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Clear-cut pictures. - Nobody wears a white coat any more... — LiveJournal
...a tribute to becoming a doctor.
Clear-cut pictures.
Two year old. There is a dividing line in medicine between sick and not sick. It's a gestalt, something you learn to feel. And this child was sick. He had ten days of intermittent fevers, watery diarrhea, and a sad face. What he did not have was an acute abdomen - in fact, in between bouts of diarrhea, he was not tender at all. G, the first-year, was his primary resident. G saw him. I saw him. Three different attendings saw him. He just wasn't getting better. Stool studies were negative. Sterile pyuria on his urinalysis. Nothing doing.
In desperation, we ordered a CT scan. We thought, maybe he has an abscess.
G passed me a note in noon conference. "(name), CT, ruptured appy, called surgery!!!"
He's doing well, post-open appendectomy and exploratory laparotomy. He's going home today. But G was kicking himself for not catching it. We all felt pretty silly, and in morning rounds we discussed it. Kids are just strange sometimes. You'd think his belly would've been tender, he would've been throwing up, we would've had something to hang our hats on.
The important thing, staff says, is that you knew he was sick. And you weren't sending him home without an answer.

Another kid came in last night to P. The attending says he has pneumonia, she presents to us. I don't think he has pneumonia. I think he's sick. And we're back trying to pin down an answer. It's interesting, how often we disagree with our attendings. Most of the time we just let it ride - most of the time we're less aggressive than they are, so it's worth letting them play out to see what happens. Sometimes, we go over their heads. "I'm putting this kid on inhaled steroids, she needs them." And if they want to discontinue them then fine, but sometimes it's just good medical practice.

Two little babies back in PICU, twins, one on a vent and one still a little sick. Mom's phone is disconnected, the address we have is wrong, and we're out of breast milk which is the only thing one baby's taking. They've called the police to find her and Medicaid to help her get here and if she doesn't start showing up to feed the babies then we're going to call CPS. She knows he needs breast milk. She's here for an hour or so daily, if that. With two new babies (less than a month old) and only home from NICU for two days before they came back to the hospital, then it's understandably hard...but we need her. The babies need her.

Two admits I've known about for simply hours and might finally show up soon. I've got last-day-itis, I don't want to do anything. No, really. Nothing. This is augmented by the fact that I can't take my usual migraine medications and the house is full of fumes.

now feeling:: contemplative contemplative

2 whispers echo . o O ( ... ) O o . whisper a word
From: broken_onewon1 Date: July 29th, 2006 02:45 am (UTC) (etched in stone)


I hope your headache has gone away and that you feel better soon.
From: dr_bobbie Date: July 30th, 2006 02:36 am (UTC) (etched in stone)
During my general surgery rotation, we were called to the ED to evaluate an eight-year-old on the hunch of one of the ED docs. CT of the belly showed a
"possible inflamation in right cecum", o/w nothing. The kid's exam? Disgustingly benign. No fever. No diarrhea. Only four days of the blahs and 1 or 2 episodes of vomiting and the mom's insistance that something was wrong.

Two surgeons saw him because the ED doc insisted he needed an exploratory lap.

Two surgeons said, "Forget it." Including the one I was working with. I had agreed with his assessment. This kid looking like nothing more than a possible gastroenteritis, if that.

Desperate, she called a third doc when the kid came back two days later. That thrid doc took a shot and found a ton of pus and a rotten appendix.

Go figure.
2 whispers echo . o O ( ... ) O o . whisper a word