned first or the first available OR, or needed the massive transfusion protocol activated. I apparently drew the short straw because I ended up in the room with the sickest kid. He had major head, chest, abdominal, and orthopedic trauma. I was in the middle of this trauma when a nurse yelled that I was being paged to the OR by one of my attendings. I stopped everything I was doing and passed off my responsibilities to someone else and bolted upstairs to the OR.

I walked into the OR and the attending had already opened up and told me he needed another set of hands and to go scrub in. At this point I still had no idea what was going on because as far as I new this doctor was running a trauma two doors down from the one I just left. I got all scrubbed and joined the doctors at the table. Here the patient has was operating on was the driver of the car in the major accident. He required IMMEDIATE surgery to save his life. The boy had demolished his spleen among other intrabdominal structures and was actively bleeding out. I will spare you all the gory details of the procedure but let's just say it took around 3 1/2 hours to do what needed to be done. I'm happy to report that we were able to stop the bleeding and do adequate damage control to save his life. I haven't heard anything since I left the hospital Friday so I'm not sure of his current status.

This was the first time I had ever been paged to the OR to assist in a life saving operation so I was feeling pretty good about myself. However like most good trauma related feelings this was short lived. Once the urgency was over and things had stabilized the reality of what just happened set in. This was a 16 year old kid, he has a sibling in the OR a few doors down undergoing a similar operation. This family was just turned completely upside down in a short second. In fact four families were turned upside down. When I go into the hospital tomorrow I'm going to have to face these families. That is perhaps the hardest part, seeing the look of despair and sadness on the parents faces. As a student I usually do not have to talk to the family but I still have to be in the room when the doctor does. Hopefully tomorrow the questions that the families ask will have positive answers. I'm going to keep the attitude that they are kids and they bounce back quickly! Only three more days of trauma, then it's off to take care of kiddos who are not teetering on life's edge.

*the picture at the top is a grade 5 splenic laceration, one of the injuries we were repairing

Only by the grace of God

Yesterday was a busy day in the trauma bay. We had four between 7 and 12 alone. There was one trauma that really stood out to me more than all the others. The patch we received said that it was a 19 y/o female involved in a motor vehicle accident, tractor trailer vs Mitsubishi galant. They said she was merging into traffic and merged directly under the trailer of a truck!! We did not receive much information about the status of the patient except that she was self extricated. She came into the trauma bay in the usual way, on a stretcher on a spine board with a c-collar on so you couldn't really tell how serious her injuries were at first look. Once we got her unloaded and began examining her it became apparent that her only injury was a laceration on her forehead and another on her chin. We took her to CT where it was confirmed that she had ZERO injuries!! While she was being CT'd one of the paramedics on scene showed me the pictures of the accident. The front drivers side of the car was completely caved in. There was no cab anymore. The picture I uploaded in an actual picture from the scene. It doesn't really do it justice though. The pictures the paramedic had looked a lot worse because he was right up on the other side of the truck. According to the driver of the truck the car became stuck under the trailer and was drug a mile before he was able to completely stop. The car had caught on fire as well. Too look at the accident you would never think anyone would come out of that alive let alone unscathed. We were talking to the girl later and found that she was not belted and there were no air bags deployed either. This story was becoming more and more unbelievable. She told us that she saw what was coming and dove over across the front seats trying to make herself as flat as possible. This move is what ended up saving her life. I've seen several car accident victims die in the last four weeks from accidents much more minor than this one. I'm sure she walked away from this with a new appreciation for life. I know I did. I guess it goes to show that it's not your time until it's your time. (Profound I know, haha)