Monday, April 14, 2008

Occupational Hazards - Or Testing My Immune System

Daffodils are Yellow for Hope!

Ok, So I worked Saturday and Sunday, but I didn't post anything on those days because on Saturday I came home to later find I had the stomach flu. I thought I was tired enough to get a good night's sleep, but of course, that didn't last long as everything I'd eaten over 24 hours was violently expelled from my body - several times over, so I got very little sleep. Sunday, I was recovering from working with little sleep and frequent bathroom "breaks," but the patients never stopped coming, and I actually ended up working an hour past my shift just trying to dispo (admit or discharge) my patients. So I came home to crawl into bed... for as long as that would last...

Luckily I had today to recover. I think everyone should go on a 48 hour fast. It will be so much easier to keep my diet this week as the mere sign of food makes me nauseous, and even the small amount I ate at dinner tonight feels like Thanksgiving dinner. So, it's small sips of clear soda and maybe some soup for me.

I direct your attention to the title, because no matter how often I and my fellow residents wash our hands, hold our breaths, or try not to touch anything in any of the rooms, we all get sick on the pediatric rotation. Kids are amazingly savvy about sticking their fingers in various parts of their bodies and then touching every conceivable surface of a room. Then, to further mark their territory, they seem to aerosolize all of their germs as well. Sigh. We just keep saying at least our immune systems will get tougher...

Anyway, let's see what we've missed over the last 2 days:

- tonsillitis
- mental status changes in an HIV patient who'd acquired it from his mother, he's also now developed lymphoma and gets chemotherapy, the most he would let us do was a CT scan (no lesions), he gets chemo again on Thursday, and they plan to admit him and get all their tests then, he's 18 so there's no holding him against his will, even though he's probably very sick, we had to let him go
- reactive airway disease, aka 1st episode of wheezing but not asthma
- hematuria (blood in urine) in a 15 y.o. who had perfectly clean urine when he got tothe E.D., strange
- "toe strain" which I didn't even get an X-ray for, it would make no difference if it was broken or not, I still would
"buddy tape" the toe with its closest mate and tell them to take the tape off in a week
- enlarged lymph node in the neck
- asthma exacerbation
- 5th MCP (metacarpalphalangeal) Salter-Harris II fracture; in regular terms, he broke the hand bone of his pinky finger across the growth plate when he fell down while rollerblading, I advised wrist guards next time he goes out
- vomiting, when we don't know why, and the baby is able to drink and keep down fluids before we let them go, we just call it what it is, adenovirus season is coming up, and this may signal the start of it
- costochondritis, kids usually don't get heart attacks, so chest pain in a pre-teen is usually just an irritation of the chest wall ribs and cartilage, his story was good for it especially when I pushed on a certain part of his chest and he said, "Ouch! it was just like that!"
- gluteal abscess which I am bummed I didn't get to drain, we called for a surgery consult (which used to be me and this is the nice juicy type of abscess I enjoyed), however, it was the end of my shift on Saturday, and I was really tired, so maybe I wasn't so upset after all....

Sunday started off as kind of an "Urgent Care" kind of morning with quickie cases and resolutions, which was a good thing because my stomach bug was getting into full swing:
- strep throat, we (the residents) do our own rapid streps in the E.D., and I had done many, all negative, this was my first positive and I was actually excited to see the double bar on the test strip, a diagnosis is always pleasing
- anal fissure, seriously, kids (and adults) need to have more fiber in their diets, less constipation and prevention of diverticulosis when you're older
- laceration on the eyebrow of a 17 month old, I patched it with steri strips and glue, she actually did very well, no more climbing chairs for her
- abdominal pain: I've told my colleagues I want there to be a separate institution that takes all 9 - 19 year old girls who come in complaining about abdominal pain because it could be anything, and we have several "repeat offenders" who come in constantly with undiagnosable pain, it can be everything from appendicitis to pregnancy (I've heard of pregnant 10 year olds) to endometriosis to constipation, etc. And, I can't say to my patients "suck it up" like I'd like to, that would be poor bedside manner, and I want all good evaluations on my rotations...
- asthma, admitted for hypoxia, he just couldn't keep his oxygen saturations up
- pharyngitis
- vomiting, when you're sitting there all "blinged out" with a $250 dollar baby carrier, cell phone, double "ginourmous" pairs of gold earrings and bracelets to match, with the designer purse and you tell me you stopped giving your baby the "good" formula because it was too expensive, I am not going to be very sympathetic, spend less on clothes and more money on the baby, and don't explain to me how you're waiting for WIC to kick in because then I'll just be thinking about how my tax dollars are paying for you to text page your friends with updates... yeah
- reactive airway disease with hypoxia, my last patient of the night, poor little guy just wasn't getting better despite multiple treatments, we had to admit him, I just hoped he wouldn't need to be intubated because he was having such a hard time breathing, and, again, I wondered about the possibility of a need for a passing score on a nationally mandatory exam prior to allowing someone to have a child... don't even ask, I was already grumpy and not feeling well

I had today off and I did very little. I am on vacation next week and I had a pile of laundry and cleaning chores planned. Those will have to wait until later... it's off to bed with a little more club soda to keep the intestinal bugs at bay. Day shift tomorrow. We'll see what the morning brings.

On another note, I saw a great quote that's had me thinking, maybe you can all comment on what it means to you:

Senegalese Proverb: Every morning when the gazelle wakes up and sees the rising sun he has to think to himself, I must run faster than the fastest lion or die. Every morning when the lion wakes up and sees the rising sun he has to think to himself, I must run faster than the fastest gazelle or die. So, whether predator or prey, when the sun rises we must all run as fast as we can.

And, finally:

44,350 seals killed so far. The EU commissioner is very close to making a decision about banning the import of seal products. Let's hope it passes!


lv2trnscrb said...

oh poor you; that's not fair when the doctor gets sick! I bet pediatricians are one healthy people once they get through their training and build up their immunities!

interesting cases; that is sad about the 18 y/o with HIV; wonder if his mom knew she had it before she got pregnant. such a sad case;

I hope you feel better soon; don't you have your honeymoon coming up soon?


pharmolo said...

When you get another kid with unexplained haematuria, ask the parents what they had for dinner (things like beetroot and red cabbage can give you a nice red urine), or whether the kid has been stuffing its face with red sweets. Just an idea. Hope you get better soon yourself