This is what I came into this morning. I think it lasted for about 15 minutes.
And then, one of the early patients was this:
Look around the middle of the top third of the film, and you will see a bright long object... that, folks, is a dental drill. This 5 year old was in the dentist's chair when the drill bit "fell off," and he swallowed it. Luckily, this should pass within the next couple of days. I gave them all the warnings in case it did not pass easily.
By the time I left, this is what it looked like:
And, this was the waiting room:
As you can see, a veritable smorgasbord of ailments. Again, we were so busy and had so many providers that around 5 p.m. we had a "constipated board;" no one was moving in or moving out.
I am about midway through the rotation so I thought I would take the time to get a few rants off my chest:
onto the soapbox:
- people are not an endangered species, please stop having children. I sometimes think birth control should be federally mandated. When you come in and tell me about your 5 children at home, and how you can't afford a bottle of $2.50 Tylenol for your child's fever for which you want me to write you a prescription so that Medicare (read, us taxpayers) can pay for it, please don't also tell me about your smoking/drinking/marijuana habit, because I can't see justifying $7 a day for a pack of cigarettes, or whatever you pay for the carton, when your child is sick.
- oh, and please don't tell me you don't "smoke inside because of the kids" because we know you do. If I can smell the smoke on the baby stroller, someone's been smoking around it, or it spends a lot of time out on the front/back/basement or wherever you say it is you go to smoke.
- missing your period for 2 months after unprotected sex, and already having had 2 children should make you think that you might be pregnant; which means that if you're considering having another child you might want to stop drinking/smoking/and doing drugs. There are a lot of important developmental changes happening to your baby during this time. And, don't use the excuse that you're only 19, and it was "your birthday." Start taking some responsibility. I can only wonder what's going on with your other 2 children if you're freely admitting to me that you "like to party" and drink and smoke marijuana daily.
- I think I have said this before, but please don't bring your entourage with you into the E.D. I don't need to meet your sister, sister's baby, your neighbor, neighbor's baby, your baby's daddy, his mama, etc. Oh, and bringing your 11 year old nephew with you for a "female exam" and talking about your sexual partners isn't appropriate, and I will be asking him to step out of the room, so don't be mad when I do.
- All I cansay is that we've been seeing way too much of CPS (Child ProtectiveServices) lately. We had a horrendous case of abuse where the childwas taken away from an abusive mother, put into an abusive foster home,transferred to a second abusive home, and adopted into her currentsituation where she was being brought in for possible abuse. She's11. I can't even begin to imagine her life or what will become ofher. Sigh.
Off the soapbox...
As for my vegetarian pledge: Like I said, I can't go completely vegan. I had a little cream in my coffee drink this morning. Cereal with soy milk. Lunch was a veggie burger with cheese and mayo (not vegan as it's made out of eggs) and veggie chips. I then went to the local upscale Wegman's supermarket to make a salad. I added a number of their "vegetarian" sides to my spinach and greens. Lot of garbanzos and beans; barley and peppers. There was even a tofu curry mix that was very tasty. I bought a number of "veggie" frozen entrees, some rice and soy milks and a bunch of fresh fruit for snacks.
I am still recovering from the weekend of gluttony so I felt hungry, but I know the stomach will shrink down and adjust to the smaller portions. Here's where it becomes the mind over matter, but I know it gets easier every day. At least, that what I will remind myself.
I always said that I could never be a pediatrician or a veterinarian because whatever happens to children and animals usually is the fault of someone else. I felt I would always be angry at someone when treating my patients, especially the injured ones. Today was a good example of when bad parents happen to children.
