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In and out... - Nobody wears a white coat any more...
...a tribute to becoming a doctor.
ayradyss
ayradyss
In and out...
With Dr. F today. She does not send me in first; I am shadowing essentially with her, and I see only abnormals. But she is so sweet and so loves to teach me that I do not complain. Took two hours at lunch, talked about Nicaragua with the church seniors, spent part of it explaining medical school. It is giving me nerves, this constant so, when are you moving to $city? when I do not know if I will be moving there or not.
Nine more days. If it's all right with daimones I would like to have cake on Friday the 18th, to celebrate wherever I will be going. Also seeking volunteers to help paint and pack soon.

Today: C is twelve months old, here for a weight check. Mother has been carrying around a mutation in her chromosomes all her life without knowing it, a 7-17 patrial translocation. Mother is normal. Elder sister is normal, having gotten either both chromosomes form Mom or both cfrom Dad, where it counts. C got one of each, so she's short on a little bit of one and has too much on a little bit of the other. Her chart is an inch and a half thick. Today, at weight check, this little girl is achieving her 3-4 month milestones and weighs ten pounds. She smiles at me, plays with the cap for her tracheostomy (tracheomalacia, her trachea cannot hold itself open), appears to listen as they discuss her G-tube feedings (she cannot eat enough to gain weight without it) and waves elfin hands in the air. She has an apnea monitor (all my trach kids do, Dr. F explains. What if the trach gets plugged with mucus?) and tiny feet the size of my keychain. Gaining weight. Increase the overnight feeds.
Outside the room, Dr. F looks at me, waves her hand at all the doors to her exam rooms. "That is why I'm a pediatrician. Anyone can see colds and flu and do uncomplicated physicals." And she smiles.

now feeling:: awake awake

9 whispers echo . o O ( ... ) O o . whisper a word
Comments
pwwka From: pwwka Date: March 9th, 2005 02:26 pm (UTC) (etched in stone)
That was rather smug of her...
amasashi From: amasashi Date: March 9th, 2005 02:43 pm (UTC) (etched in stone)
You should see surgeons :-P
pwwka From: pwwka Date: March 9th, 2005 02:52 pm (UTC) (etched in stone)
*shudders* I think I'll put off seeing a surgeon until I need something amputated. I most definitely prefer the limited (smug) human contact offered by writing for a living.
ayradyss From: ayradyss Date: March 9th, 2005 11:57 pm (UTC) (etched in stone)
I didn't hear it that way.
She's right: 80% of her cases are parents whose children have colds and need reassured that it's going to get better in a week, or need a physical exam for school. That's not what pediatricians go to residency for and that's not what they're trained as specialists to do. If it were, I'd be ready to be a pediatrician now.
What the training is for is to learn to find the subtle signs of something else going on, to know when to worry and when to reassure, to be ready to face a complicated patient and keep track of all the different needs - what do you do now, when do you refer, when do you manage it yourself? This was a patient who for me as a family practice doctor would have been most likely out of my league - something that I won't see often enough or be specifically trained for - someone who needs a specialist in children's medicine. And that's why she's a pediatrician. Just like a 24-week preemie with constant oxygen requirements goes to a pulmonologist, and that's why they're pulmonologists, not for the kids with asthma we send them.
Sound a little less smug, or are you not convinced?
pwwka From: pwwka Date: March 10th, 2005 03:22 am (UTC) (etched in stone)
I suppose better than "smug" would be the idea that people seem to have a need to constantly reaffirm the wisdom of their career choices. Perhaps it is pride-- which I'm still convinced is a ruthless and hurtful emotion, but that's for another discussion entirely.

I just wonder if you've any mentors who actually say something encouraging about going into family medicine.
ayradyss From: ayradyss Date: March 10th, 2005 04:03 am (UTC) (etched in stone)
Actually, the peds have been nothing but praises for family medicine, very supportive and really glad to hear it. Same with some of the OB's, the ones I really liked working with.
ayradyss From: ayradyss Date: March 10th, 2005 04:11 am (UTC) (etched in stone)
I still think you're mishearing it. It wasn't a "this is why I went into pediatrics," but a "this is why I'm a pediatrician" - this is the challenge and the mental exercise that makes the day to day tedium of cold after cold after flu worthwhile. An expression of satisfaction, of feeling accomplished. I know I've felt that way after a run of patients who all seem to have the very same problem, wondering if this is really all there is to it, and then coming across someone whose problems are more complex, need detective work and intuition as well as the algorithms.
loonyatcbh From: loonyatcbh Date: March 9th, 2005 05:06 pm (UTC) (etched in stone)
I might be available to pack/paint--especially if you can hook me up with anti-kitty relief. ;)
daimones From: daimones Date: March 9th, 2005 10:03 pm (UTC) (etched in stone)
Um, 1) It's your house, you can do what you want. 2) It's cake. 3) You have real parties. those are good things.

*hugs* And volunteering for packing if it falls on days I can help..Painting I reference you to ellisande.
9 whispers echo . o O ( ... ) O o . whisper a word