August 23rd, 2003

Snuzzle

I make a liar of myself...

I have yet to be on time to the pediatrician's office. I always beat the doctors in. Yesterday morning, Dr. TD was at the hospital dealing with a patient in breathing difficulties. Dr. MD disappeared after talking to the intern for a bit. And for the next hour I just sat around looking confused, until T called over to me, telling me that Dr. TD had called from the hospital with something for me to learn about. So I looked it up. And then I waited, and finally Dr. TD came in and then we had to rush through the exams. So (gasp, choke) I just got to go in with him and look at the kids while he was talking to the parents instead of doing the whole thing and presenting the patients. But I still got to see them first, and if I talked fast I could present my findings to him before he did a physical.
At lunch, he took me aside and apologised to me for not letting me do enough. I wasn't offended. I completely understood. This has been one of the best clerkship experiences ever.
A quick survey of what I've seen recently:
An infant with a facial hemangiomata in the opthalmic region of the trigeminal nerve division. ishotkenney: what disorder are they concerned about? They don't know yet whether she's got it; the current concern is the bilirubin of 14. She's got a bili-blanket, which I want to see. What do they look like?
A little girl who has Osler-Weber-Rendu syndrome, an incidentally finding as she was being evaluated for a two-month history of fatigue and malaise. Apparently, her previous doctor just kept giving her antibiotics. Her mom is understandably miffed. Dr. MD thinks she has mono. Her blood tests show a malnutrition-based anaemia. I suggested parasitic infection. Possibly. I also asked, based on the rest of her history, whether she might have immunodeficiency. That's a good thought. He wrote: "Consider immune deficiency" on her chart.
Lots and lots of little kid ears. And noses and throats. Did you know that 25% of visits to paediatricians are for routine physicals? I've found several unsuspected ear infections, including the event today where I went in to do a followup visit on a little girl. "I think she has fluid behind her eardrum, which is normal following an ear infection, but it looks good to me. I'll have the doctor check." And then I went out and told Dr. TD that I thought she had fluid behind her eardrum, but that it looked good. And then I got pulled in to play "name that rash" with Dr. MD. More on that in a moment. When I came out, he was in the room. I popped my head in, and got a very wide grin from the normally ebullient Dr. TD. Good eye. She's got a resolving otitis media with effusion. A lot of people don't ever learn to pick that out.

More on "name that rash" tomorrow (later today?). I want to post, so I can sleep, so I can go to the BMV and get my licence address changed; get a new cell phone and better plan; spend more money. Wheefun.
Plans for the Gathering are beginning to progress. Also wheefun. Glad that Quinby is going to go with James to the housewarming; Aura and LC are so great.

And now, to bed.
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