Patients seen in the E.D. today:
A 5 year old with a cellulitis, skin infection ("he was at his father's and I don't know what happened to him"). I wanted to give him a dose of antibiotics and then send him home with a prescription. Mom said she was tired of waiting and needed to go "check on her bicycle" which she states she didn't lock. A nurse asked me how they had gotten to the E.D. if the mom had ridden a bike. I said some questions I don't want to know the answers to. Anyway, I asked mom to wait a few minutes, and we would have the antibiotic. Well, she disappeared with her son and didn't return. Our social worker got involved, called the contact number that was for a "neighbor" that lived 1/2 mile away who said they would try to get a hold of mother. She eventually did show up... 3 hours later. We got the child the dose of antibiotics and got them their prescription. I hope she fills it.
When I walk into a room and the mother starts the conversation by saying, "I just got her back from foster care, and she's been sick ever since" I kind of start to wonder what's going on. I don't like to judge people, but this mother was the poster girl for a "Don't Do Meth" campaign and the father looked like, per the RN, something out of "Deliverance." The mom couldn't answer my questions about fevers, vomiting, wetting diapers on her 2 year old. All she could tell me was, "she hasn't really been eating or drinking and the doctor told me to bring her here." I had a nurse ask if the girl had a genetic disease because she "had a look about her." I asked the nurse to go in and look at the parents. We ended up admitting her for hypoxia (low oxygen saturation), dehydration, and hypoglycemia (54, in kids should be around 100). I think social work might be getting another phone call.
Ok, so you're married to a doctor, and you have 4 children under the age of 5. You decide to pack the kids into the car around noon and head off to your local Target and Lowe's to pick up a thing or two. It's summertime. It's midnight as I write this and my thermometer on the way home tonight read 80 degrees with high humidity, so I am sure in the bright sunlight of midday it was much warmer. You get out of the car and leave your kids for "just 10 minutes" with the car doors closed, the windows closed, the car turned off, in the middle of a parking lot. Soon people come by and notice the children in the car, yelling and crying for help. They stand and wait to see if someone shows up while they call the police. The police arrive and wait a few minutes to see if someone shows up before they break the windows and open up the car. Total elapsed time, about 30 minutes. EMS arrives and notes the infant (9 months old) is drenched in sweat and no wet diaper. All the kids get put into the cool back of the ambulance. Dad gets called, but he can't come because he's in surgery. Mom finally shows up and get promptly shown the back of the police car. Auntie, who's also a doctor, gets called and meets the children en route to Children's. All four are seen and evaluated in our ED. CPS (Child protective services) gets called. The four are discharged to the care of their father once he got out of surgery. Will have to hear later what happened to mom.
A woman walks into a bank carrying a year old child. She walks up to another woman and asks if she would please hold the child for a moment while she takes care of something. The second woman agrees. The first woman walks out of the bank and never returns. EMS and police are called and the child is brought to WCHOB for evaluation. Social work and CPS, already there, are brought in to discuss placement of the child who is otherwise healthy. About 5 hours later the mother shows up in the E.D. looking for her child. Buffalo PD is promptly called to escort the woman to a different waiting area. Will have to ask the resident involved what ended up happening with the mom.
I had to call CPS for a case of suspected abuse. A 9 year old "smacked around" by his father causing a bloody nose. I counted and took pictures of all the bruises and lesions he said were inflicted by the father and his new stepmother. He has 3 older brothers and 2 younger step-siblings who are still living in the home. He called his mother for help from an older sibling's cell phone, and she brought him to the emergency department. Seems she is "getting help" and doesn't have custody of the children, their father does. She gets to see her children bi-monthly. She asked if there was any help CPS could give in the custody dispute. I said I didn't think so but I was sure they could connect her with the appropriate resources.
We had another child who fell out of a window and came out the other side looking like they had been thrown into a cement mixer. Head injuries, broken arm, broken ribs. She was being admitted to the PICU.
I worked on a 2 year old riding a motorized ATV who fell off the back and also had a head injury to add to an earlier one suffered when he banged his head on a wooden door. He was going to be admitted as well.
I had a 4 month old that flipped over in their car seat when the transit bus they were on stopped hard. He had bruising all over his face. A head CT did not show any injury to his head. What was interesting is that while I tried to examine the child and talk to the mother, she was more interested in berating the "baby daddy" because he, "wasn't there when his son needed him, he had no interest that his son was injured, why wasn't he a good dad and arranging transportation for them, don't blame me for what happened it was the bus driver's fault, etc."
Sigh.
On a good note, I got to show my final patient her 16 week old baby. She was concerned that she hadn't felt the baby move, and I got to print her a lovely picture of her baby, nice heartbeat, moving all their limbs, a new life ready to enter the world. Hopefully, to a good mother. Hopefully.
Stickers are like gold in the pediatric E.D. I don't remember ever being that excited about them when I was growing up. Around 5th or 6th grade, I got into the girly "Hello Kitty" thing with the cute pencils and erasers (mind you this was the first "Hello Kitty" era in the late 1970's.) But, I really don't remember having a thing for stickers. Kids today, though, love them and actively seek out their favorites.
Unfortunately, we can't heal everyone with stickers, but sometimes it's the best gesture you can make after what these kids go through.
#1 - Foreign body in nose: "I wanted an adventure." 4 year old that decided to stick a rock up his nose. A few problems with this:
a) he lost the rock in the nose and couldn't get it out
b) he didn't like the idea of my sticking a tube in his nose to get it out
c) the "rock" turned out to have been made by a rabbit
- Sponge Bob stickers for him and some antibiotic ointment for his nose
#2 - Hand injury: 13 year old that got beaten up in front of her house by the neighborhood female bully. Supposedly. she lives in a very bad neighborhood, and there's a family that moved in that has caused a lot of problems. This is just the latest. The police report showed that after the girls started fighting, a social worker tried to pull them apart and she was struck and injured, and then more family members jumped in and there was a bigger altercation. Not to mention the reason why there was a social worker at the house: the mother is, to quote one of the ED RNs "Dumb as dirt." There are 4 other children in the house, one of which has cancer, and the mother can't be counted on to assist in his treatment (ie: remember to give him his medications and get him to doctor's appointments for chemo.)
- Princess stickers will help this poor girl feel maybe a little like a kid; she's having to grow up very fast.
#3 - chest wall contusion: 16 year old playing basketball got hit with a knee in the chest as he was bending to pick up a basketball during a game. No stickers for him; he's a little too old for them, althoughI might have given him the Spiderman one just cause.
#4 - possible sexual abuse: this was the hardest case of my night. I had to talk to and exam a 2 year old whose family was suspecting sexual abuse. Seems the little girl spends 2 weeks at her father's and 2 weeks at her mother's. Her mother has a boyfriend, and the father's family was concerned that this was the person abusing her. I had to take statements, do an exam, and call in a report to Child Protective Services. I don't know if I can follow-up with a case worker or not, so I will just have to follow her medical records to see if she pops up again.
- No number of Princess or Dora stickers could make up for the fact that I had to do a vaginal exam on a child already suspicious of anyone trying to have anything to do with that area. I can only be comforted by the fact that she's safe... at least for 2 weeks while at her father's.
#5 - #10: The usual montage of diarrhea, constipation, vomiting and diarrhea, etc. I do have to make one comment: if you're going to tell me that your child hasn't been able to eat or drink anything for two day because they throw everything up, do not hand your child a soda bottle and allow them to drink half the contents in front of me while you are telling me this. I might not believe you. And, when I ask if the child seems to be doing better, don't tell me, "No, she spits up everything she drinks down, " while the child is happily swinging her legs in the chair, sucking down her bottle of pop, and play burping along with me. Seriously, I'll wonder why you came, and you'll be left wondering why I am not doing a million dollar work-up on your child.
This was our ED whiteboard at 2030: we didn't clear it until almost 2 in the morning - and this is with 20 rooms, 2 surgical rooms, a trauma room, and an ortho room - all full.
Ok. Enough of being a vampire. Tomorrow is Grand Rounds Wednesday, and I am presenting the chapter on Pediatric Cellulitis to my reading group, so I better go read it. Back to the E.D. fun on Thursday.
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